My sister, who is in her first year in nursing school, has developed a little tradition of calling me on her way home from her clinical day. This afternoon she called and left a message “I had a patient with an NG tube! Yay, can you believe it, I totally got bile on my shoes!”

She was thrilled.

In between passing meds, patient teaching, performing A.M. care, and trying to avoid annoying your clinical instructor, keep your job-search antennae up while at clinical. Pretend you’re an anthropologist trying to figure out how this mysterious culture works; it will be more interesting and less frustrating that way. How do nurses and other health-care providers interact? How are scheduling decisions made? How do the nurse manager and administrative personnel communicate with, and receive feedback from, the staff nurses?
Observe carefully—even if you are disappointed in a certain clinical site and would not set foot on that floor again even to escape a herd of stampeding elephants. You can learn a lot about what you do want by paying close attention to what you do not want. What exactly is it about the site that you don’t like? Is it the way it is managed? Is it the setting? Is it the lack of resources available to the nurses? Is it the outdated patient teaching material? Would you prefer to work with another patient population or in a facility with a nurses’ union?
You should assume two things about every employee you encounter during your clinical rotation. One is that they have something valuable to teach you, whether it’s providing a tip about how to take off adhesive tape without compromising a patient’s skin integrity or providing a visual reminder that the scrubs emblazoned with cartoon drawings of smiling jalapeño peppers on them are more gaudy than cute. The second assumption that you should make is that you will see the person again. Listen to M.L., a BSN grad from Wisconsin: “I did not enjoy my time on the rehab floor during my first semester’s clinical rotation. There was nothing wrong with the floor itself, or the nurses, or the leadership; I simply didn’t enjoy the nurse’s role in that kind of setting. I still did the best I could to demonstrate a positive attitude. I was very glad I made the effort when I interviewed for a staff nurse position on a medical/surgical floor of the same hospital. The nurse manager who did my follow-up interview had recently been transferred from the rehab floor. I got the job, and she was my new boss. I can’t say it enough: Nursing is a small world. Never burn any bridges.”

Schools are starting all sorts of innovative programs to deal with their waiting lists, which in some cases can be as long as a few years. For instance, one midwestern school recently added two masters prepared faculty by “borrowing” them from a local hospital system. In addition to any specific arrangement between the school and hospital, the program will ultimately stand to benefit the hospital system, as they will have a bigger pool of potential nurses, sooner.

If you’re on a waiting list, what are you doing to ready for upcoming entrance into the program (besides getting nervous about your first clinical day)? Some students are:

-Re-taking prereqs to try and get higher grades and thus boost up their placement on the list (for schools that have merit, rather than time, based placement)

-Learning Spanish or another second (or third or fourth) language to increase their competence in providing culturally appropriate care.

-Reading biographies and autobiographies of famous nurses and the stories of famous medical advances.

-Working their way through a math for meds book

-Volunteering or working at a hospital or nursing home (hint: try to get a third shift position, you’ll get more experience with patients and spend less time dealing with hospital politics when all the admin folks and most of the docs have gone home).

I was just reading on the philly.com about the very sad tale of Diana Levine, who went to a hospital to be treated for a migraine and ultimately lost an arm to a drug reaction. Apparently, phenergan via IV–in rare cases– can lead to severe necrosis.

This is in the news right now because her case (and specifically whether a drug manufacturer can be sued for side effects from a drug the FDA has ruled safe) is before the Supreme Court right now.

Although in this case, the drug manufacturer and not the health care provider is the target of the potential lawsuit, severe drug reactions are something every nurse worries about. And although the issue here is not provider culpability, the medication in question was undoubtedly administered by a nurse.  I am wondering what the emotional discharge is for that nurse, and reminded that when we give medications it can have far reaching consequences.

I was reminded by a recent CNN poll about the numbers of people who planned to vote in the election on Tuesday of the quote by I think Winston Chuchill (okay maybe it was Tony Robbins) who said 80 percent of life is just showing up. This is the time of the semester where we are going to feel in need of a mental health day; when we stare at our feet as we get out of bed and will them to get moving. This is the time to employ a harm reduction strategy. Build in mental health days. If you can figure out a way to take a day off that is actually a day off (ie not my skipping classes  but by re-arranging your schedule) do it and refuse to do anything nursing school related. Don’t even watch ER. You’ll find your productivity will go WAY up.

People in general can be difficult, and when people are sick, often confused and medicated like they are in the hospital, they can be especially difficult and demanding. I have a friend who works in an ER and she talks about how some patients “if you gave ‘em your arm on a platter they’d want to know why it didn’t come with salt and pepper.” My same friend also says she keeps in the front of her mind when she is frustrated with situations at work “you have to remember, your bad day is never the patient’s fault.” I think that’s a good mantra. If you lost your paperwork on the subway and your clinical instructor gives you a big lecture on why Florence Nightingale would never have come unprepared to clinical? Not the patients fault. The patient you prepared for discharged and you had to pick up someone with a less interesting, more boring diagnosis that you’ve cared for a hundred times? Not the patients fault. You’re tired? Feet hurt? Shoes too tight? Need to go to the bathroom and can’t find the time? Right none of it it the patient’s fault. Remembering this can help you when you want to respond to a call bell with “what!!?!?!?!?!!?!?!” instead of “may I help you.”

that the clothes make the man. The first time you put on your nursing school uniform, you may feel proud, or perhaps, weirded out by the fact that it’s made out of 100% polyester and closes with snaps (okay maybe that was just MY nursing school experience). But as important as clothes are in creating an internal environment, it’s just as crucial to think about your external environment for studying.

You’re well into the semester now, so it might be good to take a look at the place you have to study. Is it well lit, with a chair that is comfy but not too comfy (so you don’t catch accidental zzzzs)? Do you have all the tools you need to work? Is it relatively quiet, and, if not, is there anything you can do about that? Do you need to turn off the wireless so that you aren’t distracted by facebook (or even this blog!). Buy a background noise machine to cut down on distracting noise? A few minutes now might save you great dividend in studying time.

Wherever you are right now: the computer lab, the sim lab, taking a break at clinical, or hunkered down in your living room surrounded by a lab manual, three textbooks, 234 pages of notes and your blood pressure cuff…you are in the right place.

Ahem, according to the friendly folks at the Bureau of Labor Statistics:

“Employment of RNs is expected to grow much faster than the average for all occupations through 2016 and, because the occupation is very large, many new jobs will result. In fact, registered nurses are projected to generate 587,000 new jobs, among the largest number of new jobs for any occupation. Additionally, hundreds of thousands of job openings will result from the need to replace experienced nurses who leave the occupation.”

Enough said. Keep up the good work!

I’ve been trying out online productivity tools lately, and been at times impressed with what I’ve found. These can be a real help when you’re trying to juggle several thousand pages of reading material, researching your patient for clinical, washing your uniform, taking care of aging parents, kids, the dog, the cat, the ferret, etc.

My favorite amoungst those that are specifically designed for students is studyrails.com. It’s basically a super fancy calendar where you input your classes, the amount of time you need to study for each, and when you want to study. You can also add in assignments for each class and when they need to be completed. The program will send you text or email reminders of your schedule which could be a very hand thing, especially if you can’t get full online access but can access this feature with your mobile phone. I like the color coding too. Another interesting feature is the ability to allow another person to login and observe how you’re spending you’re time. This is obviously created for the “helicopter parents” who are still hovering over their kids when they go to college. However, I can see how this would be a useful tool for study buddies too, with another person keeping you accountable for your time so you don’t get jammed up when exams roll around.

The other program I’m digging these days is rememberthemilk.com. Of course, I’m originally from Wisconsin so anything that starts out with a cow icon is going to charm me. But cultural affinity with their mascot aside, I’ve started using rememberthemilk.com in my own life and like it pretty well so far. The site offers some features that work really well for me, including the ability to tag tasks and use the tags to sort; I added, for example, a “www” tag to all my online tasks so when I sit at the computer I can easily see exactly what I need to accomplish while I am there. I also like their optional text feature which you can use to arrange to get all your task due on a certain date sent to your cell phone on that date.

Okay, I don’t want to point you to another blog and have you run out and JUST read that one, but I just have to share this one with you: Angels in Comfortable Shoes: Affirmations for Student Nurses. It’s just starting out, but the first post is both sensible and heartwarming.

But come back and see us when you’re done there, okay? We know there’s room enough for both of us in the blogosphere.