Emergency Department Thoughts

My clinicals in the ED for CCI have been AWESOME. So far I’ve completed 5, and will have the other five completed before November 1st. Whoop! That’ll open up even more time for me to work on projects and prepare myself for finishing up this last semester of nursing school.

My preceptor in the ED is a former TWU grad herself and she has been so amazing with me. She has a lot of patience but she tells me exactly as it is and I so I don’t have to wonder what she’s thinking or if I’m doing something that will ultimately hurt my patient. She allows me to be independent but she’s right there if I need her. Even when she’s super busy (as happens often in the ED) if I have a question or am nervous about doing something then she will patiently guide me through it.

I’m to the point now that I’m taking one patient completely on my own (well as much as I’m able to…I can’t get into the pyxis so she still has to get the meds for me) and then helping her out wherever I can with her patients. This means that I’m doing the initial assessment on the patient, getting them hooked up to monitors to take vitals, documenting in their medical record, and then carrying out the doctor’s orders on my patient while they are in the ED. It’s SO fun but it’s also quite exhausting. The ED moves at a weird pace…you’ll have moments where you are not busy at all and sometimes that can last for a couple of hours. For example, we have patients in each one of our beds, we’ve done all orders, and now we’re just waiting on what the doctor wants to do – are the patients going to be admitted or discharged from the ED? And then we’ll have hours that are SWAMPED. We’ll receive one patient just as we discharge another, and then receive another in his place…and you feel like you’ll never get caught up with the initial assessment & documentation as well as carrying out orders for each of your patients. I’ve never had 12 hours go by in such a manner…it’s a long 12 hours but at least I’m having fun while I’m there!

I’m really glad I’ve had the opportunity to be in the ED while in nursing school, for several reasons. First, it’s been great to know exactly how emergency departments work and the flow of how they run. I have the perspective of nursing from an emergency nurse’s eyes now. Second, I’m glad to have had this experience so that I can rule out ever wanting to work in the ED in my nursing career. I thought that it’d be a great place to work as a nurse but I’m discovering that it’s REALLY not for me. Not in a bad way – I think that all nurses have a “niche” and the ED just isn’t mine. Why don’t I like it? Well there’s a much more limited contact with the patients in ED. Even if they are with you for hours, they are generally NOT in a mood to be talked to. Most of them try to sleep their day away, in actuality. But most patients aren’t even with you that long. Either they get admitted up to the floor pretty quickly or they are released back to the street pretty quickly. There’s just no satisfaction of seeing a patient coming in really sick and then watching them get better over time, because once they are admitted you never get to know how they’re doing later. And then, and I’m sure I’m NOT correct in my assumptions, I feel like when we “treat” a patient in the ED they really aren’t getting better. We have  patients come in for a pain in their back, and we can’t find anything wrong with them, so we give them pain meds and street them and I’m left to wonder “well what happens when their pain comes back??” (And no I don’t think they’re just drug seekers.) And so on and so forth. A lot of patients that we see are “treated” and then sent right back out but I’m wondering if they were really helped at all. And so with that I get very little satisfaction.

That’s not to say that all the patients we see are that way. We have had some truly emergent cases come through our doors that have been admitted to ICU, all the while we were crossing our fingers that they wouldn’t crash and burn right there in the ED. Those types of patients are definitely rare though.

But I have had a great experience in the fact that I’ve had the opportunity to practice a TON of skills and see some really cool things as well. I’ve:

  • Inserted more IVs than I can count
  • Inserted two male foley catheters and one female foley catheter
  • Inserted an NG tube
  • Drawn blood cultures (my least favorite skill, I think; it’s extremely tedious)
  • Done several butterfly sticks into the veins to draw blood
  • Hung IV meds, IV fluids, given IVP meds, PO meds, IM tetanus vaccine
  • Drawn, labeled, and sent blood to the lab
  • Performed EKGs
  • Seen a STEMI on an EKG of a patient going through a heart attack at that moment
  • Watched a urologist irrigate a foley catheter for almost an hour to pull out clots so that the urine could drain
  • Watched a plastic surgeon sew up a DEEP hand laceration
  • Listed as a mentally altered patient screamed obscenities for about an hour before his meds kicked in and he fell asleep
  • Seen a BAD case of ascites
  • Had a patient that we nearly had to intubate due to a COPD exacerbation and resulting respiratory acidosis
  • Seen a hypochondriac throw themselves on the ground in an attempt to get someone to pay attention before they stormed out of the ED and were brought back in by police
  • Watched as the VA had a medical disaster drill and taught their staff how to respond in that type of situation (they had tents set up and were wearing HAZMAT suits and everything!)

Another awesome thing about being there for clinicals is the fact that there’s one doctor in the ED who LOVES to teach. Whenever he has the opportunity, he will teach you about what’s going on with his patient even if it’s not your patient. I’ve learned a lot just from listening to him!

All in all I’m SUPER SUPER thankful that I have had this opportunity. I can’t believe I’m already half-way done though! Clinicals go by SOOOO fast when you’re in charge of scheduling them when you want!

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Vent Status

Yesterday (Monday) was rough. For the first time in nursing school (I’m not including pre-reqs here) my class had two tests in one day. And those tests were absolutely, purely brutal. The kind of test that makes your head throb halfway through and makes you walk out of there thinking that you’re a failure. I can’t tell you how many times I heard those words yesterday…and after our grades went up for CCI one of the most calm people in our class literally flipped out, cussing up a storm and declaring that she doesn’t know why she’s in nursing school since her test grade shows she’s a failure. Of course all of this was in the heat of the moment and of course we all know that we’re not failures (at least I hope we do!) but it’s really hard to know that the test you had just taken was supposed to be REVIEW material for HESI/NCLEX preparation and then discover that the class average was a 79 and that the grades posted online were final grades after “extensive” adjustment to our scores. All this makes it sound like I did really bad but I didn’t…somehow I got a 90! But I feel really bad for my classmates and I’d have to agree with them that it was a crazy hard test and something needs to be done to correct the situation. Because I’m pretty sure I didn’t earn that 90 since I guessed on a lot of my answers and a TON of the questions didn’t even make sense!

And then I thought I had COMPLETELY bombed the communities test. I’m pretty sure they tested in a different language altogether because most of what was on that test was completely foreign to me. I definitely did not prepare well for that test AT ALL. I was told over and over that you have to read the textbooks in communities in order to succeed but since I never read the textbooks and I always do ok (I know I know, not great at all) then I figured that wouldn’t apply to me. WELL I WAS WRONG. I definitely should’ve read the textbooks. I’ve learned my lesson! Thankfully I pulled off a B (HOW?!) and now I know that I HAVE to read if I want to make good grades on the tests. MAN. Thankfully we have three projects in communities that will help even out my test grades by the end of the semester. I think I can maintain a B and MAYBE get an A if I work hard enough. But do I really want to work hard enough? Just being honest here…I’m SO DONE. I’m SOOOOOO ready to graduate and move on.

But looking on the brighter side…I’m almost DONE with CCI! All I have left are 5 clinicals (My last one will be on Halloween if all goes well!), the HESI, and an EBP Presentation. We don’t even have a final in that class. YES!

My Leadership and Management class is going well so far…the first test was a couple of weeks ago and I made a 97. Amazing. We only have two more tests (one during the semester and then one final) and that’s it for that class. I’m hoping for an easy A. We’ll see. 😉

And communities so far has been my nemesis. I am NOT cut out for community health, as much as I thought that I would love to get my Master’s in Public Health once I graduated. Unfortunately it just doesn’t hold my interest…not at this point in my life, anyway. And the fact that the tests are ridiculous on top of all the crazy projects we have to do makes it even worse. I’m sorry I’m whining so much but this is exactly how I feel right about now in the semester. I just want to be done.

Ok moving on to more exciting talk…graduation!! I ordered my cap, gown, and class ring last week! AHHH!!! And we finally found out when our official graduation date is: December 13, 2014. I LOVE IT! I’m going to graduate on 12/13/14! 😀 I also signed up for an NCLEX prep class with Kaplan after Christmas. I’ve heard that it’s super beneficial to take an NCLEX prep class and this one just happens to be taught by one of our S1 instructors and she has an AMAZING way of teaching. I’m so excited about it.

I think that’s all I needed to get off my chest for now. I promise a post is coming about my experiences so far in my CCI clinical ED placement! It’s been a great time so far!

My GN Interview Experiences

I completed 4 separate interviews and 1 call-back interview before I accepted my job offer, so I thought I could talk about my interview experiences to give you an idea of what might happen/what you may be asked. Now keep in mind that every single interview experience is going to be different for every single person so this may or may not be along the lines of what you experience yourself. But at least I hope it’s a general idea.

Only one of my interviews was a one-on-one interview with just myself and the manager. All others were me with at least 3 people interviewing me, and that first interview that I talked about – the ED interview – was me and two other candidates with the panel of interviewers (that was the one and only time that occurred but it was SO weird!). So don’t be surprised if you interview with other candidates, and don’t be surprised if most of your interviews are panel interviews with multiple people interviewing you. All of the interviews I went to were just the “preliminary” interviews to be followed by “final” interviews if you received a call-back for it. I received 2 call-backs total and only attended one before I accepted a job offer. I do know, however, that some hospitals (like the one I currently work at) only interview once and then base their decision off of that one and only interview. And I’ve heard of some hospitals that interview up to three times before choosing a candidate! So at the end of your interview I would suggest asking those that interview you what the process is on moving forward. When I asked that at each one I learned that there would be a second interview – if they liked me –  and then they’d decide after that.

At each interview I made sure I was presentable, polished, and professional appearing. Unfortunately I’m the type of person that flushes really bad when excited/angry/nervous/pretty much any other emotion, but there’s nothing I can do about that except to pretend like it’s not occurring and move right on along with my interview. I don’t let that one issue affect my confidence, even though I HATE that it’s happening at the time. But it’s a fact of life for me and I promise they are not looking at your physical appearance as much as they are paying attention to your answers…because that’s what counts. As long as you are very-well put together and make a good first impression, your spirit is what matters to them.

Ok so here’s what I know you’ve been waiting for: what was I asked during my interviews??

I’ll put it in bullet-point format to make it easy to read; essentially these were all the questions that I was asked during interviews. All my interviews except for my call-back final interview for the CSU were about 10-15 minutes long (one of the managers called it “speed interviewing,” saying they were really just trying to get an initial first impression to determine whether or not to call-back for a final interview).

  • Tell me about yourself.
  • What made you choose the nursing profession?
  • Tell me about the time you made a clinical mistake and how it impacted you.
  • Tell me about a conflict with your coworker and how you resolved it.
  • Why do you want to work on (whatever unit you applied to)?
  • Tell me about a time that you worked with different cultures and how that impacted you.
  • Tell me about a time that you were extremely stressed and how did you handle it?
  • Tell me about a time that you showed caring behavior for a patient.
  • Tell me about a time when you had communication difficulties with a patient and how you resolved them.
  • Tell me about a time that you did something to boost the morale in your workplace.
  • Have you worked night shift before? (If you’re applying for nightshift they want to know that YOU know what you’re getting into and that you can handle it.)
  • Tell me about a time that you had to find a solution to a difficult situation.
  • Tell me about a time when you saw a coworker doing something wrong and how did you handle it?
  • If you had a patient with a blood pressure of 200/100, a patient with a blood glucose of 47, and a patient who urgently needed to go to the bathroom, who would you see/help first? Give your rationale for your answer.
  • Tell me why we should hire YOU.

I feel like there were more but I will say that a lot of these were repeated at each interview. They’re very behavioral based questions to try and get to know you. I never got a question like “what are your strengths?” and “what are you weaknesses?” so just remember you could prepare all day long for some popular interview questions and yet they never get asked at all (I was ready to go if they asked me these questions, lol!).

Here are some of the questions I asked at the end of the interviews – always ask questions at the end!! Doing so shows that you’re interested in the position and that you’re making sure it’s a right fit for you as well.

  • What qualities/personality are you looking for in a new grad nurse on this unit (whatever unit you’re interviewing for)?
  • If I’m selected to move forward in this process, what comes next?
  • What are the expectations, responsibilities, and duties of the nurses on your unit?
  • What happens when census is low on your unit?
  • How often do nurses on this unit float? And relatedly, how soon in my job will I be expected to float?
  • How do night shift and day shift differ as far as workload and keeping busy?
  • What is the RN/patient ratio when there’s proper staffing? What happens when staffing is low? (Ask for differences between day shift/night shift if you applied to both positions.)
  • What is your average patient population on this unit? What is the acuity of the patients on this unit?
  • Staff: how do you like working on the unit? Do you have good teamwork/team morale? How long have you been working here?
  • Manager: what is your management style?
  • What is the average length of nurse tenure on your unit? (AKA how many years do nurses stay on the unit? If there’s fast turnaround then that’s not a good sign.)
  • What are the reasons given when nurses leave this unit?
  • What type of professional development opportunities are available?
  • How does the orientation process work and how long does it last?

So there you have it! Remember that your interview experiences will differ from mine but the biggest point I hope that you take away from this is that you have to give a good first impression and you need to be prepared! Come prepared with your own questions to ask your interviewers based on the unit you are interviewing for and what you want to know about it. Don’t ever NOT ask questions at the end because it looks like you are uninterested. And if you have time, don’t just ask 1 or 2 questions because then you look like you’re only asking them to fulfill the requirement of asking questions at the end. Have a good list ready and whatever isn’t answered in the interview process – ask!

And remember to trust your gut instinct. If you get a job offer but you had some reservations about the staff and the manager in the interview process, you might want to get more information before accepting that job. Especially if you have to sign a contract for that job – you don’t want to be stuck at a place that you don’t mesh well with for years on end!! The interview process is just as much about them trying to feel you out as it is about you trying to feel them out.

So, next week when I’m done studying for the two tests that I have on Monday (AAAHHH!!!) I will give y’all an update on how my semester is going thus far…Almost done with week 6 already!! WHERE HAS THE TIME GONE???

Graduate Nurse Portfolio

I’m going to apologize now for the quality of these pictures but I only have an iPhone and I was in a hurry when I took them (about to go to my first interview) so you get what you get. 🙂 Anyway, I wanted to write a post on how I put together my nursing student portfolio to take to my interviews; also if you click on the picture of my resume and enlarge it, you can see how I set my resume up. I hope it helps some of you out the way that this knowledge passed down to me did!

I bought 15 leatherette 1″ binders with the intention of taking approximately 3-5 to each interview to give to those interviewing me. In reality I took 5 to each interview but only gave one away each time because they didn’t want to keep my beautiful handiwork! LOL!

So, for your portfolios you’ll need 3 things: a nice presentation binder, resume paper, and sheet protectors. These are what I used:

  • INFUSE Premium Leatherette 1″ Presentation Binder, Black
  • Avery Recycled Economy Weight Sheet Protectors
  • Southworth Exceptional Resume Paper, 100% cotton, 24lb, Ivory

Depending on which hospitals you apply at and what they require with your application/interviews, you’ll want to have these documents ready to go (the order they are listed in is the order that I put them in my portfolio):

  • Exemplar (if your hospital requires you to write one…it’s usually a 1-page essay)
  • Cover Letter
  • Resume
  • References
  • Certifications
  • Awards
  • Letters of Recommendation. I started asking for these through the summer; I’d recommend asking your professors to start writing them about two months before you’ll need them! If possible, ask them to give them to you electronically that way you can print several copies of them for your portfolios. You’ll probably want around 3-5 LOR; all from current/previous managers (if applicable) and your clinical instructors. Hospitals will specify if they want more and if they want them to come from specific individuals.
  • Unofficial transcript
  • Immunization record (I just printed mine off from my school records)
  • Extras: if you want, you could probably put in any publications that you’ve had, a list of organizations that you belong to, etc. But remember you don’t want your portfolio too long or convoluted!

Please also keep in mind that you want everything printed on the same resume paper, and in the same font & format. Please note how my layout is practically the same on every page. You do NOT want to put “titles” on your resume, cover letter, and your letters of recommendation (what I mean by this is putting the word “resume”  on your resume; they will know its your resume when they start reading over it!).

Pg 1 of my graduate nurse portfolio: order of contents

Pg 1 of my graduate nurse portfolio: order of contents

Up close and personal: order of contents

Up close and personal: order of contents

Pg 2 & 3: exemplar & cover letter

Pg 2 & 3: exemplar & cover letter

Pg 4 & 5: resume

Pg 4 & 5: resume

pg 6 & 7: references & certifications

Pg 6 & 7: references & certifications

Pg 8 & 9: awards

Pg 8 & 9: awards

Pg 9 & 10: awards

Pg 9 & 10: awards continued

Pg 11 & 12: LOR

Pg 11 & 12: LOR

Pg 12 & 13: LOR

Pg 12 & 13: LOR

Pg 14 & 15: unofficial transcript

Pg 14 & 15: unofficial transcript

Pg 16 & 17: unofficial transcript continued

Pg 16 & 17: unofficial transcript continued

Pg 18: student health immunization records

Pg 18: student health immunization records

 

What I wore:

  • Hair brushed, combed back into a neat ponytail
  • Stud diamond earrings (only 1 pair!)
  • 1″ non-flashy black heels
  • Grey slacks
  • Black blazer
  • Bright pink/black/grey/purple sleeveless top underneath the blazer for a pop of color
  • Black leather nondescript purse
  • VERY minimal makeup; light mascara & eyeshadow with face powder & concealer
I forgot to take a picture when I was actually WEARING the outfit; but this gives you at least an idea of what it looked like! ;)

I forgot to take a picture when I was actually WEARING the outfit; but this gives you at least an idea of what it looked like! 😉

 

And there you have it! This is my graduate nurse portfolio and I must say I am very proud of it! Hopefully next week I’ll type up a post about the types of questions I was asked as well as which ones I asked myself. 🙂