My First Week as a New Graduate Nurse

My First Week as a New Graduate Nurse

I finally did it. I graduated, landed a job, and passed NCLEX. It has been a whirlwind blur for the past several months during this process so I thought it would be helpful to share the experience with others. That way you know what to expect upon graduating from nursing school. Remember the Seven P's from the Marine Corps: "Proper planning and preparation prevents {piss} poor performance." My family is full of rough and gruff straight shooters that tell it like it is. Guess you could say the apple doesn't fall too far from the tree. So let me tell you about my experience so you know what to expect!

{UPDATED} 8 Drugs Every ICU Nurse Needs to Know

8 Drugs Every ICU Nurse Needs to Know {EXPANDED}

Ask and ye shall receive!! Thanks to viral pinners on Pinterest, my previous (very brief) post on 8 Drugs Every ICU Nurse Needs to Know has gained some recent attention. Thank you, Peter, for your comment asking for a post about these drugs and what the nursing implications would be, what we need to monitor, and the contraindications, etc. Also, if you aren't already follow me on Pinterest so that you can keep up with new posts! Nurse Nightingale's Super Awesome Pinterest Profile!

Ok. Here it is folks!!

Student Nurse Song Celebrating Nurses Week

Student Nurse Song for Nurses Week

This is the one week of the year that I should be on top of this website. It's nurses week. I write a nurse blog for student nurses. Why on Earth is there no posts?!?!?!?! 

Let me enlighten you...

Happy Nurses Week

Happy Nurses Week

Happy nurses week everyone. In honor of the lady with the lamp whom nurses week ends on her birthday, I wanted to pay a little tribute to her. 

I love this quote by Nightingale. It really resonates with me. This is how I felt during nursing school. I always did my best to accept and take responsibility for everything. The teacher made a test and it was nothing like the material she presented in class-- I didn't find an excuse. Instead I found an opportunity. 

I should've known more. Next time I'll study more. I'll do more. I'll be better. 

Whatever I realize I don't know today; I'll make sure I know tomorrow.

Really, to succeed in nursing school and as a nurse you need to develop a thirst for knowledge. Let it be unquenchable. Be a little anti-social. Dig deeper. Read more. Ask questions. Get thirsty.

Anyways, off to class I go!

Xoxo,

Nightingale

The Nursing Student's Guide to Tube Feedings

The Nursing Student's Guide to Tube Feedings

I feel like this is a topic that isn't discussed very much in nursing school. Sure that first semester you learn how to drop a NG tube, but when do we decide to give a patient nutrition through a tube? What do I need to look at as a nurse to evaluate that the patient isn't experiencing a complication? What's the difference between enteral and parenteral nutrition? How do we choose which one to give? What's refeeding syndrome? 

These were all thoughts that have at some point raced through my mind. I didn't have much experience with feeding tubes prior to six months ago. Now I feel much more better about them. I'd say I feel like a whiz, but well, I know that I still have a lot to learn. Isn't that the beauty of nursing? There's always something more to learn. No matter how confident you feel, you only know the tip of the iceberg. Medicine is a sea of knowledge. 

Millions of patients have tube feedings so I'll do my best to give you the quick down and dirty facts on tube feedings.

Nursing Care for the Patient Experiencing Hypovolemic Shock

What is Hypovolemic Shock?

Medically, shock simply means that the tissues of the body aren't receiving adequate oxygen or nutrients and this leads to cell death. There are several different types of shock: septic shock, due to bacteria infection; neurogenic, involving the spinal cord; anaphylactic, due to an allergic reaction; cardiogenic, due to heart damage; and hypovolemic shock, due to a loss of blood/fluids. 

This post will cover hypovolemic shock. What it looks like and how we treat it.  

8 Unique Ways to Earn Money in Nursing School

8 Clever Ideas to Earn Money During Nursing School

Everyone warns you before you start nursing school of how hard the classes will be. They ask, "Can you handle cleaning up vomit, blood, poop, urine?" And while those are very valid points to consider before deciding on nursing school, there is one other major thing I hadn't given as much thought. I knew it would cost a lot of money. (It costs A LOT of money.) I just didn't realize how bad I'd feel about being so deeply in debt.

Nursing school is like boot camp for your mind (and body. Hellooo 13 hour shifts!) You don't have much time to spare. You'd like to spend whatever precious free time you do have with friends or family enjoying this simple little thing we call LIFE. 

I hear you loud and clear. Here's 8 creative ways to earn money while in nursing school.

Fluid & Electrolyte Problems in Surgical Patients

Fluid and Electrolyte Problems in Surgical Patients

No matter what field of nursing you go into, you'll most likely take care of patients who have had surgery. Even if you're not an OR nurse, it's important to know these common fluid and electrolyte issues that can occur in surgical patients. Here's a quick guide on F&E for the preoperative, intraoperative, and postoperative patient.

How to Score above a 900 on HESI

How to Study for HESI

HESI exams are taken towards the end of your nursing school career. HESI is a great tracker to determine how well you will perform on the NCLEX. It's a stressful test. It's long. Some schools may even hold you back if you have not scored above a 900 on it. It's comprehensive. So how do you study for it? Here's a few strategies and programs I've been using. 

How to be an Awesome Nursing Preceptor

How to be an Awesome Preceptor

As you know this blog is written by a nursing student for nursing students. So what in the heck do I know about being a preceptor when I've never been one? The truth is, I don't. But I have had many preceptors thus far in my studies and I can tell you what worked and what didn't work. I can also tell you what you need to be as a student for these amazing preceptors we have.

I value all of the input I received from every nurse I worked under. I appreciate their time that they gave to me. I know I slowed them down by asking a million questions but I will be better and it's all due to them. So Thank you, preceptors! You've all done a smashing good job.

9 Tips to Conquer Anxiety in Nursing School

Dealing with Anxiety in Nursing School

I'm only anxious about once every 4 minutes. Usually about midway through a semester I have a lot of anxiety due to midterms, projects, papers, etc. This usually leads to numerous panic attacks. I'll admit to not being invincible. I'm not iron man (though he too has panic attacks). I have many Achilles Heels. I feel like I've been dumped in kryptonite.  I can't move. I can barely breathe. I'm overwhelmed. I feel as if I'm lost at sea.... even though I'm lying down on the couch.

"The best use of imagination is creativity; The worst use of imagination is anxiety." -Deepak Chopra.

I have scoured the web many times, each semester, and have compiled a list of things I do to try to calm myself when these inevitable panic attacks strike. From humor, to meditation, to loving on my human; these are my top secrets to conquer my anxiety.

How to Rock Your Monday

Make Monday Your Bitch

I went back and forth on this title... "How to rock your Monday"...... "Monday morning motivation" 

But let's be real. Monday IS a bitch. I'm a classy broad, but I do have a wicked sense of humor and I'm slightly rough around the edges. You've probably noticed that by now. If this title offends you, sorry... but feel free to click on an ad ;)

The weekend was glorious. We took our bras off Friday night. Kicked back in some fuzzy socks and caught up on a well earned Netflix binge. Saturday was spent in the sun in the park by the fountain. On Sunday we had mimosas at brunch and enjoyed a little cat nap in the afternoon... Then Monday shows up.

Beep. Beep. BEEP. BEEP. BBBBEEEEEEEEEEEEP!!!!!

The alarm goes off. You realize you're restarting your week all over again. The bed is too comfy. The floor is too cold. Screw you, Monday. I don't want to get out of bed and take a shower. I want to roll over on my stomach and sleep two more hours.... but you have to show up.... always....

 If Mondays were shoes they'd be Uggs. Why doesn't Monday jump off a cliff into a pit of acid?

Monday is the red-headed step child.

My weeks are Monday, Monday 2, Monday 3, Monday 4, OH MY GOD IT'S NOT MONDAY, SATURDAY MORNING CARTOONS, Oh, no! It's almost Monday, Monday, Monday 2, Monday 3.....

If you're like me and have realized that you can't give up Monday for lent (or people) then this post is for you. Here are my super easy, fool proof, no caffeine needed (but strongly encouraged) tips to make Monday your bitch.

9 Tips for the Clinical Nurse Leader Exam

9 Kick-Ass for the CNL Exam

So I've let myself get talked into taking the CNL exam in a few weeks. As I've been studying I've been keeping track of tips to help me pass this exam. There are a few ways that this test differs from NCLEX, so you'll need to keep that in mind. A CNL and an RN are different roles, therefore the test questions are going to be a bit different. You'll need to think in a different way than you've thought before. 

In an NCLEX world, you're never leaving the patient. You have that nursing process down pat. In a CNL world, you're going to guide the RN to deliver the best patient care that he/she can. It's weird because you have to take a different approach to these questions. 

{Also I feel like I may mess myself up when I sit for NCLEX. Why of why did I agree to this? Haha. Do I hate myself this much that I'm missing out on a beautiful day outside to sit inside and read. Perhaps I'll go chill on the rooftop.}

Anyways, without further ado, here are my kick-ass tips!

Renal Failure: Are You Kidneying me?!

Renal Failure: Are You Kidneying Me?!

Renal/Kidney failure is a pretty common condition in our patients at the hospital. They can have an acute episode, or it can be a chronic condition. 25% of patient admitted to the ICU develop Acute Renal Failure. 

I'm currently on a liver transplant ICU-- so nearly everyone has also developed renal failure.

This post I'll discuss acute and chronic renal failure's patho, labs to watch, causes, signs and symptoms, and how to treat these disorders.

P.S. I make terrible puns. Earlier today had a visitor on the unit that broke her humerous bone. I asked if it was funny... No body laughed... #thisiswhyimsingle.

Congestive Heart Failure 101

Congestive Heart Failure (CHF) 101

CHF occurs when the heart cannot adequately pump blood to the rest of the body. There are two different types: Left and Right. They both produce a wide variety of clinical symptoms. It causes imbalances among fluid and electrolytes. This post will give you the 101 on Congestive Heart Failure.

8 Drugs Every ICU Nurse Needs to Know

8 Drugs Every ICU Nurse Needs to Know

These drugs are used frequently in the ICU setting. It is imperative that you understand what these drugs are and when they are to be used.

When I started on my current unit I had no idea what these drugs were. I had a vague idea, but really, I was pretty clueless. I had spent the last few months just trying to pass class. Unfortunately, I didn't have a critical care class. (Which I really wished we would have!)

Here's a quick guide to 8 drugs that we use frequently in emergency situations. ALCS (Advanced Cardiac Life Support).

10 Prominent Women in Nursing

10 Prominent Women in Nursing

In honor of today being International Woman's Day, let's take a look back at 10 important female figures that have shaped the field of nursing into what it is today.

How to Deal With a Nurse Bully

When Nurses Eat Their Young: How to Deal With a Bully

Here's a sad truth about being a nurse; there are bullies. 

82% of nurses say that they have been a victim of a bully.

We encounter them often. In the classroom when you ask a question and a peer snickers. In simulation when you mess up and the instructor berates you. On your first day of clinicals when a more experienced nurse belittles you.

I started my path to become a nurse 6 years ago and promptly changed my degree because of the bullying I witnessed. Eventually I was drawn back into nursing. This time a little older, a little wiser, and ever so slightly tougher.

Here's how to recognize, understand, and change your toxic environment when you are in the company of a bully.

6 Tips to Become More Positive

How to Become More Positive

Life in general sometimes makes it hard to stay positive. Certainly going to nursing school can take a toll on you. You bomb a test, you make a mistake at clinical, you forgot to turn something in, etc. It's HARD to not feel defeated during nursing school and it's easy to let yourself slip into negative thinking.

But I'm here to help!! Here are my 6 favorite tips to stay positive.

Big Announcement: Easy Guide to Interpret Acid-Base Imbalances Ebook Released

Big Announcement: Ebook on Acid-Base Imbalances Released

Hey guys! I know I haven't been posting as much as I normally do. That's because 1) I had a couple huge tests this week and 2) I was writing this ebook guide to interpreting acid-base imbalances.

If you're struggling with interpreting these imbalances then I suggest checking this out. I have it for sale for only $3.99 on Amazon. You can check it out HERE! It also contains some practice problems to work through. I go through the problems step by step because I know how confusing it can be. It took me over four different professors before I FINALLY had one explain this to us correctly.

I think this is a great tool for any student to have! You don't even need a kindle to read it! 

Sorry, I had to do a shameless plug. Ha. I'll post some new stuff this week. Life will be less hectic for me in 24 hours.

You guys are great.

Happy Hump Day!

Xoxo,

Nightingale

Nursing School Graduation Checklist

Nursing School Graduation Checklist

Congratulations on being in your last semester of nursing school!!!! Whoooo hoooo!!! You're almost there!! There are just a few more things that you need to do before you graduate. I'm including a list of popular things that nursing schools will require before graduation in a handy dandy list that you can use to stay organized!

Insanely Rapid Way to Ace Pharmacology in Nursing School

INSANELY Rapid way to Ace Pharmacology

Is pharmacology killing you?? Ruining your life?! Destroying all the happy thoughts that once used to dance in your head?!

Yep. Pharm sucks.

But luckily for you, you found this fabulous post where I'm going to share something great with you!

Ventilators Explained Extremely Easy

Ventilators Explained Extremely Easy

I don't think I'm alone when I say I have no freaking clue what PEEP, SIMV, AC, IMV, FiO2, etc means when I'm getting report.... I do now. So don't flip. 

But I remember what it was like when I had my first patient on a ventilator. What are all those settings? We had only had a one hour lecture on this stuff, once. Oh god! I'm so lost!!

Breathe easy {pun intended} I'm going to try to make this as pain free as possible.

ARDS {Acute Respiratory Distress Syndrome} Explained Incredibly Easy

ARDS {Acute Respiratory Distress Syndrome} 

I've had several patients the past couple weeks with ARDS. I needed to refresh my memory on the syndrome.

ARDS is a progressive and sudden form of acute respiratory failure. You'll see these patients in the ICU. It's life threatening. In this post I'll talk about the causes, patho, prognosis, and a couple nursing diagnosis for this type of patient.

A Nurse's Guide to Beta Blockers

Beta Blockers

I'm awful at pharmacology. There's just so much to learn! Here's a quick post that gets at the nit and gritty of Beta Blockers. You know the drugs that end in "olol".

All of your patients will be on them. Why? When should you hold giving a beta blocker? When should you expect to give a beta blocker? What adverse reactions should I look out for?

5 Facts You Didn't Know About C Diff

5 Facts You Didn't Know About C diff

C diff is a nasty bug. It's hard to kill. It's a major problem in healthcare facilities. 

It's a gram negative rod. It is anaerobic, and endosporic. When stressed it forms dormant spores. And the smell will knock you dead.

Nursing Diagnosis for Common Diseases on the Organ Trail

Not everthing that starts in Missouri has to end with Dysentery....

Remember the days, long ago, before nursing school, when we could play really awesome games like The Oregon Trail??

Yeah!!

Well, if you ever wondered what those diseases were that your sister died from after fording the river get ready to be amazed.... or it's Monday and you don't want to be productive. Whatever.

Respiratory Alkalosis Study Guide

Respiratory Alkalosis

Respiratory Alkalosis occurs when pH is high (above 7.45) and PaCO2 is low (below 35). This acid-base imbalance is due to hyperventilation. The patient's body is ridding itself of CO2 too fast which elevates the pH. This post will explore the common causes, symptoms, and treatments for respiratory alkalosis.

Happy Valentine's Day

No, not that kind of furry...

Happy Valentine's Day!

Here's to you, dear reader, may you have a wonderful Valentine's day! I hope you get some much needed rest, tender love and care, and spend some time with your loved ones. 

Also, I hope you don't forget the yeast in your pizza dough like I did last night... man was my human disappointed when I called supper time...

Xoxo,

Nightingale

Respiratory Acidosis Study Guide

Respiratory Acidosis

Respiratory Acidosis occurs when the patient's pH is decreased (below 7.35) and their PaCO2 is increased (above 45). Hypoventilation is the most common cause of the acid-base imbalance. It is also commonly caused by the overuse of sedatives. It can be acute and chronic. Chronic sufferers are those with COPD. This post will help you identify the cause, recognize the symptoms, and find the best treatment for your patient with Respiratory Acidosis.

Metabolic Alkalosis Study Guide

Metabolic Alkalosis Study Guide

Metabolic Alkalosis is another acid-base imbalance. In this imbalance there is a high pH and a high bicarbonate concentration. It can happen from a gain in bicarb or a loss of hydrogen ions. This post will cover the causes, signs and symptoms, and treatments of metabolic alkalosis.

Metabolic Acidosis Study Guide

Metabolic Acidosis

Metabolic Acidosis is an acid-base imbalance in which the pH and the bicarbonate are both low. Being able to interpret and understand acid-base imbalances will not only show up on NCLEX but will also show up frequently in the hospital setting. This is a post over the signs and symptoms, causes, and treatments of Metabolic Acidosis.

{ABGs} Arterial Blood Gases: The Ultimate Beginners Guide

Arterial Blood Gas

It's a lab we draw from the patient's artery that tells us the patient's arterial oxygen (PaO2), arterial carbon dioxide (PaCO2),  arterial oxyhemoglobin saturation (SaO2), bicarb (HCO3), and acidity (pH). It's often used in ICUs. It is a very important lab draw that is vital in caring for critically ill and patient's in respiratory distress.

Correct Order of Blood Draws

This seemed to be one of those things that fell through the cracks during nursing school. What order do we draw our blood labs? Why does it matter? What tubes are used for which tests? Should I shake the tube once it is filled?

HELP!!!

Catheter Fundamentals for Nursing Students

Catheters 101

Catheters are used to relieve urinary retention, obtain sterile urine specimen, measure residual urine volume, surgery, or managing incontinent patients (such as a spinal cord injury, etc).

CATHETERS ARE A LAST RESORT!

But sometimes catheters are needed, so this post is here to help you with tips on how to insert, care, and remove urinary catheters.

Hypercalcemia: Signs & Symptoms, Causes, Treatments

Overview of Hypercalcemia

Hypercalcemia is an excess of calcium in the extracellular space. If it is allowed to become severe it has a significant morbidity and mortality rate. Normal calcium serum levels are 8.9 - 10.3 mg/dL. When the serum levels are greater than 10.3 mg/dL is referred to as hypercalcemia.

It's important to read this post (at least the clinical manifestations) so you recognize when a patient is experiencing hypercalcemia.

Hypocalcemia: Causes, Symptoms, and Treatment

Overview

Normal levels of serum calcium range from 8.9 to 10.3 mg/dL. Give or take, institutions will vary. Hypocalcemia is when we are low on calcium. The patient's serum level is below 8.9 mg/dL. Hypocalcemia is a big deal because it can potentiate arrhythmias and seizures. 

Side note: that whole "I before E" is a load of bull.

Erikson's Stages of Psychosocial Development

Erik Erikson's Stages of Psychosocial Development 

These stages always show up a couple of times on NCLEX questions. This post will have an easy to read table to reference for the stages of development and the tasks that correlate with each stage.

7 Killer Tips to Survive Night Shift Nursing

 7 Killer Tips to Survive Night Shift Nursing

Working 12 hour shifts can be difficult on most days. It's even more difficult working those 12 hours at night. Since I'm the low man on the totem pole I know I'll most likely be stuck working night shift again for the first part of my career. I've had a couple clinicals now that were at night. Thankfully my classes at the time were online. 

Here are 7 tips that help me survive night shift nursing.

Diuretics: Everything a Nurse Needs to Know

Know Your Drugs: The Pharmacology of Diuretics

This post will cover the four classes of diuretics: loop diuretics, thiazide diuretics, potassium-sparring diuretics, and osmotic diuretics. In each class I'll point out the mechanism of action, therapeutic uses, and adverse effects. 

Fast Facts on Hyperkalemia

Fast Facts on Hyperkalemia

Potassium is a very important electrolyte. Having too little or too much is a BIG problem. This post is about having too much. I'll discuss the causes, the clinical signs, and the treatments of hyperkalemia.

Quick Guide to Hypokalemia

Hypokalemia at a Glance

This is an electrolyte that is very important. Having too little or too much Potassium is a BIG problem. This post will cover the causes, clinical signs, and treatments of hypokalemia.

Everything You Need to Know About IV Fluids

IV fluids aren't nearly as luxurious as that graphic, but knowing these quick facts will keep you golden.

And no. That wasn't a reference to pee.

Increased Intracranial Pressure

This week I had a patient who had herniated. I know that neuro is a weak topic for me so I decided to do a post on intracranial pressure.

This post will act as a quick guide to increased intracranial pressure. What is it? What causes it? How do we treat it? I've also included a quick table on assessing rising intracranial pressure (ICP). We'll do a slight case study.

The Character of a Nurse: My First Patient Death

I lost my first patient this week. It's something we don't talk about in school.

Death.

{Dirty} Mnemonics to Remember the 12 Cranial Nerves

The healthcare industry is full of mnemonics and abbreviations. If you're anything like me you probably have problems remembering all of these "helpful" mnemonics. I think it's harder sometimes to remember the "helpful" saying verses just learning the material to begin with.

However, the order of the 12 cranial nerves is a bit tough to remember. First, let's look at these 12 cranial nerves.

Renin - Angiotensin - Aldosterone System Explained

I'm not sure why, but it does seem that some systems are easier to understand than others. I've always struggled with the Renin - Angiotensin - Aldosterone System (RAAS). In this post I'll talk about the pathophysiology and pharmacology associated with this system.

Clinical Manifestations of Hypernatremia

In this post I'll discuss hypernatremia's pathophysiology, the causes, the clinical manifestations, and how we treat the imbalance.

Clinical Manifestations of Hyponatremia

In this post on hyponatremia I'll discuss the pathophysiology, what causes it, the clinical manifestations, and how to treat the imbalance. 

Glasgow Coma Score

Here's a quick table to reference for when you are assessing your patient using the Glasgow Coma Score: