Tip for new nurses: Layering

After the excitement of getting my first job as a new nurse, I quickly realized how much I really didn’t know about taking care of patients.  I graduated nursing school with a 4.0 GPA but felt like an idiot my first few months (well, truth be told, first few years) as a new grad.  It wasn’t until I understood how learning works that I appreciated my naivety and adaptability as a novice nurse. Learning works best when delivered in layers.  The brain can only process so much information at a time. When you try to cram big important details with little non-priority ones, the brain has difficulty figuring out which ones to commit to memory.  Therefore, you may remember something insignificant (such as the color stain of an eosinophil) but fail to remember something important (checking a pulse ox when a patient is short of breath). Layer 1:  The basics  Just like when we start nursing school with nursing theory/fundamentals, the basics should be the need to know – not the nice to know.  For example, when learning how to insert a foley catheter, you start with how to maintain sterile technique.  After you master that, then you learn how to insert catheters in anatomically unique individuals;  you know – the ones that you just can’t seem to find the entrance.  You can’t begin to focus on the actual...

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Horizontal Violence: What’s the impact?

I’ve been spending a lot of time discussing the issue of horizontal violence.  Some nurses may not recognize this term.  However, if I say, “nurses eating their young,” they nod heads with full recognition.  Horizontal violence (bullying) is pervasive in our profession.  It doesn’t matter if you are on the east coast, west coast, from a small community hospital or urban mega center – nurses are still hazing/bullying other nurses.  With over 3.1 million nurses in this country, it’s a huge problem.Why is this such a big deal? It’s a big deal because of it’s significant impact on the delivery of healthcare. The impact is felt by:Individuals – Victims of HV suffer emotional pain that can lead to physical pain and loss of work.  Victims have feelings of humiliation, incompetence, lack of confidence and loss of self-worth. Nursing profession – Nurses that are victims of HV leave the profession, further adding to the shortage of high quality nurses available to care for patients.  To make matters worse, our dirty little secret is getting out.  People outside of the healthcare environment are learning about horizontal violence and asking the nursing staff if it’s happening in their work environment.  Our image as an ethical professional is clearly in jeopardy. Organization – Absence from work due to HV is on the rise.  Many nurses do not have the support or the skills...

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Celebrating Certification:

I am one of several nurses that teach the Academy of Medical Surgical Nurses Association’s (AMSN) certification review course.  Several weeks ago,  I taught the course in Fountain Valley, California.  Yesterday, I received a text from one of the nurses that attended the review course letting me know that she passed!Her name is Mary Ann.  You could just hear the joy (and relief) in her text. I hope she does something to celebrate her accomplishment. Certification is a big deal.  It means something to you as an individual, to your patients knowing that the nurse caring for them is competent, and to your organization charged with providing high quality care to the sick community.  There may be some of you that don’t have your certification and truly have more knowledge than some nurses that do.  Maybe you have wanted to become certified but just haven’t made the commitment.  If so, why?There are 2 big reasons why nurses don’t become certified:Fear:  I blogged about fear last week but I’ll address it again. If you are truly afraid (as I was) that you might fail – and what would everybody think if you did, consider these 2 options: 1.  Don’t tell anyone you are taking it until you’ve passed.2.  Realize that you are human and not perfect. Bad test-taker:  Being a good test taker is a skill that can be learned.  I...

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Advice for new nurses looking for a job: Guest blogger Nicole Spellman

I met Nicole when she was in nursing school at Robert Morris University.  There was something about her that gave me hope for the future of nursing.  I’m not sure whether it was her obvious enthusiasm or her serious determination but after we met, I knew she was going to be a great nurse. She just graduated and found herself a great job.  I asked her to blog about her experience and to offer any advice for other new nurses that are searching for their first job in a market that isn’t as open and welcoming as it used to be. Thanks Nicole!The job search is intimidating and just another added stress to passing the boards.  With limited time in one-day it can be difficult to determine whether to study, write papers, job search or sleep.  I guess this is only the beginning of learning to prioritize.  It can be disheartening to submit applications on-line.  Every month it was a task to submit applications to numerous floors never hearing any feedback, let alone a callback.  While my friends were going on interviews and getting offers for jobs, I could not figure out how to get my foot in the door.  The clinical floors offered dead ends and I did not know anyone.  I had gotten an e-mail offering mock interviews at a local hospital and went.  It was during the mock interview a nurse was discussing how...

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Certification: Fighting Fear

Many nurses want to be certified in their specialty.  Being certified means that you are knowledgeable and competent.  It gives nurses a sense of pride in their accomplishment and justifies the respect given to them by others.  But their fear of failure sometimes prevents them from taking that next step. “What would other people think if I didn’t pass the exam?’  It is this fear that limits us.  It’s time to fight the fear. There have been times in my life that I was overcome by fear.  Fear that I failed a test, fear that I was going to lose a job, fear that I wasn’t good enough.  I remember calling my dad a few of those times in a mini state of panic.  He would ask me, “What is the worst thing that can happen?”  Depending on the situation, I would reply, “Fail, or lose my house, or lose my credibility, etc.”  To which he would reply, “Wrong.  Can they chop off your head?” Well that’s just silly.  Of course they can’t chop off my head.  “Well then”, he would say, “you’ve got nothing to fear. Just do the best you can and know that if it doesn’t work out, you can just try again.” Every now and then when I get the fear bug inside of me, I do stop and think….what’s the worst thing that can...

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Professional Development: The value of certification

Education levels of nurses are a popular topic.  Having 3 entry levels into nursing (diploma, associate and bachelor) has its pros and cons.  It allows nurses to start their career within a shorter period of time but then creates confusion within the healthcare arena regarding our level of knowledge and competence.  The latest report from the Institute of Medicine (IOM) – Future of Nursing: Leading Change, Advancing Health, specifically talks about nurses practicing to the full extent of their education and training.  What to do?  If you want to advance your degree but perhaps it’s not the right time for you, consider certification. Becoming certified in your specialty validates your knowledge and competence as a professional nurse.  It doesn’t take nearly as much time as formal education and is far less expensive. There are many review course available to nurses in almost all speciality areas that can help you prepare for the exam.  Certification demonstrates your commitment to your profession.  Check out your professional organization to see what they offer! If you are a medsurg nurse, consider becoming certified by the Academy of Medical Surgical Nurses Association (AMSN) www.amsn.org. Take care...

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Personal Development

I am not a big sports fan but don’t tell my family who are crazy Steeler fans!  I think Pittsburgh would exile me if they found out the I went shopping when the football games started.  Shhh.  But I am always inspired by coaches of successful sports teams – their focus, dedication and commitment to their sport – always having their eye on the goal.  I just read an article in Success magazine (one of my favorites) about John Wooden.  He was the UCLA head basketball coach and was known as “Wizard of Westwood”.  He passed away last June but left a legacy behind for others.  He is well known for his “Nine Promises”.  When I read his promises he made to himself, it inspired me to borrow some of his and to make some of my own.  EnjoyJohn Wooden said that happiness comes from making and keeping nine promises: Promise to talk about health, happiness, and prosperity as often as possible. Promise to make all your friends know there is something in them that is special and that you value. Promise to think only of the best, to work only for the best, and to expect only the best in yourself and others. Promise to be just as enthusiastic about the success of others as you are about your own. Promise to be so strong that nothing can...

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Who’s bullying whom?

I am doing a workshop in San Diego on horizontal violence in a few weeks.  Not because I suggested it but because I was asked to speak on this particular topic.  I am teaching an on-line class right now and received a phone call from one of my students asking me for help in dealing with bullying behavior on her unit.  Unfortunately, I guess this is still a huge issue in nursing.  I used to think that nursing created the term horizontal violence but I was wrong.  Paulo Freire, a Brazilian educator and influential theorist of critical pedagogy, coined the phrase, “Horizontal Violence” during his experiences in Africa where he observed oppression not by government to the people but rather between the people. Sandra Roberts in 1983 observed the same behaviors in nurses and adopted to phrase to describe the bullying of nurses by nurses.  Who’s bullying who?  We typically hear stories of older nurses “eating their young” and being mean to the younger nurses.  It’s shocking but I am now hearing stories of newer younger nurses bullying the older new nurses.  Take a look around, are we just stressed out and lashing out at each other or are we perpetuating oppression in our own profession?  A profession that is expected to provide care through knowledge, competence, caring and compassion.What is happening in your...

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Team Building

I read an article this morning about the power of teams and couldn’t help but think of nursing.  It does seem that every workday is similar to a sports event – physically challenging, requires a great deal of focus, and even if you play well, doesn’t always mean you win the game.  By looking at basic teamwork concepts, we could really tap into the talents/strengths of each other – not only nurses but other members of the healthcare team – to build stronger teams (champions), a greater nursing workforce (legends) and better patient care (touchdowns).According to Clark, basic teamwork concepts include setting goals, among others.  Ask yourself, does everyone on your team know the goal?  Is everyone moving in the same direction, focused on the same thing, making decisions with the goal in mind?  We often get sidetracked and don’t always remember what the goal is or perhaps nobody ever told us – and we never asked. Start now.  Ask you supervisor/manager to articulate the goal of your workplace.  If you are a supervisor/manager, make sure your staff knows the goal whether it be patient-centered care, or safe care, or collaborative care.  But you have to have a goal.  Then demonstrate the behaviors that lead to the goal.  Once everyone knows it, can speak to it, can recognize it, it’s like a well trained sports team trying to get...

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Nurses want the same thing

I was in the Bronx last week doing a certification review course for AMSN.  There were 26 nurses in the class – mostly women along with a few men. It was sometime during the second day (it’s a 2-day course) when something struck me.  Nurses basically all want to do the same thing – take good care of patients.  However, whether it’s because they don’t have the resources, time, energy or even the education, many feel like they don’t know enough, don’t provide good care, and struggle just to get through their day.  Regardless of educational level, the location, or the position – we all have the desire to do a good job.  It’s just a matter of knowing how.These nurses were knowledgeable, warm, caring, and respectful.  They allowed themselves to be vulnerable – admitting that they didn’t know enough.  And the humbled me in how gracious they were. I’ve met with nurses all over the country.  We are all the same.  Knowledgeable but still have a lot to learn. Competent with our skills but not always consistent.  Caring and compassionate without limits even when we think we don’t have any more to give. It’s good to be a nurse.  Even better when you take your role seriously as these nurses did.  Congrats!...

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Renee Thompson
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