Last Instructor-Led Clinical - First Day!

Saturday I showed up at the hospital for clinical orientation. Unfortunately, we had to wear our "whites". I hate wearing those things cause everyone looks at you LOL

Anyways, I met my last clinical instructor. She seems to be very nice! Kinda quiet, but I love her calm demeanor. She's very knowledgeable and I feel confident having her there by my side when I need her. This is a great way to end out the last instructor-led clinical. In 6 weeks we go on with our preceptor. I still don't have my preceptor assignment. I don't know which hospital or specialty I'm doing. I requested OB or OR, but I'd be real happy with ER or Peds. I just love nursing LOL

So anyways, I'm also very happy with the group of students I'm in with. They are all very cool. There's a few I haven't really met yet cause they just joined us from the other campuses but they seem very nice. Sometimes you get people with a chip on their shoulder and they hate life itself and everyone in it and that makes it hard to work and learn. But we don't seem to have that this time around.

I like this hospital so much more than the other hospital I did telemetry at. The only thing I like better about the other hospital is we had our own user names and passwords to access the computer charts. This hospital doesn't do that for students, so when we need to look at the chart (nearly CONSTANTLY! LOL) we have to hunt down a busy nurse and pull her away from her job.

My goal for this clinical is better time management. I've always been able to get done everything that I need to during my shift. Now I've got 12 hours. I want to STAY busy for 12 hours.

Good news: No more stupid care plans
Bad news: Those stupid care plans gave us something to do when we had down time

I guess we're starting out with 1 patient for now. But we're adding more and more patients as we go. So having more than one patient means that I HAVE to stay on top of meds and tests and what needs to be done. We had a lecturer on Friday who gave us a great notecard idea. On the front it had all the pt info you need to know at a glance and on the back it broke down the hours and you marked what meds needed to be given/were given. I might try that. A notecard would be simple to grab out of my pocket and then glance at as needed.

Oh, I also found out we're not working 7a-7p. That's a bummer. We're doing 6a-6p. That extra hour of sleep means alot to me! LOL I'll manage though. The idea of a 12 hour shift doesn't bother me too much. I'm just afraid of being bored. I HATE being bored. But then again, if we're too busy we MIGHT not get any lunch break. I'm going to have to tell my instructor (Ugh) that I'm diabetic and "this is why I'm sneaking a snack". I can't eat at 5 am before clinical and then eat when I get home after 7 pm. That's not good for anyone. Especially when you need a clear mind to work with your patients. Oh well.

But I've had days when I worked 8 hours where 8 hours wasn't enough. Especially the TB patients. You couldn't just walk in and do what you needed. You had to gown up, mask, gloves, etc.

NCLEX Test Taking Tips

Hope this helps all of you. I got this from another site http://pinoynurseszone.blogspot.com/2007/09/nclex-test-taking-tips.html. If any of you that have already taken the NCLEX have any tips, or if you agree/disagree with anything here, please comment!

NCLEX TEST TAKING TIPS

Over the course of my studying I have ran across a lot of helpful hints that have helped me study. I thought I would post them in hopes that it would help out others......These are bits and pieces that I use whenever I get a question I have no clue how to answer while I study. They have really helped me out tons and I hope they can help out others as well. There are also some self talk things in here too......

*Everyone thinks they have failed the NCLEX but more people pass than fail. It's OK to cry and feel horrible after taking the test, every single person who walks out the NCLEX feels this way. Know this right now before you take the test so that you don't freak out during the test or shortly thereafter.

*You have no idea how many questions you got right. It may feel like you missed them all - chances are, you didn't. People who get 75 questions have a 50/50 chance of pass/fail just like people who get 265 questions. The amount of questions has NO BEARING on whether or not you'll pass/fail the test.

*The NCLEX is hard, it's harder than your review books, your NS tests. It's harder than anything you could've ever imagined. If you use common sense and ABC's when answering your questions you will get more right than wrong. Do not freak out, do not panic and do not run screaming out of the building. This test is hard for every single person who takes it. It isn't just you.

*You have to know and understand your basics in order to answer these questions. If you don't know how the heart works, it will be difficult to answer questions relating to the heart.

*You don't have to memorize every single drug out there - there are 60,000+ drugs. Break down the drug name and look for something that jumps out at you. If it's a cardiac drug - look for the cardiac answer. 2 cardiac answers...look for the one that doesn't harm, kill or delay treatment to your patient.

*Trust your instinct. Do not sit there and try and talk yourself out of an answer because you don't know why you know it. If it feels right to you - it more than likely is right and pick the answer. Your mind stores a huge amount of information and it's burried deep down in there somewhere and it comes out when you least expect it.

*You are going to get things on the NCLEX over material you have NEVER seen or studied before and that's OK......just stop, breath and use common sense here.

*The test isn't trying to make you fail...it's testing your ability to think and rationalize and safely care for your patient. It doesn't know that you stink in one particular area or another, it's a computer. It doesn't know just by looking at you that you didn't study your drugs and therefore it's going to ask you 14 questions on drugs. It's a computer. It also isn't trying to allow you to redeem yourself 10 questions later by asking you a similar question. It's a computer.....it's a random selection of questions. Treat each question like you've never seen it before.

*Remember, there are test questions that do not count.

*Pain has never killed anyone....yes they think they are dying....but more often than not, pain is not the answer on the NCLEX usually if you look, there is something much worst going on somewhere else.

*Always pick the least invasive answer. If you have to choose between a trach and an ET tube, pick the ET tube.

*NCLEX people don't like when you tie people up....so trying looking for a more therapeutic approach.

*If you can do something 1st without drugs...that is more often a better choice for NCLEX than drugging up the patient.

*This is not the real world - repeat that over and over and over when you take the test. Do not rely on the information you have seen or done in the real world. This is a "perfect world" test.

*The test adjusts the difficulty based on how you answer the questions. The first question will be a medium level question. It doesn't matter if the question says....a Potassium level of 100.5 is lethal...you are going to freak out and suddenly not know the answer because all 4 answers are going to look good. Pull yourself together.

*If you get a multiple answer question, answer it the best you can and don't freak out if you get 10 of them.....remember there are questions that do not count and these might be it. You never know.

*People always think they got more questions on one certain topic than they really did. When you leave the test - if you are weak in say....ortho...you will be positive you had 25 questions on ortho alone, when in fact, you probably had 1 or maybe 2.

*Cover up the counter at the bottom of the screen. It's never wise to know how many questions you took. People pass/fail regardless of the of questions. There is no magical number that means you have passed and no magical number means you have failed.

*You aren't supposed to know all the answers. The NCLEX people know this. What they do want to know is that you are safe in your practice and you won't do things that will kill, harm or mame the patient.

*Get that idea of percentages out of your head right now. This is the NCLEX and not NS and you are not trying to make 100%, you are trying to get more right than wrong. Take all the practice tests you want - forget the % at the end - just make sure you got more right than wrong with a couple to spare.

*If you have never heard of it, no one else has either. Don't pick that answer.

*You are a nurse, not a doctor or a surgeon, so don't pick the answer that makes you do things that are outside your practice. You can call the dr. and ask for pains meds, but you can't order them. You also can't trach a person or crack a chest open or insert a chest tube.

*The NCLEX people know you are a brand new nurse with 2 weeks of experience. Keep that in mind when taking the test. Don't pick answers that are outside your level of knowledge.

*You aren't there to make the doctor happy, you are there to keep your patient alive. If the answer says to question an order....DO NOT think...I can't call and question the doctor...he might yell at me. Who cares...this is the NCLEX...you are there to keep your patient alive.

*In every single NCLEX question you get, there is a problem. Figure out first what exactly the problem is.

*Do not pick answers that delay treatment. If your patient is unstable, don't pick the answer that says to reassess in 15 mins. because your patient might just be dead in 15 mins. Look for another answer that doesn't delay treatment and calling the dr. just might be the ONLY thing you can do.

*NCLEX is the perfect world. You only have the patient in front of you on the computer screen. Forget that 2 questions ago you had 14 patients, RIGHT NOW you have just 1 patient. If the answer says to stay there for the entire shift because you patient is unstable....that is OK for NCLEX because THAT IS YOUR ONLY PATIENT.

*Because the NCLEX is the perfect world, you have RT, OT and every other "T" available to you and your beck and call 24/7. But remember, don't pick the answer that dumps your patient off either.

*When you get the priority questions...you are looking for the "killer" answer.

*Always think....is this answer going to 1 kill or harm my patient or 2 delay treatment. If it does....look for another answer.

*If you have to, put yourself in the patients shoes. If it's asking how to position after a procedure...picture how this person will look laying in each of the answers. If you get it narrowed down to 2, pick the one that won't harm or kill your patient (or mess up the suture lines).

*Always pick the answer that allows your patient to speak. The patient has 100% right to their healthcare. Do not pick the answers that make the family speak or answers that make the family happy. You are only talking about your patient here.

*Eliminate answers that have "always, never, etc..." because in the nursing profession - nothing is that certain. They will be tempting to pick too because they look so good....but nursing IS NOT certain and those words make it certain.

*If there is anything that you can do that will not harm, kill or delay treatment to your patient, pick that answer before you call the doctor.

*Don't pick answers that will cause long term consequences to your patient.

*Like patients can be placed in the same room. Think about cross contamination issues when thinking about room assignments.

*Stable, chronic, etc...patients can be released to go home when you get the question about which patients can be released to free up an empty room on your floor.

*Stable patients can be cared for by an LPN. Something may sound really, really bad but chronic disease are usually stable...that's why they are chronic and not acute.

*For RN's, do not delegate unstable patients to anyone. Again, this is the perfect world and you only have the patient on your screen RIGHT THEN to care for.

*You can't use a medical dx in a nursing dx. NCLEX people are testing your ability to be a nurse, not a doctor.

*When you see assessment or eval in the stem of the question....start thinking S/S.

*When giving report to the oncomming shift, you are reporting things that are "new" or "different" or "possible" to them. Don't pick the answer that reports the obvious to the oncomming shift.

*Try to narrow it down to 2 answers and then pick the answer that is the most threatening to the patient.

*If you have no idea how to answer the question - look for the answer that will kill the patient. Sodium, Mag and Potassium can all cause problems when they are out of whack....but Potassium will cause heart issues and if your heart isn't beating...nothing else matters.

*It's all about ABC's for the test. If you patient doesn't have an airway - he doesn't have anything else for that matter.

*Pick the answer that address the problem in the question (because every question...there is a problem). If it's talking about the heart...no matter how good it sounds...the leg is not an issue.

*Tell yourself over and over during the test, you can pass it and you will pass it. Self talk goes a long way during a test like this.

*Take a break, even if you think you don't need one...you do.

*Use your dry erase board for other things that just calculations. Draw pictures....eliminate answers on it....it's there for you to use for whatever you need it to be used for.

*You can't think the same way you think in NS or even at work. This test is going to give you questions, scenerios, etc.. .over things you have never seen or heard of. All the NCLEX people want to know is that you can safely care for your patient. Pick the answer that does that.

Common Drugs for RN’s - Last Semester

In preparation for my last semester I've been getting a jump start on studying. I know my (school) clinical for my 5 weeks. I'm so excited about it! It's at my fave hospital close to home and I work 12 hour Saturdays! How cool is that? Friday lectures and Saturday clinicals. I don't know my preceptor schedule yet. I'm assigned to Telemetry, which I did at another hospital in my first semester. I totally enjoyed it and look forward to doing it again.

But I need some ideas on medications. Especially from Telemetry nurses. What are the most common drugs that you need to know? I know I also need to brush up on lab values. I also need to know what information helped you guys the most making it through your last semester.

I found this on nurses.com and it gives the 10 most common meds for each specialty. Maybe it'll help some of you prepare for your clinicals! Especially with regards to emergency care and perhaps psychiatric, naloxone should probably be added to the list, don't you think?

Critical Care (also good for Telemetry):
amiodarone hydrochloride
diltiazem hydrochloride
dopamine hydrochloride
epinephrine hydrochloride
furosemide
insulin
lorazepam
morphine sulfate
nitroglycerin
propofol

Emergency Care:
acetaminophen
aspirin
diltiazem hydrochloride
diphtheria and tetanus toxoids
famotidine
ibuprofen
ketorolac
levofloxacin
metoclopramide
nitroglycerin

Home Care:
acetaminophen
acetaminophen/oxycodone
acetaminophen/propoxyphene napsylate
digoxin
diltiazem hydrochloride
docusate sodium
furosemide
metformin hydrochloride
potassium chloride
warfarin

Long-Term Care Nursing:
carbidopa/levodopa
digoxin
docusate sodium
donepezil hydrochloride
enalapril maleate
furosemide
metoprolol tartrate
mirtazapine
pantoprazole sodium
potassium chloride

Med-Surg Nursing:
acetaminophen
diltiazem hydrochloride
enalapril maleate
furosemide
heparin sodium
insulin
levofloxacin
metoprolol tartrate
morphine sulfate
potassium chloride

Obstetric Nursing:
acetaminophen/codeine
acetaminophen/oxycodone
dinoprostone
ibuprofen
magnesium sulfate
nalbuphine hydrochloride
oxytocin
penicillin
promethazine hydrochloride
terbutaline sulfate

Pediatric Nursing:
albuterol
amoxicillin/clavulanate potassium
amoxicillin trihydrate
cetirizine hydrochloride
co-trimoxazole
fluticasone propionate
gentamicin sulfate
hydrocortisone (topical)
methylphenidate hydrochloride
montelukast sodium

PACU:
bupivacaine hydrochloride
fentanyl citrate
hydromorphone hydrochloride
lidocaine hydrochloride
lorazepam
meperidine hydrochloride
metoclopramide hydrochloride
midazolam hydrochloride
morphine sulfate
ondansetron hydrochloride

Psychiatric Nursing:
carbamazepine
clonazepam
divalproex sodium
escitalopram oxalate
lithium carbonate
olanzapine
paroxetine hydrochloride
risperidone
sertraline hydrochloride
venlafaxine hydrochloride