Every nurse will experience that first day on the job and all the emotions that go with it. “This has happened to me a dozen times since I graduated from my nursing school. The first day on a job is the most memorable experience in my life,” says Mary Wiske, a retired community health nurse who has experienced several first days at jobs throughout her 25-year nursing career.
No matter whether you’re a new graduate or an experienced nurse, the first day at a new job or new location can be exciting, stressful, or overwhelming. There is so much to learn in addition to the duties or responsibility related to the job. If you are a new graduate, congratulations on your first job! This is your chance to begin your career in health care.
Here are four steps that will help you prepare for your first day.
1. Learn all you can about your new employer.
Read through any contracts, induction packs, or emails you have received. These will have important information about your employment, responsibilities, and what you may need to bring with you when you start. When you are familiar with your job description, you will be able to work more safely and efficiently.
2. Plan the route you will take to work as well as some alternate routes.
Find a map, get directions. Incorporate contingency time for bad traffic, public transport delays, or getting lost. If you are driving, remember to find out where you can park.
3. Get yourself ready – pens, a notebook, and a high-quality stethoscope.
Look for comfortable and durable scrubs that make you look professional. You should also plan to wear comfortable shoes that offer strong arch support and a roomy toe box, in addition to heels that do not pinch or slip and a no-slip sole.
4. Take care of yourself.
Be calm and relax. Remember to go to bed early the night before and have breakfast before you go to work. Give yourself plenty of time to get to work so you do not show up late.
Finally, you are here–the first day on the job. It is normal to feel nervous or excited. It is wise to remain calm and carry yourself with confidence; that is the key to this. Keep a positive attitude and an open mind. Remember to take an active role in your orientation and do not be afraid to ask questions. Make an effort to learn new things and learn how to do something a new way. All you can do is try your best and do your job the best way you know how.
October 10 is World Mental Health Day, and nurses are in an excellent position to notice when patients might be suffering from a mental health condition.
Nurses have the knowledge and authority to offer patients the facts about mental health, and they can normalize conditions like depression or anxiety. They can convey the important fact that, like any other medical condition that needs to be treated properly, mental health conditions are a physical and chemical imbalance and not a character flaw.
Although the general attitude toward mental health conditions is gaining more mainstream discussion and acceptance, the attitudes vary greatly. Factors like location or family culture can either normalize depression or obsessive-compulsive disorder make it a forbidden topic. Knowing a little about how your patient sees mental health conditions can help you adapt your approach.
On World Mental Health Day, nurses worldwide can spread the word by offering access to online screening tools through places like Mental Health America or the Anxiety and Depression Association of America. They can offer referrals to area mental health providers if appropriate. This year’s theme focuses on mental health in the workplace, so it’s also a good time to open up discussions in your workplace about paying attention to our own mental health and how it impacts job performance.
But nurses can also just talk about mental health issues in a nonjudgmental manner to put patients at ease. If someone is struggling with something like racing or unusual thoughts, severe anxiety in public places or about specific topics, or experiencing significant impacts to daily life because of sadness, they want to know they are not alone. Nurses can fill that role with care, compassion, and expertise. They are also there to offer hope that with treatment, the person can feel better and can begin to resume a life they are happier with.
Of course, some patients are reluctant to talk about their mental health directly, but they might bring it up in ways that are less obvious. Nurses can ask direct questions or they can listen for clues in conversations. What are your patients saying? Are they gaining or losing weight? Having trouble sleeping? Becoming more argumentative or less engaged with their family and community? Are they missing work or getting in trouble at work for being late or making errors? Are they drinking more or using recreational drugs?
It’s good to remind patients that a mental health condition doesn’t always require medication, although that is often a good option, and it isn’t always a lifelong condition. Other treatments like therapy, stress reduction, and healthy living basics like exercise, quality sleep, and a good diet also help lesson some symptoms. Sometimes problems are a result of a different condition or a side effect of a medication—factors many people don’t know. Getting to the root of the problems will help a patient find the right treatment plan.
The important message is that help is available, treatment works, and that first step can bring them enormous relief. Your positive attitude and compassion can make a big impression and can influence how people see their condition and think about treatment.
On World Mental Health Day, remain alert to what your patients are telling you. You may be able to help change their lives in a way you didn’t expect.
Emergency Nurses Week kicks off today and offers a reflection of the lifesaving efforts and skill of emergency nurses who are called on to deal with catastrophic conditions, both natural and human-created, with little or no notice.
Karen Wiley MSN, RN, CEN, and president of the Emergency Nurses Association, says recent events highlight the unpredictability of the job and the exceptional need for emergency nurses.
“I am most proud of the way our nurses have come together in the past several weeks,” she says. “With the devastation from multiple hurricanes and the unconscionable event in Las Vegas, we have seen countless acts of sacrifice, selflessness, and dedication in emergency care from our nurses. I am proud of my colleagues every day, but the effort I have seen through these tragedies is truly remarkable.”
Wiley says emergency nursing is a complex role that involves treating the physical reasons for the visit, but also careful and expert communication with the team and the patient, families, and loved ones. “Most people do not realize the diversity of work emergency nurses must perform besides treating physical injuries,” she says. “Patients enter emergency departments struggling with addiction, mental health issues, as victims of sex trafficking, and, all too often, are violent themselves.”
If nurses are considering moving into emergency nursing or are wondering if the path would be right for them, Wiley says it helps to consider the range of what nurses encounter on a given day. “Thinking quickly on your feet is an essential skill for emergency nurses,” she says. “Situations change in a moment in the emergency department and nurses must react effectively.”
In the midst of an environment where many things are happening simultaneously, emergency nurses are still in charge of the patient’s comprehensive needs. “Emergency nurses must keep patient advocacy foremost at all times,” says Wiley. “The care, safety, support, and education of patients is our primary focus and dominant concern during a shift in an emergency department.”
Because they will take care of patients with many different conditions and situations, emergency nurses have to stay current on the latest medical information, so they have to be willing and able to constantly reeducate themselves about new developments, treatments, and methodologies. Emergency nurses continuously hone their craft, says Wiley, and that means being able to multitask effectively, efficiently, and accurately in a high-stress situation.
Emergency nursing is physically taxing, but it can also be an emotional challenge as well. Because of the very nature of an emergency room, patients don’t always survive despite the heroic efforts to save them. “Emergency nurses need to be prepared for the death of patients while not letting emotions affect their care,” says Wiley. Many hospitals have supports for their emergency room teams, especially after a trauma event, but the day-to-day exposure to death is something emergency nurses must cope with for their own job performance and their own mental health.
In addition to the challenges of treating so many physical and mental health issues, emergency nurses have to be able to quickly decipher and assess patients’ needs and conditions. “Choosing which patients need the most immediate care is challenging because the number of factors that need to be taken into consideration,” says Wiley.
For some nurses, the emergency room is where they perform best. And the ability to make such deep connections during that time is powerful. “Caring for patients who are in the most vulnerable state of their lives is an absolute privilege and an honor,” says Wiley. “The ability to comfort the patients and their loved ones when they need it most is humbling.”
One of the many specialties in the nursing filed is nephrology—working with kidney patients.
Shamekia Gullatte, RN, BSN, CPN, the Lead Post Kidney/Pancreas Transplant Coordinator at the University of Alabama at Birmingham, has served as a nurse with many different kidney patient populations, including working as a dialysis nurse, a pediatric nephrology nurse, and currently as a transplant coordinator.
What follows is an edited version of our communication.
As a nephrology nurse, what does your job entail? What do you do on a daily basis?
My current job entails educating and managing care of kidney transplant recipients. After working nine years in an outpatient pediatric nephrology setting, I decided two years ago that I want to care for patients who overcame chronic kidney disease and received a transplant. As a kidney transplant coordinator, I meet with newly transplanted patients while they are still in the hospital and provide education about their care. After the patient leaves the hospital, I continue to be a resource for the patient in the outpatient setting.
Why did you choose to work in nephrology? How long have your worked in the field? What prepared you to work in this kind of environment?
As a dialysis nurse, my first professional nephrology position, I became passionate about the disease processes in this patient population. Over the last 13 years, I have worked in various areas of nephrology. I was prepared to work in this environment because I worked 12 combined years as a dialysis nurse and pediatric nephrology nurse caring for children with chronic and acute kidney disease.
My parents laid the foundation for me to be a compassionate person and appreciate every aspect of life, which really are essential attributes of a nephrology nurse. Then I was awarded an excellent education at the prestigious Tuskegee University, where I obtained by Bachelors of Science in Nursing.
What are the biggest challenges of your job?
One of the biggest challenges of my job involves the lack of resources for patients. Some of our patients have limited financial resources and may have difficulties paying medications and sometimes have transportation issues. Although this is a challenge, UAB Transplant has a multidisciplinary team that includes amazing social workers who assist patients with these obstacles.
What are the greatest rewards?
The greatest reward in being a nephrology nurse in transplant is walking into a patient’s room to educate them on their new organ and saying, “Congratulations!” I certainly understand that some patients may have had a tough journey. For example, I can remember when one of my patients told me her story of when she was diagnosed with a rare disease, and she was getting prepared for transplant. This patient had been struggling from dialysis complications. Just to listen to her story leading up to kidney transplant was definitely a tear jerker, but now I was sharing a moment with her that she thought would never come.
I know that I was meant to be a nephrology nurse at UAB Hospital in post-transplant because I get this flutter of joy in my heart and soul every time I receive a new patient.
What would you say to someone considering this type of nursing work? What kind of training or background should s/he get?
To become a nephrology nurse, one would have to earn a degree in nursing and gain clinical experience in nephrology. To become a transplant coordinator at UAB, you have to get all of the above, but also have that little flutter of joy in your heart and soul when a patient receives a kidney transplant. UAB has performed more kidney transplants than any other transplant program in the nation since 1987, and we all take great pride in the care we provide our patients.
Being a nephrology nurse really takes more than just credentials. You have to be a person who is truly compassionate about your patient population, and someone who has a real love and desire for them. I love my patients, and appreciate the opportunity I have to care for them every day.
As the country continues to grapple with an ever-increasing opioid addiction crisis, the medical profession and patients alike struggle to treat real pain issues while managing their pain safely.
Sherry McAllister D.C., M.S (Ed)., CCSP, executive vice president of the Foundation for Chiropractic Progress recently answered some questions from Minority Nurse about how to navigate this tricky path. October happens to be National Chiropractic Health Month and is a good time to begin thinking about managing chronic pain with medication-free methods when possible and safely with medication when it is necessary.
“The human toll of prescription opioid use, abuse, dependence, overdose, and poisoning have rightfully become a national public health concern,” McAllister says, noting that opioid drug abuse was named an emergency by President Trump. “The sheer magnitude of America’s prescription opioid abuse epidemic has evoked visceral responses and calls-to-action from public and private sectors. As longtime advocates of drug-free management of acute, subacute and chronic back, neck, and neuro-musculoskeletal pain, the chiropractic profession is aligned with these important initiatives and committed to actively participate in solving the prescription opioid addiction crisis.”
What can concerned patients and health care teams do? “Begin treating pain with conservative options first,” says McAllister. Many people suffering from pain just want it to go away and often hope the pain medication will hasten that. As nurses know so well, pain medication treats the symptom, but not the underlying problem. “But the opioid emergency demonstrates that masking pain can lead to long-term persistence of both the pain and the drug use,” she says.
The necessity for finding alternatives that will help people without exposing them to the risk of addiction or dependence is clear. “Data released by the Centers for Disease Control and Prevention (CDC) revealed that ‘opioid deaths continued to surge in 2015, surpassing 30,000 for the first time in recent history,’” says McAllister. The rates continue to rise.
Often addiction starts with something as simple as dental work or as common as a back injury. McAllister cites an April 2017 report on lower back pain in the Annals of Internal Medicine that “strongly recommends non-pharmacological treatment” that suggests a long list of first-line alternatives including heat, massage, acupuncture, exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation.
If those options don’t work, moving on to medication trials of non-steroidal anti-inflammatory medications (like Aleve or ibuprofen) or muscle relaxants should be tried. Opioids are considered an option if all these other methods have failed to provide necessary relief. But they should only be prescribed after assessing each individual case and with a discussion with the patient about realistic pain management expectations and what the risks are.
Nurses can help deliver information about pain management options to their patients while not minimizing the impact chronic pain has on their lives. They can encourage therapies that don’t include medication and back it up with the proven evidence that these approaches help patients in the long term.
Opioids, in particular, can also cause a host of associated health problems, with addiction being the most well-known. But patient’s bodies can also become adjusted to the drugs and require increased does to deliver the same pain relief. McAllister recommends Chiropractic: A Key to America’s Opioid Exit Strategy or Chiropractic: A Safe and Cost-Effective Approach to Health for more information.
The American College of Nurse-Midwives (ACNM) is once again sponsoring National Midwifery Week, which kicks off today, October 1, and lasts through Saturday, October 7.
For centuries, nurse midwives have been partners and guides in women’s healthcare around the world. They carry out their compassionate care wherever it is needed as a woman progresses through her life. Nurse midwives are best known for their care during pregnancy, childbirth, and the post-partum period, but they can assist women throughout each stage of their lives—from the teen years to women past menopause.
Nurse midwives deliver services in homes, hospitals, birth centers, and other healthcare settings. They are there to carry out routine physicals through to newborn care.
Although there are several types of midwives, certified nurse midwives (CNM) have a degree in nursing and a graduate degree in midwifery nursing plus additional training and specific certification (through the American Midwifery Certification Board) in midwifery. CNMs are able to prescribe medication. Certified midwives have degrees in an area other than nursing, but then progress through the same certification process. In the United States, the overwhelming majority of midwives are CNMs.
Midwives have always played an important role in patient-focused healthcare as their care approach is directed on the patient and what she needs at that given point in time. Every woman’s body is as different as her healthcare needs, so midwives are trained in assessing each woman’s individual situation to bring her the best healthcare possible.
Most midwives work as part of a woman’s healthcare team, and spend direct one-on-one time to establish a trusting relationship and to learn what the woman wants from her healthcare. Nurse midwives provide their patients with plenty of education so they can make the best, most informed, and most comfortable decision for themselves.
And a nurse-midwife provides the essential hands-on care during labor and delivery, offering both physical comfort and emotional support. Especially during a low-risk pregnancy and birth, the guidance and presence of a nurse midwife gives a woman a greater sense of control as labor progresses and reduces the occurrence of interventions like a c-section while raising the percentage of new moms who initiate breastfeeding.
According to the ACNM, “In 2014, CNMs/CMs attended 332,107 births—a slight increase compared to 2013.” Those numbers amount to about 8.3 percent of all US births. The expertise provided by nurse midwives coupled with the patient-centered and customized plan of care is becoming an increasingly popular option for women who are seeking more personal care from a highly trained professional.
This week, celebrate the nurse midwives in your life with a acknowledgment of how their steady care helps moms and babies throughout the world. If you are a midwife, this is a good time to share your story and call attention to your profession. Post on social media using #MidwivesMakingStrides and share your patients’ feelings about nurse-midwife care.