Continuing Education Requirements by State

January 30, 2015 in On the Job

“Continuing Education” – That state nursing mandate that nags at nurses for the entire length of their career… That is, unless you find yourself practicing in one of these 14 states:

AZ, CO, CT, HI, ID, IN, ME, MD, MI, MO, SD, TN, VT, WI

Georgia was one of those states, however it will start checking competency (through CEUs or other optional methods) starting in January of 2016.

Oregon only requires a one-time 7 CEU in pain management, and if you’re in Wyoming and have passed the NCLEX within the last 5 years, you don’t have any CEU requirements!

For the rest of us Americans, the required hours and length of time to achieve the total CEUs varies by state nursing boards. New York has one of the lowest requirements with a one-time 2 CEUs in child abuse and then 3 CEUs in infection control every 4 years. Rhode Island is also pretty relaxed, with a requirement of only 10 hours every 2 years.

West Virginia requires 12 CEUs/year while Kentucky requires 14 CEUs/year. Louisiana has an interesting annual requirement where full-time nurses – 5 CEUs, part-time nurses – 10 CEUs, and unemployed nurses (or limited hours) – 15 CEUs.

The following states require 30 CEUS every 2 years:

CA, DE, KS, NC, NH, NJ, NM, NV, PA, SC, UT*, VA*, WA*

(Note: * signifies a more complex or optional components to the state competency requirements).

Most of the rest of the states not mentioned here require a certain number of CEUs, with the average being 20 CEUS/2 year period. You can find more information about your state nursing board’s requirements by visiting your specific state nursing website.

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This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at The Days When I’m Not A Nurse. Find out how to participate.

The Importance of a Professional Portfolio

January 26, 2015 in Cover Letters, Job Hunt, Nursing School, Resume Help

In today’s job market for new nurse graduates, the role of the professional portfolio can be vital to the hiring process, and ultimately, to success in landing a first position. You may have found that many online applications are quite limiting in the amount of information that can be shared as only so many documents can be uploaded. The professional portfolio incorporates a number of pieces that allow you to present yourself as both a custom tailored and competitive candidate for hire when put together. It is most helpful in an interview as a tool used to guide your conversation by pointing out relevant speaking points when addressing questions. It can then be left with the nurse recruiter or nurse manager at the conclusion of your interview for further review. You might consider including your:

 

  • Resume + Cover Letter
  • Personal Statement (introduction & future goals)
  • Official Academic Transcript (if unofficial, on school letterhead including logo)
  • Letters of Recommendation (ie. professor, clinical instructor, academic advisor, supervisor)
  • Honors/Awards
  • Professional Membership Involvement (ie. NSNA, Sigma Theta Tau)
  • Sample Work: Scholarly Paper, Evidence Based Inquiry Presentation, Performance Improvement Project (ie. powerpoint or sample teaching)
  • Research
  • Certifications/Licenses (ie. CNA, RN, BLS, ACLS)
  • Clinical Experience Matrix
  • Clinical Rotation Evaluations
  • Complex Care Plans/Patient Concept Maps
  • Volunteer Work
  • Publications

 

Developing a stellar professional portfolio allows an employer to thoroughly get to know you through your experience, accomplishments, and ambitions, and shows initiative. It also provides an organized approach to demonstrating competency and career pathways as a nurse. For a closer look at the value of the professional portfolio, please feel free to visit the following articles highlighting its use in nursing practice.

* Evidence-based assessment of portfolio

* Professional nurse portfolio

* The value of portfolio building

Technological Advances in Healthcare

January 14, 2015 in On the Job

My name is Taryn. I have been a nurse for 2 years, specializing in critical care. I have an interest in information technology and the implications it has on today’s world of medicine. This is the first of a few articles on the implications IT has on healthcare, both beneficial and risky.

Technology has grown tremendously the past several years. Many aspects of the technological world are being used among us and in our surrounding cities and towns. Health care providers are finding easier and more efficient ways of reaching out to individuals no matter how far they live from access to healthcare. Prevalent disease in the United States such as diabetes, hypertension, and hyperlipidemia are lurking around every corner and often neglected due to forgetfulness, lack of money, time, and resources. Technology is finding ways to bridge gaps in healthcare concerning these disease processes. Another gap in the healthcare system is the need for better communication involving language barriers. Many technological advances such as text messaging systems, cell phone monitoring, translating devices such as MARTTI (similar to Skype), and telemedicine have recently been developed and continue to improve the healthcare system. These advances, naturally, have advantages and disadvantages. I will talk about some of the amazing technological developments in my next couple of blogs.

Text messaging has been used by the younger generations for over a decade. It was not until fairly recently when texting became popular even amongst the baby boomer generation. Healthcare has latched on to this and taken advantage of this new resource. Recently, I went to an urgent care clinic. I made my appointment online and waited at my house instead of in the waiting room at the doctor’s office. I received a text message several times telling me how long each time before it would be my turn. At approximately 15 minutes out, it texted me and told me I should come to the clinic to begin filling out paperwork before my visit with the physician Physicians are using the texting service to remind patients of upcoming appointments and to send tips and medication reminders. Information service messaging is also sent in emergency situations which can save lives. Text messaging services have been used in a number of healthcare related topics such as reminder service, mobile pharmacy service, psychiatry, diabetes education, sexuality information service, HIV prevention, and warning about prevalent diseases. Other examples include weight management and smoking cessation video and messages to improve adherence.

The advantages to the above topics are that this is a quick reminder sent by text message that otherwise may have never reached the patient. Many patients, especially younger generations communicate very well this way and benefit from this type of technology use. One other advantage is that there is no time or money put into writing out a letter or flyer and mailing it to the recipient.

Disadvantages of the text messaging system being used are some people do not have unlimited text messaging and may have to pay additional fees for receiving the text messages. People do not always carry a mobile phone and may not see the message on their phone. Others may not be as adept at using their phone for this advantage. Some patients report that they would rather have information in a printed form to have on hand at all times and did not know how to save the information in their phone, making it useless.

Other implications of technology on healthcare include the use of mobile devices to monitor health status. These devices can relay information back to the provider. The provider will then contact the patient and let them know important things related to their health. One example is a monitor system for a patient’s blood sugar. The blood sugar gets low so the provider contacts the patient to check on them and report the information so the patient can raise their blood sugar before experiencing adverse side effects. There are also monitors for heart rate and rhythm, blood pressure and asthma management.

An advantage to these types of scenarios is the ability for a health care professional to intervene before something injurious happens to the patient. Doctors can keep a closer eye on their patients. Patients can better manage their health with the help of these 24/7 monitoring devices. First responders can be notified when patients are in distress and cannot operate a phone.

Disadvantages of this technology are that it can be costly and the monitoring device can malfunction or become dislodged. Patients may also prefer less invasive measures, as being monitored brings up many privacy concerns.

Transitioning to Night Shift

January 5, 2015 in On the Job

As a nurse who recently switched from day shift to night shift, I understand the anxiety of this change. If you’ve found yourself in this boat, it does take some time to adjust to a new schedule, but I promise you will survive this metamorphosis. Some of my concerns as a night shifter-to-be were getting enough rest, functioning with fewer resources, working with a new group of nurses, and having time for my family, friends, and other commitments. Despite these obstacles, I’m now six weeks in and surprisingly, loving night shift.

A few things that helped me get acclimated were sticking to a routine sleep schedule (with a little help from blackout shades), eating small frequent snacks throughout the night to keep me energized, and a lot of coffee when in doubt. I would recommend trying to schedule yourself on for as many night shifts in a row as your hospital allows within a week (and as many as you can handle, of course), because this makes it easier to keep a relatively “normal” schedule on your days off. Switching back and forth every other day becomes very difficult and you will have a higher risk of burning out. I also try my best to stay up the night before I begin work to get my body ready for the night schedule. Put extra thought into being resourceful, prioritized, and staying organized at work, as night shift is sometimes less staffed, depending on your facility, and you can’t always count on having unit coordinators, patient care assistants/techs, and on call nurses if things get busy. Be sure to follow minor protocol changes, such as with calling the provider- for me, I work on a labor and delivery unit and on day shift we typically call obstetricians every 2-3 hours to update them on our laboring patients. However, on night shift, we typically don’t call until it’s time for delivery unless anything out of the ordinary, or a significant question/concern, arises.

That being said, I quickly learned that there are many pluses to night shift. Working with limited resources also means you’re challenged to function more independently, and for the most part, direct your plan of care, as physicians/managers aren’t on the floor as frequently. With less traffic on the unit, such as visitors, I’ve found that the night shift environment tends to be a little more laid back- not that nights can’t get crazy because it certainly has kept me on my toes, but overall I’ve enjoyed this change of pace. The nights differential pay doesn’t hurt either! Ask other nurses how they’ve handled the transition to night shift, it’s good to gather advice because everyone is different. Once you establish a steady routine for yourself, things get easier. Lastly, remember to take care of yourself: stay hydrated, especially if you’re taking in a lot of caffeine, and give yourself a solid 6-8 hours of sleep during the day.

Good luck to all you night owls!

An Intensive Start to Your Career!

December 30, 2014 in Job Hunt, On the Job

Many nursing students have aspirations of becoming critical care nurses. There is a certain appeal/allure to this specialty that draws in the energetic and ambitious individual. It certainly is an exciting field of nursing, filled with an abundance of experiences to gain and a ceaseless fire hose of knowledge to drink from.

An overarching theme in critical care nursing is understanding what’s happening, in regards to the patient’s health, as a whole. Most patients have an collection of illnesses that, when combined, put them in their current, ailing condition. It is therefore crucial to conceptualize how all of the human body systems are integrated, in order to understand the patient’s plan of care towards recovery.

Critical care nurses should also expect to start their shift with a tentative plan in mind, but be flexible enough to change everything at a moment’s notice. Your patient may be stable for the first few minutes to hours, and suddenly something changes that requires your immediate and complete attention for most of the remainder of the shift. These instances are often incited by emergent, life-threatening situations. Patients that find themselves at the center of this much attention require constant, close monitoring.

The main argument against new nurses entering the critical care specialty stems from the understanding that the ICU environment demands a great deal of critical thinking from the primary nurse. Whereas a medical-surgical focused nurse must be able to balance an assortment of tasks and skills between 5 or more stable patients, a critical care nurse typically cares for only 2 critical patients and must manage a vast amount of specific information on both patients. The autonomy that ICU RNs hold is a great privilege. This responsibility predicates that the nurse is able to constantly monitor their patient’s condition and consistently make informed decisions based on a multitude of data. Critical thinking is honed through a nurse’s on-going experiences and training, therefore it is hardly expected for a new nurse to start out with high proficiency.

Fortunately, most medical institutions who hire new RNs into this occupation assist their staff with the tremendous learning-curve through a lengthy critical-care orientation. The new nurse is typically paired with a well-experienced nurse preceptor who can show them the ropes and guide them through difficult situations.

Another major hindrance facing new nurses in this career is the need to develop strong time management. In order to practice safe and efficient care, critical care nurses must constantly prioritize their never-ending, myriad of tasks. They must also find time to chart the assessment findings on their patients and minute-to-minute condition changes. This skill also comes with time on the job.

One final trait of this field that should be noted is the high amount of stress one can anticipate. Nursing students are well accustomed to the extreme stress of making good grades, passing clinical practicums, and studying until they are blue in the face. Critical care nurses endure psychological stress of keeping track of their patients’ changing conditions and the barrage of new (sometimes unsafe) orders entered by an array of specialized physicians. There are also the added stressors of family emotions (such as with trauma patients and end-of-life care), difficult physicians and coworkers (yes, sometimes other nurses too), and regularly fluctuating vital signs that require intervention. Not to mention the stress of a full bladder wishing to be emptied when you know it will have to wait.

It is generally a fairly difficult profession to join directly out of nursing school. With the high supply of new nurses eager to work in critical care and the extensive education required by institutions to train competent nurses, finding a spot in an ICU straight out of nursing school is a very competitive process. Larger, teaching hospitals usually offer new graduate nurses opportunities to work in critical care through ICU internships. Those internships are probably offered near you; check out listings by state!

It’s not always a daily grind, in fact there are some shifts when you are mainly observing your patients who are stable for your entire shift. A critical care nurse, however, has to be well-trained and have the mental fortitude to endure an entire shift, fraught with just about every imaginable thing that could go wrong, going wrong. At the end of such a shift, you are usually too tired to do anything except go to bed, but you always realize how much of an impact you’ve had on your patient’s care and well-being – and it makes the job 100% worth it! If you think you can handle all of this, persevere until you get the job!

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at http://thenurseteacher.com/. If you are interested in participating find out more details and sign up.

Relaxing the Intubated Patient

December 23, 2014 in On the Job

BreatheIf you are an ICU nurse (or plan to become one), taking care of ventilated patients is commonplace. There is a frequent adage among many seasoned nurses that a vented patient is the preferred patient to be assigned. The caveat to this belief is that the intubated patient is also heavily sedated. Naturally, patients can’t be left sedated indefinitely or they will never recover and be able to breathe on their own again. Thus, a typical process in the day of an ICU nurse is to provide a “sedation vacation” to the intubated patient. This is a cessation of sedative medications for a period of time in order to allow health-care providers to assess the patient’s neurological function and gauge their ability to be liberated from the ventilator. Sedation vacations are usually initiated in the early AM, with a test performed shortly thereafter (once the sedation has worn off), determining how well the patient can breathe, unassisted.

During the sedation vacation (and whenever the sedation isn’t strong enough to fully sedate the patient), your patient will likely be startled by their current condition and new environment. Having a tube resting within your trachea is not an enjoyable experience and will cause much discomfort and alarm.

The best way to allay your patient’s anxiety is through communication. When your patient is not receiving sedation, it will be the only action that can be taken to relax your patient. Explain to your patient who you are, where they are, what has happened to put them in this condition, and why the tube is coming out of their mouth. It is also helpful to explain to them why their hands are tied by restraints.

Give them a chance to ask questions if they can write legibly. Many nurses believe that vented patients are less capable of using call lights in their condition and with their upper extremities hindered by restraints. A simple trick to assisting the patient find the call button is to place an EKG electrode over the button. The metal induration of the electrode gives the patient a braille-like means to locate the button. Many ICUs also have small, electronic, communication boards which can be used by the patient by pointing to the question or problem they need addressed. Family members are another important part to mitigate anxiety and ICU psychosis.

It is important to realize that, although you may think the patient is overreacting (despite having explained everything to them), only they can understand what it feels like to be stuck in a bed, with a tube helping them breathe, with no ability to use their hands. Try to avoid asking your patient to “calm down”. Instead, offer them sympathy and offer them the plan of care and time frame they can expect before having a chance to be extubated.

Every patient reacts differently, so be aware that these tips won’t work every time. As with most situations in nursing, you will gain more confidence and be more comfortable once you have been through the experience a time or two. Ask your colleagues or charge RN for guidance if your patient is still unmanageable.

Calling the Provider

October 12, 2014 in Miscellaneous, On the Job

A major tenant of good nursing practice is advocating for one’s patient(s). This is accomplished through

effective communication within the healthcare team. Sooner or later, you will find yourself needing to

notify the patient’s provider of condition changes, either face-to-face or by telephone.

 

First, consider the problem or question and whether it can be managed without the provider. Many

institutions have standing orders that are in place for common patient needs, such as comfort

medications (for nausea/vomiting or mild-moderate pain management). If you are unsure if a standing

order applies, consult an experienced RN, such as your charge RN.

 

If the situation can only be handled through communication with the provider and it can’t wait until

they round on the floor, get ready to speak to them. Before you call, prepare the information about

your patient that needs to be addressed; this is also known as “getting your ducks in a row”. Have

the patient’s chart nearby and open in case the provider requests other info, such as recent history,

the medication regimen, vital signs (including trends), and recent lab values. Before picking up the

telephone, go around and ask your coworkers if they need to speak to the provider too in regards to

their own patients. Again – Make sure you have all of your questions ready (and written down) before

you call. It’s not fun to have to call them right back because you forgot something the first time.

 

When the provider picks up:

Start with your name and the unit you are calling from. Next, state the patient’s name and room number

that you are calling about. Next, quickly summarize the situation and what it is that you require from

them. Be precise and to the point, don’t give unnecessary info.

 

When the provider gives you orders:

Write them down and then repeat them back for confirmation. If the provider gives you a new order

for a medication, be sure to obtain all of the required order information (such as whether to administer

it via PO or IV route and if it can be given PRN or only once). It’s easy to get caught up in everything

they’re telling you, only to realize you don’t know whether to give a medication via IV or PO – after

they’ve hung up.

 

Remember to tell the provider about the other coworker(s) waiting to speak! Thank the provider, too!

If the provider has been rude to you and his/her response to your question or need results in unsafe

patient care, notify your charge RN and follow the chain of command at your institution in order to keep

your patient safe. Also chart the conversation you had with the provider (in quotes, with exact words

spoken). Include the provider’s full name and the time at which the conversation occurred.

 

If the provider does not respond to your repeated telephone calls or pages within a timely manner,

pursue the chain-of-command until you are able to help your patient.

 

Speaking with providers can be intimidating at first, but it gets much easier with practice!

5 Keys for Dealing with Difficult Patient/Family Situations

June 10, 2014 in On the Job

nurse-upset-with-visitors2With nursing comes all types of patients and family units, and in this profession you are likely to come across a tough situation once in a while.  Whether it be overbearing loved ones, cases of abuse or neglect, or the sensitivity surrounding death and dying, as nursing students and new nurses, there will be many new scenarios that you encounter and you will need to quickly learn how to best deal with them.  Soon I will be beginning a nurse residency program on a Labor & Delivery Unit, and though the joy of new life is a happy area to work in at most times, I am sure I will occasionally face difficult issues such as fetal demise, teen pregnancy, and poor parenting.

Here are a few things to keep in mind when you find yourself in a sticky situation:

  • I think that one of the first things to remember is to be patient with yourself.  There will be lots of new territory, and it’s okay to feel like you don’t have the answers to everything.  If you need help, use your resources, and ask your preceptor, manager, or peers how to approach a tough situation because they’ve probably been there before.
  • These situations may come with emotions you didn’t expect to feel.  Many think you need to mask your feelings, but as long as you remain professional, it’s okay to cry in the moment.  Don’t be afraid to grieve with your patient or family – it shows that you care and feel a connection to your patient.
  • If things get messy and there is a disagreement, be sure to maintain good communication.  Being clear and concise prevents miscommunication.  If the situation has left you frustrated, take a moment to collect yourself and gather your thoughts before engaging with your patient or family.  If there is conflict in the family, be diplomatic but remember to advocate for your patient, as your patient’s safety and well-being is your first priority.
  • Sometimes the time following a difficult event can be the hardest and it is easy to carry it with you even when it’s passed, especially if you have regrets about the way you handled the situation.  It is important to talk with someone in these instances, because self care is essential to your ability to perform your job well.  Many hospitals, especially new graduate programs, offer group discussions that serve as a forum of exchange among nurses, and can be beneficial to learning.
  • Stay resilient to adversity.  It is one of the skills that you will quickly acquire as a nurse, and though not every day will be good, the challenging days will undoubtedly make you a stronger nurse for the next obstacle that comes your way.

I hope that this post brings you comfort in knowing that you are not alone in the struggles of nursing.  Please feel free to comment below any personal tips that you’ve found helpful.  Keep calm, and nurse on!

 

What you really need to know about charting!

May 31, 2014 in On the Job

charting-is-my-favorite-part-of-my-job-said-no-nurse-ever-234c5

 

During nursing school, I didn’t comprehend the significance of nursing documentation. During my 3rd semester, the faculty chose to give us a short lesson on nursing documentation. The instruction lasted two hours, and I was glad because I had more important things to worry about, like passing tests!

Most schools still don’t adequately prepare their graduates to chart with a legal dilemma in mind. Now as a staff RN in a busy ICU, it’s easy to see the importance of having clear and concise documentation.

There are many reasons to be competent within your documentation. What you chart has considerable bearing on future assessments by the interdisciplinary health care team and your patient’s plan of care. Accurate charting can also assist in the development of research to improve future charting practices. Finally, what you chart can have a major impact on your life and whether you keep your license.

Everything you type or “check box” in the electronic medical record stays in that patient’s chart for years to come. If a legal situation ever arises, anything that you have written may be presented as evidence before a judge and jury. Depending how much time has passed, you may not even remember the situation very well and will have to rely on what you wrote to defend your actions.

Accountability

Regardless of where you work, a deteriorating patient condition requires you to elicit help and obtain a response from the physician or advanced practice nurse.

If you document anywhere in the chart that your patient’s condition or overall status has declined in any way (nausea, pain, fluctuation in blood pressure, fever), make sure you chart the details surrounding your assessment along with your intervention and follow up evaluations. If you only chart that the patient has a problem, but no other notes regarding what you did for your patient, a court of law will likely find you negligent. Make sure you note the times and dialogue of your physician notifications and the telephone orders they gave you (or if they didn’t).

The mantra of legal nurse consultants is: “if it wasn’t documented, it wasn’t done”.

Abbreviations

I try to stay away from abbreviations. Typing out the whole words takes very little time and ensures definite clarity. Abbreviations saved time when documentation via pen and paper was commonplace, now not so much. There are so many revisions of institutional and JCAHO “Do Not Abbreviate” lists, today, that it has become hard to pinpoint the most current version. I simplify my practice by refraining from using most abbreviations. If there is any chance of a jury misunderstanding a term, use specific descriptors and non-abbreviated words in your charting.

Double Charting

Redundant charting can set you up for an inadvertent discrepancy and furthermore, it is a waste of your time. If I write in a nurse’s note that my patient has received a PRN medication, I direct anyone reviewing the chart to simply “see eMAR”. If there is a change in a body system assessment: “See ICU Assessment”. If any part of your testimony in court (including your documentation) is proven to be incorrect or negligible, the entire record you have created and account for becomes questioned. Any error in your charting can become the weakest link, causing major consequences for you and the defense.

Just the Facts…

This is probably the most commonly made mistake in documentation. Until recently, I would often type “patient resting comfortably in bed.” How do I know if that patient is resting comfortably? What if (s)he is intubated and sedated? Is there any reasonable way for me to really be sure that my patient is resting comfortably? If you think your patient is sleeping peacefully, are you going to tell a future jury with 100% certainty that (s)he was sleeping and not playing possum, sedated, or in a coma?

I also used to type “patient tolerated _______ well”. Did you ask the patient? Did they tell you how they tolerated the walk?

Instead of these general assumption phrases that are based only on subjective data, describe the objective data you notice that enables others to draw their own subjective conclusions. “Patient lying in bed, snoring, eyes closed, respirations regular with rate of 16, skin warm and dry.” That sentence tells anyone reviewing the chart that the patient was probably sleeping or at least resting in no apparent distress. Your patient tolerated a walk well by “denying shortness of breath, verbalizing no discomfort, and ambulating without assistance around nurse’s station and back to room”.

Don’t use labels such as ‘violent’, ‘inebriated’, or ‘delirious’; instead, describe what the individual is doing that would paint a picture of that state of being.

If the patient is angry, chart the specific body language cues that tip you off: voice intensity increasing to shout/yell, face turning red, arms shaking, fists clenched, cursing loudly, and posturing aggressive stance in front of nurse.

If the patient is drunk, document the clinical symptoms being exhibited (slurred voice, stumbling gait, smell of alcohol on breath).

If the patient is confused, note what the patient said (in quotation marks) that would lead a jury to believe the patient was indeed confused.

Your reporting should reflect objective clinical nursing judgment and data; chart what is, not what “appears” or “seems”.

A good way to chart only facts is to only record information that you observe and collect through your senses. If you directly see, hear, smell, or touch the occurrence and chart without creating an assumption, it’s probably going to be seen as objective.

When you hear pertinent dialogue by a patient, their family, or a doctor, chart their statement verbatim in quotations, identifying the individual by name.

Risky Words

RN.com (2012) published a list of words to avoid using in your nursing notes:

Accidentally
Apparently
Appears
Assume
Confusing
Could be
May be
Miscalculated
Mistake
Somehow
Unintentionally

These descriptors paint you in a negative light and raise doubt towards your competency.

In today’s era, being sued for frivolous reasons has become somewhat of a norm. The longer you practice nursing, the more likely you (and your documentation) are to become part of a legal action. The best way to prepare is to enhance your documentation now while correcting any bad charting habits you currently practice.

Also keep in mind that it is always prudent to confirm that the way you are charting is in accordance to the policies of your institution.

Keep your license safe from lawsuits – paint a clear and objective picture now for that future jury!

Reference

RN.com (2012). Professional Documentation: Safe, Effective, and Legal. AMN Healthcare Education Services.

How to Help the Even Newer Nurses!

May 17, 2014 in Nursing School, On the Job

Nursing is a work of loveHi all you new grad nurses!  So we’re all familiar with the ABCDE’s of the primary assessment.  I now aim to give you the ABCDE’s of helping the nurses that are even newer than you are.  Of course, these tips can also be applied to nursing students that may have their clinical rotation or preceptorship on your unit or sometimes to float nurses as well.

A Always Ask! – You know how helpful it was for you when you were just out of the gate when more experienced nurses checked in on you and asked what they could do for you.  Or maybe that wasn’t your experience but you wished it was!  Even if the newer nurses don’t need anything from you at the moment, at least asking will let the new nurse or nursing student know that someone is watching out for them and that they have someone to whom they can turn if they have an issue or question.

B Be a good tour guide – Be proactive and show them the unit essentials: the med room, the clean supply room, the soiled utility room, the codes they may need, the nurses station, and the break room.  Also introduce the new nurses to those who are available to help and to answer questions; teach them how to get in touch with their resources.  If you both have time, give a tour of other departments or areas of the hospital with which they will need to be familiar depending on the unit where you work such as radiology, pre-op department, main help desk, etc.

C Check your policies and protocols – Cover yourself, your patients, your colleagues, and the organization for which you work by checking the policies, procedures, and protocols related to capabilities of the nursing student or new nurse specific to your organization.  This step is particularly important for and pertinent to nursing students as they are not employees of your organization and operating under the license of another registered nurse.  Knowing what both nursing students and what new nurses are allowed to do and what each is prohibited from doing protects everyone involved.

D Duplicate! – Repeat the learning techniques that you had found to be most helpful when you were on orientation.  Throughout my clinical rotations I was the recipient of a variety of education techniques.  For example, various nurses would quiz my knowledge and supplement it; others would show me the resources on the unit to look up that which I did not yet know; and still others would take me through their thought processes in order to show how a nurse operated throughout the duration of a shift.

E Expose! – Think back to your clinicals.  Didn’t you love and appreciate it when the unit nurses or your instructor pulled you in to see a procedure or a case that you’ve never seen before?  Didn’t it open your eyes and provide a prime learning opportunity?  Now you have the chance to do that for your newer staff and students .  If you have a particularly interesting or unique case or need to complete a nursing task that new nurses would benefit from observing or performing, invite them! The earlier and more often the new nurses are exposed to new things, the quicker they are able to learn and the sooner it can become not so new.

We all remember how difficult and overwhelming it can be when you are just starting out since for a lot of us, it was only a short time ago.  So the more we are able to help the newer nurses, the more we contribute to improving the profession of nursing as a whole.  If any of you have been fortunate enough to have welcomed nursing students or newer nurses already and have anything to add that helped you help them, please feel free to leave those tips in the comments so that many generations of future nurses may benefit.

Nursing love <3