Non Traditional Nursing Students

So just before Christmas I was asked to teach a new class in a new program for non-traditional nursing students.  Basically if you already have a degree in another discipline you can (in theory) get your BSN in 14 months....mad I know.  It means very few breaks, very full weeks of long lectures, each semester lasts 6 weeks instead of 12, so exams and readings and homework and presentations are happening ALL the time.  The first class had 38 students in it.....nuts all of them!!!

The class I was teaching was called Introduction to Professional Nursing.  A great deal of discussion was had on the good ole nursing process, critical thinking, evidence based practice and other great mantras of our profession.  It was as scary for me that first week as I think it was for the students, but it turned out to be a wonderful experience

I love teaching/mentoring second career nurses.  They tend to be motivated, they want to be in class, they want to do really well and they have just about enough experience of life to know how to talk to people and deal with the ups and downs that brings along with it!

A diverse group from several places in the US with backgrounds in nutrition, psychology, the military just to name a few.  We were a happy bunch, meeting twice a week for many hours.  It was fast it was furious, there were many exams to give, much grading to do, it just finished.....I am tired!!

No good being tired I still have the rest of the semester to go with those other sensible I'll-Do-This-In-4-Years-Thanks type of people.

Research is kinda fun (said no-one ever) but second semester in I am beginning to get in my groove and the fact that I have had near 100% attendance speaks more to the students desire to get through the muddy waters than my sparkling enlightening lectures.  I try and make it fun, there are the weekly pictures of Toby and his various adventures and every now and then I throw chocolate and show a funny video but lets be honest, nursing research can be a very dry subject, there just is no good way to liven up a correlation coefficient and what the heck is the P Value anyway.  But we soldier on, got some good students and they are trying really really hard so we shall all stick together until the end, end of April that is, when we can all take a big breath and hope that all this snow will be gone by then

Here is one of Toby in the Fall, he had just caught a mouse....clever boy!!

The Next Generation Of Nurses

A few semesters a go I had a group of students who I really connected with.  They were all without exception the trifector threat of nursing, they had incredible academic, people and clinical skills.  Sometimes you get lucky.....that semester I got lucky about ten times.  I felt incredibly blessed at the end of that semester because these students got the stuff you just cannot teach.  As a result I stayed in touch with many of them after our time together as I am very invested in helping them be successful.

Well at the end of December, many of these students passed their final exams and graduated from the University.  I wanted to go to their pinning ceremony to wish them well.  Now I have not been to a pinning ceremony since my own over 26 years ago and that was in another country.  I did not know what to expect. I did not expect it would be a very emotional experience for me.

Having students is a bit like having children, you are incredibly proud when they do well.  These students did not disappoint and it was with great pride that I saw the excitement in their faces.  They had finally done it, achieved the dream of graduating nursing school. 

People get passionate about their careers, but there is something a little extra for nurses I think.  We see the best and worst of people, experience a huge spectrum of emotions ourselves.  When we begin in our career we are idealistic, maybe a little cavalier and very naive.  Over time we move from novice to master nurse but maybe also loose a little edge on our passion to heal as long shifts, exposure to too many body fluids, heartbroken patients and family members harden us a little.  Its unavoidable and maybe even a little necessary to carry on working as a functional nurse, but there is nothing like the eagerness of a new grad to bring you back to your basics.

As I watched these shining faces  receive their pins it restored me and reminded me of why I became a nurse and how I felt when I first graduated.  I was going to save the world, I was so happy to get my hands (and the rest of me!) dirty in the name of my craft.  And it has been rough in places, I have been exhausted and beat up in a way I never thought possible.  But most of all it has been good, extremely rewarding and I needed this ceremony to understand that some nurses are educated and some nurses are destined to be.  The class of 2013 are those kind of people.  If ever I am unfortunate enough to need care I want one of "my" girls to be there for me.!!!!!!!!!

Nurse Simulation Time

We are at that point in the Semester where we retreat from the clinical area, head back to the University to do Simulation

Nurse Simulation is where we take the students into the lab and have a computer powered and controlled baby that we can create different scenarios for the students to practice different events.
Two groups over two day, each group was split into two (because of size) and so I did simulation 4 times....I'm a bit simmed out but it was a very good experience

The scenario we set up for the students was a 24 month old baby with previous diagnosis of asthma who came in wheezing.  They had to manage the care and depending on how they were doing we manipulated the situation to drop the pulse ox levels, increase the pulse, creating stress and see how the students reacted.

The cons of this experience has to be it is not real, and so some students may not take it seriously.  However, the pros far outweigh the cons.  In the clinical environment it is very difficult for me to "schedule" and emergency event.  In simulation we can create an event for the student and they can manage it in a safe environment, i.e. no-one dies.....always a good thing!!!

It was interesting to see how my students reacted, all the groups had some issues and one group very nearly killed the poor child as they did not notice the pulse ox had dropped to the low 80's and the pulse had risen to above 200!!!  They were so focused on their tasks they failed to see the big picture but what a great learning experience this was when we watched the video in debrief (yes, we taped them!)

One student froze, was literally paralyzed when things started to go downhill, another student reacted to this by yelling at her!!  These are all real life events that happen in the clinical area so we were able to talk about how people react to stress and how you can develop your own personal strategy to be both effective and safe.

A good day, we all had a bit of a giggle viewing the tape afterwards but a wonderful learning experience for all.

Pediatric Palliative Care

Do you think there can be such a thing as a beautiful death?
Do you think there can be such a thing as a beautiful pediatric death?

These are questions that we do not normally discuss, even in nursing arenas but it needs to be discussed more.  We are very uncomfortable with talking about end of life issues, but you know what they say, the only two things that are certain are death and taxes.  It is a sad sad world where children die, but as tragic as that is, it still happens and I do believe we can orchestrate such a thing as a beautiful death for a family, if possible. 

 There are those situations due to trauma, accidental or non-accidental that there may be no time to prepare all concerned but there is certainly lots of follow up that can be done to help with the grieving process.

Yesterday in clinical I took my students to a brilliant lecture by the head of the Palliative Care Team at the hospital where I teach.  She spoke bravely but simply, challenging my students to examine how they felt about these difficult issues.  Some of the questions she asked.

• What is your attitude to death?
• What is your attitude to a child's death?
• What is your own experience with close family death?

The answers to these questions is the beginning of an attitude to end of life issues, and eventually you wear your attitude on the outside, don't you think?

It helps tremendously to be a part of a healthy team, where up:down communication freely flows, where you have an ability to debrief, to say you need a break without recriminations, where you have wonderful collaborative care with the family, physicians, pastor, rabbi whoever, child life, the patient (duh obvious!...not always).  It also helps if you have a dedicated palliative care team aimed at the population you are working with, even better if there is a pediatric hospice in and out patient facility with endless resources for these families.  

It can be unusual for all or any of these components to be present and as a result we are doing our children and families a huge disservice because at all costs I DO think we have an obligation to create a beautiful end of life experience for the child if we possibly can.

Our speaker ended with strong words about taking care of ourselves as nurses so we can be the best we can be, this seems to be a theme this semester and I am so glad my students are hearing it over and over again.  It does not work to run yourself into the ground emotionally and physically, nobody wins, least of all you!

Think I got my second wind this week, inspired by my students, the children we are seeing in the clinical area and the richness of the professionals I am coming across.

I think I can make it til Thanksgiving!!!!!

Mid Semester Exhaustion And How To Conquer It

What, exhausted already, its only the middle of October.  I have to keep going until beyond Thanksgiving.  I seem to be making heavy weather of this semester and I am wondering why but I am determined not to let it affect my standard of teaching.  From one who has gone through extensive education and know how expensive it is, I am determined to give my consumer (the student) the best possible product.  So I try to engage with every student on an individual level and group level. 

This past week in Pediatric Clinicals the Hospital Chaplain came to speak to us in post conference.  He surprised (and impressed) me by talking as much about taking care of ourselves as nurses as how he cares for the families he comes across daily.  He encouraged us all to ground ourselves in a belief system, whether that be Christian, Muslim, Atheistic or whatever, but ground yourself there and find your stress reliever without self medicating on the unhealthy things like alcohol, recreational drugs and prescription drugs ( a huge problem amongst health care professionals right now).  He encouraged us to find that one trusted person to talk to and not to have an ego that keeps you silent, a burden shared and all that.......

I see the pressure all my students are under in Nursing School, the classes, the clinical days, the projects, the exams.....those dam exams that count so much toward the final grade.  And last week especially I felt like everyone was in a mid-semester hump.  I am honest with them about my desire, no need to see a continued high performance but I do cut them a break any way I can and hope I can be that trusted person to talk to.  A couple of them have really sad stories and I have to stop myself from bundling them up in my car and taking them home with me to "nurse" them through nursing school......really done it before.  But really here is some serious advice on how to survive the semester, I need to do this myself as well as advise it to my students.

Keep a routine. Keeping a schedule can help students tackle one hurdle at a time, and as a result, feel more in control. Get a schedule from a supply store or make one yourself and hang it up in your room. Write down everything you need to do in order not to miss things out.

Get enough sleep. Students should at least sleep 7 to 8 hours a day to make it easier for them to cope with stressful situations. Students will also be less irritable and tense.

Exercise regularly. Exercising at least 30 minutes a day can help alleviate stress, tension, and boost confidence. Get on the treadmill, run a mile, lift some weights.

Try to relax. Listen to relaxing music, take a long bath, watch a romantic movie or meditate. Relaxing for at least an hour per day can help you get rid of that stress building up inside.

Have fun. Take a step back and remember to have fun with friends. It can be helpful to have a group study session. It will be entertaining and instructional at the same time.

Stay calm. Do not rush yourself and then start to panic. This will only add to your stress level. Just take it slow and be steady. Take deep breathes! Breathing will physically and emotionally relax your body.

(taken from http://www.wikihow.com/Cope-With-Stress-at-School)

Moving To Computerized Charting

The hospital where I teach pediatric clinicals has recently made the transition to computerized charting.  Everyone held their breath during the preparation time and now it seems people are learning to use the system, kicking and screaming if they like it or not.  Nursing informatics is here to stay and so we had all better get on board.  However, watching from a slight distance and having no bias one way or the other to the outcome of this huge project I have made some interesting observations.

There seem to be many pros and cons to computerized vs paper charting.  The first biggie is the sheer size of implementing a project like this.  The training goes on and on and on to every single member of the team.  There is a sharp learning curve that creates momentary frustration and in the meantime, the nurse especially, is not spending as much time at the bedside.  When I walk on the floor early in the morning gone are the days when the staff are chatting with each other, now they are glued to individual computers on wheels, catching up on their documentations and trying to figure out what the heck all those icons mean.  I also have noticed that when the nurse enters a room to conduct an admission she now takes her trusty new BFF (said computer on wheels) with him/her and stares at that while feverishly inputting data and the family do not get much of a glance.

Having said that it is a huge bonus to be able to now read the chart with legible handwriting and not to be wasting mounds and mounds of paper that previously had to be securely shredded!  It is also worthy of note that the new system has automated reminders, which has to help decrease the incidence of medical errors.

A patients status can be updated quickly and all who are involved in the care can see that status promptly, this can only help improve cross-team communication.  

However, approaching week 5 of the semester, despite lots of training, begging and weeping I still have to receive access to computerized charting and then it will be in Read Only Status!  As a result me and my students have been conducting clinicals pretty much blindfolded having very limited access to the patient chart.  The students also have no opportunity to do any charting which I think is a huge loss for their clinical experience.

Am I a fan of transitioning to computerized charting?  I think inevitable I am, but it has many many teething problems in the meantime.

New Semester. New Students. New Challenges New Season

Its already October and I have been guilty of some serious blog neglect.  I feel like I lost September to new semester business, traveling and a nasty bout of pneumonia (apparently I am not superwoman!!)

However, now into the first few weeks of the semester I feel like I a hitting my stride and for the first time since August feel somewhat on top of things in terms of class prep and grading.  My Monday and Thursday pediatric clinical classes are in full swing and going really well.  Face to face teaching with students is really my favorite.  Especially when I have students who are likable, communicate well and are eager to learn.  Yet again I have groups that represent the United Nations very well, I think the school assumes that because I am a foreign nurse I can cope with these non-native speaking students, and to be honest I do not hate it but it does pose its own challenges.  I have students this semester from Haiti, Liberia, The Ivory Coast, Jamaica and its not so much the language that is the issue, they all have mastered the English language really well, but culturally there is a little disconnect.  I can only imagine what assumptions and faux pas I would be making if I was nursing in their country, so open and honest communication without judgement is key.  We are all learning together which is essential and fun.  Cold season is beginning with a vengeance so we have had our fair share of bronchiolitis and RSV so far, lots of babies.  These are good cases for mastering that first basic assessment.  So far so good.....we did not kill anyone yet.....always a good thing!!!!

Online teaching this semester I am focusing on 120 students in one class. My life was just that crazy I could not face bopping around with several different syllabi's, this class is the intro in the RN-BSN course.  It is where students orientate to the online learning environment, start to learn about APA and posting assignments.  However, we have had some very interesting assignments this week including writing a letter to your local legislator regarding an issue in your own clinical environment that is of concern.  Lots of great topics including violence in the ER, the cost of safety with the nursing shortage, how to make the transition from RN -BSN and better one for all.  All huge topics that are worthy of being visited in discussion and with more funding.

I love love love this time of year, although I am still waiting for it to cool down some, we are having a burst of heat here in the Northeast.  But October means its nearly November and that means my kids will almost be home for Thanksgiving.  The test kitchen already started in my house!!!!  Bring it on, cool weather, crisp mornings, sweaters and colorful scarves, evening fires, feeling blessed.