As the new fall semester starts for thousands of nursing students around the world, many are concerned or anxious about their upcoming clinical rotations. The question is often asked by our student listeners, “How can I make the most of this year’s clinical rotations when I don’t like the specialties covered this semester?”

First of all, no one is expected to enjoy every aspect of the varied career options that comprise the field of nursing. The issue is not that you will enjoy every aspect but that you learn from the experience. Part of what you learn may be that you don’t want to work in pediatrics or psych.

Here are 8 tips to make sure you get the most out of the rotation, ANY ROTATION!

Be willing to work: Come prepared to spend your time working. Despite the time you think you are spending, no nursing student gets enough time in a clinical setting before graduation. That means you must make the most of the time you have. Be prepared when you hit the floor. If offered the opportunity, look over your patient charts beforehand and plan your day.

Keep an open mind: I’ve heard more than one nursing student make a statement like, “I thought I was going to hate this rotation, but now I think I want to be a long term care nurse and work in a nursing home.” I’m serious. A closed mind will be unable to learn anything. Work to remove your preconceived notions and focus on what is going to be positive about each rotation. Take 5 minutes and make a list of the pros if you have to.

Remember the golden rule: You are there to learn, but that doesn’t mean that you can’t be a helping hand to the unit. A little good will goes a long way. If you see someone who needs help with something, lend a hand! This shows a couple of things. First, you have demonstrated that you aren’t afraid of hard work. If you decide you like the working environment, you have put yourself in a position to be hired. Second, what goes around comes around. When you help someone, they will remember to help you. When a nurse has some interesting skill, procedure, or wound come up, they will be open to inviting you to come take a look. Help someone change some sheets and increase your opportunities to learn.

Divide and conquer: Team work with you fellow students is vital to success in nursing school. Working together in study groups, watching out for last minute scheduling changes, and sharing clinical experiences are all tried and true methods for nursing school success. In the clinical setting, you will need your classmates to proofread your nursing notes, patient care reports, and patient goals and interventions. They will also offer you additional learning opportunities by “sharing” their patients and

List your clinical needs: Knowing what you need to learn will help focus your efforts. Make a list of the clinical learning opportunities that you need, either for competencies or for you own satisfaction. If you need more practice placing a foley catheter, add it to your list. If you want to focus on wound care or replacing dressings, add it to the list. Review the list every week and make changes, marking off those items you’ve completed and adding others as they occur to you.

Use the Instructor: Share you successes and failures with your instructor. They are there to help you succeed. Tell them the areas in which you need improvement. They’ll watch the clinical opportunities for the class and be able to steer you towards the opportunities that will help you reach your goals. Also, ask the instructor to tell you where they think you need to improve. Sometimes, even though you have made a list, you miss something, a blind spot in your clinical education. Your instructor can help you identify these blind spots and help you move forward.

Have resources handy: Students need two things every clinical day. First they need a top quality drug guide. I recommend subscribing to an electronic drug guide like the one provided by Lexi-Comp for nurses. They can be updated regularly (much more often than books) and a good one provides all of the information a nurse needs, all carried in a PDA or on a smart phone. The second item needed is a clinical procedure review guide. You will probably already have one that is part of your textbook package. This gives you a resource to look over when you get a patient needing an intervention you haven’t performed before or haven’t performed often. With these two items, you will be ready for anything.

Know your staff: This goes hand in hand with the “golden rule” tip above. Get to know your staff. Not just the nurses but the techs, CNAs, pharmacists, and unit clerks. Nothing happens in a vacuum. A well run nursing unit is a team effort. Learn people’s names, say hi, and be respectful and friendly. This will pay off when you need something for your patient and can’t find the supplies, need an item from the computer, or just need an extra pair of hands to do something.

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Bonus Tip:  Visit the Nursing Show blog often and subscribe to the Nursing Show podcast for tips just for nurses delivered right to your computer!

The Nursing Show, the number one nursing and nursing student podcast, is proud to announce a new sponsorship agreement with Lexi-Comp and their innovative suite of electronic nursing tools. Lexi-Comp is the perfect partnership for us here at the Nursing Show.

As innovators in the marketplace, Lexi-Comp’s Nursing Suite offers a unique package of frequently updated drug and patient care information.  Available for PDAs, smart phones, and via wireless interfaces, the Lexi-Comp suite for nurses and nursing students offers a wide array valuable services to subscribers.

We have been using these nursing tools for almost 6 months and have been very pleased with the quality, thoroughness, and innovative nature of the products. We also found the Lexi-Comp PDA connection and sync tools to be much easier and smoother to use with our palm devices than other nursing suites we have used in the past. This exciting partnership will provide an opportunity for the Nursing Show listeners to find out more about Lexi-Comp’s line of products and where they can go to listen to special listener-only expert advice from Lexi-Comp’s professionals.

Plus, visitors who visit via the Lexi.com/NursingShow link will be able to use a coupon for 10% of their purchase!

Nursing students are returning to school right now and they are scratching their heads and wondering what they can do to improve their study skills, make the most of clinical situations, and prepare for the NCLEX exam at the other end of the tunnel. Many students have found success using resources here at the Nursing Show but there are other excellent resources out there.

A new book written by a Rutgers, State University of New Jersey nursing professor give practical tips to nursing students. Getting the Most from Nursing School: A Guide to Becoming a Nurse by Robert Atkins is now available at Amazon.com.  To quote the author, “The book is aimed at helping students to acquire the knowledge, skills, and attitudes they will need to become clinically competent and caring nurses.”

If you are interested in getting this book, use the link above to go directly to the Amazon.com page and purchase it there.

Over at this week’s MedicCast podcast for EMS providers, we take a look as some of the special considerations in the treatment of geriatric patients. First, a look at geriatric trauma considerations and why special care is needed to ensure that the elderly trauma patient is taken to the most appropriate facility just like younger patients. A recent study by the State of Maryland found that geriatric trauma patients were not being taken to trauma centers as much as younger patients with similar injuries.

The show also includes a look at polypharmacy and how it affects the geriatric population. Polypharmacy is the presence of at least 5 to 7 prescribed medications for a patient.  Each additional med increases the risk for adverse drug interactions, compounded side effects and endangers the patient.  Encourage patients to review their medications at least annually with their physicians.

Any person may experience problems with polypharmacy, but an elderly person will have more issues due to decreased metabolism, reduced renal and hepatic function, and slowed GI clearance and absorption.

Visit the MedicCast Episode show notes pages here.

One question I often receive is about what podcasts I take the time to listen to. It seemed like a good time to pass on to you some of the better medical podcasts out there. If you have been listening to the show for a while or reading the blog here, you might have a good idea of a few of them based on comments and links here at the Nursing Show.

Now for the shows I Recommend (in no particular order):

Johns Hopkins PodMed Medical News Podcast is a standout review of recent medical and health news and research. They do a good job of boiling down the news to the key issues without the news hype and with an understanding of good research.  Hosts Elizabeth Tracey and Dr. Rick Lange give us a look at science based medicine at its best — short, sweet and to the point!

Mitigation Journal Podcast is produced by Rick Russotti and is an outstanding look at some of the key issues surrounding disaster preparedness and planning from the streets all the way up to the major hospital response and beyond. If you wonder how you would respond to a disaster in your region and how your medical response might be affected, the Mitigation Journal podcast is for you.  You should check out Rick’s podcast now!

The Brain Science Podcast with Dr. Ginger Campbell. Ginger Campbell is an ER doc with an interest in what makes our brains tick. She takes that passion and turns it into a very informative program on how our minds work featuring interviews with leading neuro-science experts from around the world. If you’ve ever wondered why you wonder — this podcast is for you!

PediaCast with Dr. Mike is a show on a variety of pediatric issues presented for parents and providers. Mike is a pediatrician with a large practice who shares his views on recent pediatric medicine news and issues, along with a chuckle and a healthy dose of common sense.

Surgery ICU Rounds with Dr. Jeff Guy. Jeff Guy is a former paramedic who is now a surgeon, medical school professor, and a burn doctor at a major U.S. hospital. His program takes a single ICU or critical care topic and reviews the anatomy and physiology, the etiology, and morbitiy and mortality associated with the problem. He also reviews the research surrounding the topic and the changes to current treatment guidelines. Check this one out!

EMS Live podcast is the granddaddy of EMS and medical podcasting. John Bignell looks at a variety of emergency medical topics in this informative and innovative show. Currently on hiatus, you can still find the back episodes at iTunes and I’m assured by John that the EMS Live microphones will be warming up with fresh episodes again soon!

I’ll wrap up by tooting my own horn a bit:

The MedicCast EMS podcast is a show that offers information on general medical treatment for emergency services providers at all levels. The show covers common medical emergencies seen in the field as well as meds and procedure reviews. My first podcast and the longest running regularly produced EMS podcast out there!

The Nursing Show podcast for nurses, nursing students, and nurse educators lives here on the Nursing Show blog. If you stumbled onto this page but haven’t listened to the show, click the play button and decide for yourself.

The MedicCast News podcast is a weekly review of some of the news items that pop up mid-week between my other podcasts. Each show is only 6 minutes long and is a quick look at some interesting medical news for you without taking up too much of your time. This is hosted over at the Podcaster News Network.

In this past week’s podcast I talked about some online resources to check out for child and teen health education. These resources are just the tip of the iceberg. What do you do with the vast amount of information out there?

In this series here on the Nursing Show podcast site, I will point to some recent nursing ideas that will give you some concrete ideas on how to implement some educational interventions to help children and teens to understand their role in making healthy choices in their lives. Today, let’s talk about teens.

Teens are in that stage of their lives where risk taking and independence often go hand in hand. Many may not even realize that their behaviors are a risky as they are and would rein themselves in when given the opportunity and the information to make an informed decision. If they still insist on making risky choices, the health care team needs to provide them with the tools and resources to protect themselves.

For instance, 16 year old Joe wants to ride his ATV after school every day. This is a risky behavior that could result in serious injury. What can Joe do to reduce his risk while riding his ATV?

• Wear a helmet
• Choose a safe riding area
• Attend an ATV safety course
• Make a list of safety rules for himself
• Understand basic maintenance of his ATV
• Refuse to ride with passengers

These are all possibilities. A recent news item from Illinois looks at a flight paramedic there who had seen enough preventable ATV accidents and decided to do something about it. He contacted his local children’s hospital and asked if they would start an initiative to teach ATV safety in the community to teens. The hospital system said yes and a new teen health and safety program was born.

The paramedic and his flight nurse companion will be paid by their employer to travel to local fairs and events to teach about ATV safety. Their goal is to reach 1,000 teens with the message by Fall 2008. The key parts of their message are — wear a helmet and don’t take on passengers.

This is something that can be done in any community. Identify a risky behavior, contact a partner or facility with an interest in that field or population and begin to assemble a program to reach out and provide information to the proposed audience. Contact local celebrities or bands to provide promotional resources or write a song about the issue.

This doesn’t have to be a purely local initiative. *The State of Washington put together a program to educate teens about the dangers inherent in the workplace after they were identified to be more at risk for work-related injuries. Washington collaborated with teachers and accessed publicly available information on injury rates from the federal government. The program was put in place, evaluated, adjusted and re-adjusted based on effectiveness according to teens and teachers. It used videos, games, role-playing, and written materials to achieve a positive result in reducing teen worker injuries.

The lesson here is to not be afraid to think big. The best nursing interventions are often the simplest so don’t try to reinvent the wheel. If you have a program that is successful locally, find out how you can implement the initiative on a larger level.

Act locally, but think globally! It’s true for nursing as well as the environment.
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*Journal Reference:

Linker, D., Miller, M. E., Freeman, K. S., & Burbacher, T. (2005). Health and safety awareness for working teens: developing a successful, statewide program for educating teen workers. Family & Community Health, 28(3), 225-238.

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Good Parenting Resource on Healthy Teens at Amazon.com

My wife just got herself a Wii Fit. She loves it and this is a truly amazing thing.

Those of you who don’t know her won’t appreciate the magnitude of this revelation. You see, my wife has had a long standing aversion to exercise. She hates to sweat. So I chalked up her Wii Fit purchase as another item that I would soon find relegated to the basement next to the exercise bike and the total gym.

But — the Wii Fit has something that every other home exercise device lacks — it’s a game, too!

The device comes with a balance board which is basically a step aerobics step with some built in pressure sensors. When you stand on it, the Wii can detect how well you maintain your center of balance, your approximate weight, and when coupled with a few prompts from the TV screen, will output your BMI score (Body Mass Index).

You can choose from a variety of exercise options like yoga, aerobics, and strength training and the device tracks your time in each exercise and as you exercise more, gives your the option of unlocking new exercises and games to try out.

Not only that, you can track your progress toward a goal, watch your BMI increase or decrease on the calendar and track your progress against other members of your family. You can also choose to lock your profile, too, so that no one else can see your numbers.

What does this mean for the health care profession? Think about the difficulty in motivating patients for physical therapy, ambulation, and being more active in general. Put a Wii fit in the room and have the patient just do basic balance exercises. Perhaps just doing some yoga stretches from side to side while deep breathing. Open up those alveoli folks and decrease incidence of pulmonary complications and pneumonia during recovery!

I’m excited because this is one of those things that can be easily adapted to a variety of settings and cultures. It’s just programming. The music and other items can be easily adjusted to meet any group’s needs. I’m looking forward to seeing how innovators in the hospital setting bring this unique device into their setting and do some research to see if it is indeed as effective as I think it will be.

Sure, Wii Fit can be a fun item for your home, but it can also become a great tool for nursing excellence, too!

Get the Wii Fit for yourself here!

In part two of the series on advice for new nursing graduates, I continue with the interview responses of recent nursing school graduates from the last few years. (read part one here)

The question asked of them was:

“What were the biggest surprises or challenges when you started working as a new nurse?”

1. Dealing with Senior Nurses — It’s often hard to come to a new work place as a recent graduate in any field. Nursing students are not immune to this. Students arrive with new ideas and practices and this can cause a prickly reaction from the nurses on the floor. Some have become settled in their ways but in most cases old ideas don’t equal out of date ideas, any more than new ideas make them “better.” Show some respect for those who have gone before and try to learn from them instead of telling them about your new and improved methods. If you have learned a different method or technique, communicate with your preceptor, mentor, or supervisor and follow their lead.
2. Afraid of Saying “I Don’t Know” — It is hard to tell someone you don’t know how to do something when you think it is something you should know how to do. New nurses come in to the work environment with a variety of experiences behind them — even those from the same schools. One student gets a chance to use a variety of catheter techniques while another had no clinical opportunities, one student is the NG tube queen while another hasn’t done it since first year, and so on. Be confident in the skills you know and don’t be afraid to ask for help.
3. Using Critical Thinking — The instructors in nursing school talked about critical thinking all of the time but it isn’t until a new nurse has a patient on her own that she understands how much she needs to use it. Those of you who mastered (or at least became comfortable with) critical thinking in nursing practice will find that you will use it frequently in caring for your patients. If you don’t think you have good critical thinking skills — check out the next point
4. You Know More Than You Think You Do! — You survived nursing school, finals and the NCLEX test. Now you are dealing with patients on your own with no instructor staring over your shoulder. It is frightening, right? Sure it is, but have some faith in your self. You DID survive nursing school, finals, clinicals, hard and easy instructors, critical and well patients, and you did pass the NCLEX test. You know more than you give yourself credit for. Trust your well honed instincts and remember the basics: assessment, diagnosis, planning, implementation, and evaluation.

One of the hardest things in any nursing career is to develop good nursing job interview skills. I recently sat down with a group of recent nursing school graduates from the last few years to ask them about their experiences transitioning from nursing school to nursing job.

I’ll be featuring segments of this interview in articles posted here over the next few weeks under the category “career guide.” This segment looks at questions these recent grads had wished they had asked in their first job interviews. A wise person once said, “Those who refuse to learn from the past are doomed to repeat it.” Learn from the experience of those who have gone before and remember these 10 tips for new nursing grads when you interview.

1. Didn’t remember to ask any questions — The key word here is to remember! I can be the most scatterbrained person in the world sometimes. Especially when I’m in a new place and meeting new people. That is why I have become the list guy. Write your questions down and bring the list with you. That will show your prospective employer that you are organized and have a mechanism in place to get things done and not forget important tasks.
2. Ask about the salary — Some people think that talking about money and salary is in bad taste and they are right, when you’re at a dinner party. The place where it is in good form and even expected is in a job interview. A good interviewer should volunteer that information but may not if they think you already asked someone else. Ask the question! What do new nurses make? How are pay increases determined? What bonuses are offered for increased education or certifications? Is there a shift differential? How is overtime handled? These are things that you want to know before you go to work on your first day.
3. Nurse to patient ratio — What is the ratio of patients to nurses on the unit for which you are applying? This is important because the average nurse to patient ratio for the facility may be different than the ratio for your floor or unit. Also, ask about how that changes at night and what mechanism is in place when they are short handed.
4. Ask about health benefits — What is the health insurance plan like and how are the other health related benefits like dental, mental health, and life insurance? You may make $2 more an hour at one facility but your primary care co-pays are doubled. If you have a family or small kids, that $2 an hour can disappear fast!
5. Ask about perks for employees — Some facilities have become very creative in the ways they offer “value added benefits.” These are extras you get as an employee that don’t cost the facility that much per employee, but may be a great benefit to you. This goes beyond something like tuition reimbursement (although that’s a good one, too). It includes things like a workout room in the facility, or a gym membership, and even on-premises services like oil changes, dry cleaning pick-up and return, and personal shopper services.  These are just some of the extra perks that one hospital might offer to attract and retain employees.  When time is money, time saved is money saved and these types of perks might be valuable to you.
6. Ask questions about the nurse retention rate at 1 year and 3 years — This may seem like a loaded question but you can put it in terms of how they might be addressing employee concerns. Believe me, they know these figures. That is why they are out there hiring. Ask about employee input for change, opportunities for career advancement, learning opportunities, and open door policies with management.  What is this facility doing that addresses employee concerns?
7. What is the UAP ratio? Find out about how many UAP (unlicensed assistive personnel) are on the floor during a shift. This is as important as the nurse to patient ratio mentioned earlier. It doesn’t do any good if there is a 1 to 4 or 5 nurse to patient ratio when there are no techs or CNAs around to help with AM care and linen changes. Find out this number, too!
8. If there is a sign-on bonus — ASK WHY! The nurse recruiting rage for a while was for facilities to offer sign on bonuses to nurses as an incentive to come work there. Now this tactic has become a last ditch effort of some facilities to fill vacancies. But why do they have such a hard time filling jobs, even in a tight market? If they are willing to pay you just to walk in the door, you need to ask, “What’s the catch?” Now, I’m not saying that you won’t end up working there. If the money’s right and you go in with your eyes open, then you’ve made an informed decision. Just know the details going in.
9. What is the relationship between the doctors and nurses in the facility? Is there an institutional philosophy of mutual respect? This is a hot button for many nurses. Some nurses just accept that doctors don’t treat nurses very well and look down on the nurses with whom they work. I’m not one of them. I never let someone treat me disrespectfully and I refuse to work for a company that would allow that kind of abuse in their workplace. That said, I have had very few negative experiences like this and I believe that the tone of mutual respect and teamwork is the norm in most facilities, but it is important to know your rights and how a facility handles these things.
10. Ask to shadow a nurse for a shift — This falls under the category of LAST BUT NOT LEAST in this list. Once you’ve decided that you would like to work in a particular facility, do one more sanity check. Ask to follow a nurse on your unit around and shadow them for a day. Take the opportunity to see how the working relationships on the unit fit in with your style and find out how the policies outlined by your interviewer’s answers to your other questions work in real life. Other than talking about salaries, you can ask your shadow nurse just about any of the prior questions, too. This will give you the final piece you might need to decide whether this is the slot for you.

So that’s it! The top 10 questions new nurses forgot to ask but wish that they did as they started out their nursing careers. Just remember, it’s an open nursing job market out there. Your dream job may turn out to be something totally unexpected. Ask these questions to help you get there sooner and congratulations on graduating!

Welcome to Episode 26

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News–

Pregnant Women Admit Drinking

Realistic Neonatal Stimulator

Delay in Reaching Hospital Can Be Deadly

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Tip of the Week — Tips for New Nurses: Questions in the Interview

Read the companion article here

Monster Career Advice

Reality RN

Nursing Spectrum

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Other Podcasts from Jamie Davis:

• The MedicCast (for EMTs, Paramedics, EMS field work)
• MedicCast News (Weekly short medical news program)
• MedicCast Live (Monthly live call-in show with a single EMS topic)
  
• Headliner News Roundup (Weekly single new item with facts and commentary)
  

Contact Me!

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Music from the Podsafe Music Network

Artist – P. W. Fenton and the Second Ward
Song – Silent Treatment
Website — Click here for band info!

Click here to get other Songs from the MedicCast at the iTunes Store.

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Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.