In many people’s minds, the “typical” nursing student is an 18- to 22-year-old enrolled in a bachelor of science in nursing (BSN) degree program at a college or university. However, there are many degree options available for aspiring nurses at all stages of life—even if you’re a nontraditional student—and you’ll be graduated and putting on your scrubs before you know it.
According to the National Center for Education Statistics, a nontraditional student meets one of seven criteria: delayed enrollment into postsecondary education, attending college part-time, working full time, financially independent for financial aid purposes, dependents other than a spouse, single parents, or those without a high school diploma. If any of these describe you and you’d like to go back to school to get your nursing degree, here are seven online programs that anyone from around the country can take.
1. St. Xavier University
St. Xavier has numerous online options for those looking to earn nursing degrees. It offers an RN-to-BSN program for currently licensed registered nurses who have completed an associate degree in nursing (ADN) from an accredited school of nursing and are looking to take the next step in their education. St. Xavier was also named the best online master’s nursing program by U.S. News and World Report, and it offers three master of science in nursing (MSN) tracks online: clinical leadership, executive leadership, and nurse educator. If you’re not looking for the full degree, St. Xavier also offers certificates in clinical leadership and nurse educators.
2. Medical University of South Carolina
The Medical University of South Carolina (MUSC) offers an online RN-to-BSN program, which is a 12-month program that covers three consecutive semesters, allowing registered nurses to earn their bachelor’s degrees in just a year. The online program is designed specifically for working adults. MUSC also offers several online advanced degrees in nursing, including a doctor of nursing practice (DNP) and a PhD in nursing science, though some of the courses may require a visit to campus.
3. Johns Hopkins
Johns Hopkins is an incredibly well-respected name in the medical community—and you can earn a graduate nursing degree from the university online. Johns Hopkins provides an MSN in health systems management both by itself and in combination with an MBA. It also offers a DNP in three specialties: adult-gerontological health clinical nurse specialist, adult-gerontological critical care clinical nurse specialist, and pediatric critical care clinical nurse specialist. You can also earn a DNP Executive Track, either on its own or in combination with an MBA. Finally, Johns Hopkins offers a couple post-master’s certificates for nurses looking for even more education.
4. George Washington University
George Washington offers a wide range of online programs for nurses of all experience levels. It has both RN-to-BSN and RN-to-MSN programs, as well as four other master’s programs for adult-gerontology primary care nurse practitioners, family nurse practitioners, nurse-midwifery, and nursing leadership and management. Other options include three post-MSN certificate opportunities, two post-BSN doctoral degrees, and two post-MSN doctoral degrees, including a DNP degree.
5. The University of Texas at Tyler
The great state of Texas has equally great online programs for nursing students through the University of Texas at Tyler. Its RN-to-BSN track has a flexible schedule and graduation date, so you can proceed through the coursework at your own pace as your current job allows. Their graduate options include four MSN programs (administration, dual MSN administration/MBA, education, and family nurse practitioner), four certificate programs (post-master’s administration, post-master’s education, post-master’s family nurse practitioner, and post-baccalaureate health care informatics), two PhD programs (MS-to-PhD and BSN-to-PhD) and one doctor of nursing practice (DNP). As an added bonus, the University of Texas at Tyler was named the #1 most affordable online master’s in nursing program.
6. Duke University
Duke’s School of Nursing has been using distance-learning education strategies for more than two decades, and the school has honed its creative approach to distance teaching and learning over the years. Some programs do include a few short on-campus intensive sessions, usually two to three days in length, but the commitments are minimal. Duke offers a doctor of nursing practice as well as eight different nurse practitioner tracks for their master of science in nursing: adult-gerontology (primary and acute), family, neonatal, pediatric (primary and acute), psychiatric mental health, and women’s health. It also offers three systems MSN degrees in nursing and health care leadership, nursing education, and nursing informatics.
7. University of Cincinnati
Cincinnati’s reputation as a great online nursing school has spread: The school’s number of distance learners has been increasing, and the website boasts that more than 62% of the student body is now enrolled in online classes. Most of its graduate nursing degrees are offered completely online, though a few courses do have minimal on-campus requirements for clinical or lab work hours, so don’t forget to pack your nursing bag. The school offers four MSN specialty programs (adult-gerontological primary care nurse practitioner, family nurse practitioner, nurse midwifery, and women’s health nurse practitioner) as well as two post-master’s certificates (psychiatric mental health nurse practitioner and family nurse practitioner).
If online classes don’t appeal to you, see if any schools in your area offer a nursing degree for working adults who usually rely on night and weekend classes in order to accommodate work schedules. And no matter how your get your degree, you’ll have to study for and pass the National Council Licensure Examination for RNs (NCLEX-RN) exam if you haven’t already and perhaps pass additional licensure requirements depending on your state.
Whether you’re a working nurse looking to take the next step or a young professional looking to switch careers, there’s a nontraditional degree program out there for you. Thanks to the recent breakthroughs in education technology, students can now attend nursing degree programs online anywhere, anytime, and these seven well-respected programs are a great place to start.
Effective communication is one of the foundations of good nursing care. The honest forms of nurse-patient communication include verbal and non-verbal communication (e.g., body language, facial expression, gestures, and distance between you and your patients). Effective nurse-patient communication can improve quality of care, clinical outcomes, and a nurse-patient relationship that enhances patient satisfaction. However, effective nurse-patient communication is the biggest challenge for nurses and requires much more than experience and skills.
Here are 3 principles you should follow to help you improve your communication skills with patients.
1. Always put the patients first.
Putting patients first takes a shift of mind. Start your conversation with the patients by taking the time to introduce yourself and tell them how you are going to take care of them. Smile and use a calm and welcoming voice. Provide comfort when they need to be comforted. Always show respect to your patients. Understanding who the patients are as individuals will help the nurse connect with them and will make the patients feel more comfortable while receiving care and treatment. These approaches can make the patients feel really cared for and can improve relationships.
2. Practice active listening.
Active listening is an important part of communication and requires listening for the content, intent, and feeling of the speaker. Active listening involves paying attention to what the patients say and allowing them to finish without judgement and interruption. Paraphrasing or echoing back to them what they have just said, and maintaining eye contact are also key elements of active listening. Lastly, pay attention to their non-verbal clues, such as facial expression, gestures, and eye contact. These skills can improve patient satisfaction and build trust over time.
3. Talk with heart.
Communicating with patients requires ample time. Honesty and frankness are important parts of effective communication between nurses and patients. To achieve effective nurse-patient communication, nurses need to have a sincere intention to understand what concerns their patients have and show them their kindness and courtesy. Acknowledge the patients’ attitudes and tune into their feelings. Always ask patients open-ended questions, speak slowly, and use simpler, non-medical language. If the patient has difficulty understanding the information, you need to clarify or modify the information or instructions until the patient gets it. You may consider using written materials such as handouts, notes, or pictures to demonstrate what you are saying.
Every day, nurses come to work providing care for patients requiring multiple levels of skilled nursing care ranging from basic to complex. Some patients may require vasoactive or vasopressor drugs to reduce or increase a patient’s blood pressure and other devices, such as a ventilator, intra-aortic balloon pump, or continuous renal replacement therapy, just to name a few, in order to preserve a patient’s life. In addition to caring for patients, nurses also have to make sure the patients’ family members understand the different aspects of the patient’s plan of care, such as the medications’ indication, side effects, and expected outcomes, as well as blood tests and diagnostic tests.
On a daily basis, nurses deal with the various level of stress caring for their patients and family members. These stressors could be the workload, time management, difficult patients and/or family members, discharges, admissions, and cardiac or respiratory arrest events. While nurses set goals to provide quality care that leads to better patient outcomes, nurses have the tendency to neglect themselves while working for the welfare of their patients by occasionally taking shorter meal breaks.
The big question is: who cares for nurses so they can continue to provide quality care every day to achieve positive outcomes? I see myself as a guardian angel for nurses whom I work with every day. Driving to work, I talk to God and ask him to help me make a positive difference, whether it is a soft touch of my hands, my soft-spoken voice, or my tight hugs. I believe that nurses should be cared for similarly to the way we take care of our patients and their families. Therefore, I look for a bible verse that would facilitate me making a difference in the lives of others. The bible verse I read is Proverb 3:6, which reads: “In all thy ways acknowledge him, and he shall direct thy paths.” The reason for this particular verse is that I need God’s guidance so I can be a blessing to others. The way I believe that I am a blessing to others is demonstrated by monthly birthday cards and luncheons for coworkers who are born in a particular month as well as greeting cards and gift cards for expecting mothers and fathers or weddings. I also recognize coworkers if they have achieved any type of certification or graduated from college.
Sometimes, I make and bring in desserts and have food delivered for lunch. On our unit, we are a melting pot of people. Every year in August, we celebrate International Culture Day where the staff brings an entrée from their culture and shares a little bit of history and its meaning. Additionally, I show concern about them as a whole and will ask them how they are feeling, what is going on with their children, dogs and/or cats, and their commute to work. The admiration of taking care of nurses and others as extended family members at work gives me great joy and pleasure that leaves my heart full of exhilaration every day.
“I feel dizzy” is a common complaint in the ER and triage nurses sometimes use the shorthand, IFD, when describing the patient’s complaint. Finding a diagnosis for this vague symptom can be challenging. One thing the nurse can do to speed up the process is to drill down to a more firm description than dizziness.
Dizziness is a complaint that can include four separate symptoms, sometimes overlapping. A careful history will reveal one or more of these: vertigo, disequilibrium, presyncope, or lightheadedness.
Vertigo is the feeling that the room is spinning. Often, there is a false sense of movement. Sometimes vertigo is accompanied by nausea, vomiting, sweating, and/or nystagmus. It gets worse when the patient’s head is moving. The question the nurse can ask to differentiate vertigo from other forms of dizziness is, “Do you feel like the room is spinning or moving around you?”
Vertigo has relatively few causes. Benign paroxysmal positional vertigo (BPPV), Meniere’s disease, and labyrinthitis are the most common. Less common are brain tumors, brain injury, stroke, MS, and migraines. You can see that they divide into central and peripheral causes; central causes involve the brain and peripheral causes come from the middle ear. Anything that causes inflammation in the structures surrounding the organs of balance can lead to vertigo. Often the patient will have a cold or sinus problems. Tinnitus, hearing loss, and feeling of fullness in the ear can accompany vertigo. There is a rapid compensatory process when things go wrong with the organs of balance. Usually the course is self-limiting and resolves within a few days.
BPPV is caused by loose granules of calcium carbonate moving in the semicircular canal. It can be diagnosed with the Dix-Hallpike test and can sometimes be effectively treated with repositioning movements called the Epley maneuver. BPPV does not present with hearing loss.
Meniere’s disease involves episodic vertigo along with hearing loss and a sensation of fullness, usually in one ear. There are few treatments and the disease is poorly understood. The course can last from 5-15 years before the episodes stop and the patient is left with mildly disturbed balance and decreased hearing.
Labyrinthitis is believed to be caused by a viral infection of the inner ear and can result in permanent symptoms of dizziness.
Disequilibrium exhibits itself in the patient’s gait. A stumbling or shuffling gait can be a sign of stroke, a life threatening emergency that calls for immediate activation of the emergency medical system. Other causes are Parkinson’s disease and peripheral neuropathy. Alcohol and drug intoxication frequently lead to disequilibrium. In older people, poor vision can accompany disturbances in gait, leading to falls. Benzodiazepines and tricyclic antidepressants can also lead to higher incidences of falls in the elderly.
Presyncope is a problem of circulation and is most commonly described as feeling like one is going to pass out without actually losing consciousness. It’s either a pump or a fluid problem and exhibits as orthostatic hypotension. When the patient stands up, he or she gets dizzy. It can be caused by dehydration (fluid problem), arrhythmias, myocardial infarction (pump problem), multiple medications, or debilitating illness. The nurse should ask the patient if he or she gets dizzy when standing up from a sitting position.
Lightheadedness is often associated with a psychiatric diagnosis and/or hyperventilation. Anxiety is the number one factor predisposing a person to lightheadedness. It is reproducible with voluntary hyperventilation.
Asking the patient a few extra questions and taking a careful history can assist the provider in making a diagnosis. Dizziness is not a very good descriptor of this problem, so drill down a little.
Mental health is no longer a taboo topic in much of society, but for many minorities, the stigma is still strong and prominent. July is Minority Mental Health Awareness Month to help those affected by mental health conditions get the treatment they need and begin to erase the stigma through education and awareness.
In general, people are talking about mental health much more than they ever did before. Advertisements for drugs to treat depression and bipolar disorder are common; celebrities openly discuss their mental health challenges; and support groups are often well attended across the country.
But for minority groups, the stigma of mental health struggles is often present. While some groups in the country feel freer to make their challenges known, minorities often struggle with mental health in silence. Afraid to bring their symptoms to light, they often don’t get the treatment that could help them feel better and make their lives easier.
As nurses know, mental health is a physical condition. It might be called mental health because it affects the brain, but anyone with a mental health disorder is struggling with a physiological disease. But because the topic has been taboo for so many for so long, the freedom to be honest about their disease remains elusive.
As a nurse, you can be especially in tune to these startling facts from the Office of Minority Health:
- Over 70% of Black/African American adolescents with a major depressive episode did not receive treatment for their condition.
- Almost 25% of adolescents with a major depressive episode in the last year were Hispanic/Latino.
- Asian American adults were less likely to use mental health services than any other racial/ethnic groups.
- In the past year, nearly 1 in 10 American Indian or Alaska Native young adults had serious thoughts of suicide.
- In the past year, 1 in 7 Native Hawaiian and Pacific Islander adults had a diagnosable mental illness.
According to the American Psychological Association, minorities have additional roadblocks. Even if they are ready to get help, they often lack access to high-quality mental health care and treatment. There might not be enough providers or those providers might be hundreds of miles away. Providers who take insurance might be hard to find and those who offer culturally competent care might be even more sparse. Speaking with a provider who isn’t aware of the cultural stigmas against minority mental health issues in a specific community could make the patient feel even more isolated.
You can learn more about the barriers to adequate care in your own community and begin to seek out solutions. Finding a few culturally competent providers, keeping a list of online resources, and referring patients to trusted specialists if they are available can be a big help as can keeping a compassionate and factual approach to patients who are struggling with symptoms and with stigma. If they are treatment resistant, you still have a powerful tool in voicing that mental health is a imbalance of brain chemicals, is not their fault, and that help is available.
Being an open ear can also help someone who is having a tough time but is reluctant to get help. Urge them to get relief, offer helpful resources, educate them to dispel myths they may be holding, and work with your team to raise awareness and ensure no unconscious bias exists.
I recall my first clinical rotation as being one of the most exciting but stressful experiences as a student nurse. I was excited to finally apply the theories that we were taught in class to the ‘real world.’ However, I soon realized I was very unprepared. From the very early start times, extremely long days, and limited support from some faculty and peers as I ventured down this new path ultimately resulted in exhaustion and feeling unprepared. These feelings eventually affected my self-confidence more times than I care to admit. In addition to that, let’s not forget the culture of the units that I would be assigned to for weeks at a time. No one told us that the nurses would scatter when they saw students enter the ward and those that were forced to be with us made it known that they were not pleased with having us ‘tag along.’
Based on my personal experiences, I decided to put together a few key steps that I know would have been beneficial to me when I was a student nurse entering my clinical rotations and hopefully will be a benefit to you today.
1. Be Prepared.
- If you’re able to get some basic information regarding your specific patient or the types of patients on that unit a night or two before your clinical day, take some time to do some research.
- Look up the diagnosis and medications attributed to these patients.
- Write this information down in a small notebook that you can keep in your pocket that is easily accessible for you to review.
2. Be Early.
- It’s a good practice to start this habit now in preparation for the real work world. Treat clinicals like your job!
- Arrive a minimum of 15 minutes early. Grab some coffee or tea and take this time to review your material. This will also give you a few minutes of alone time with your clinical instructor, which is always a plus.
3. Look the Part.
- I know that ‘looking good’ is NOT on the list of priorities for someone who is sleep deprived and stressed. However, it’s necessary and will leave a positive lasting impression.
- Always make sure you are dressed per your school’s policy. If scrubs are provided or purchased, make sure they are always neat and pressed. If you are like me (i.e., not a morning person), pick a day during the week to complete this small task and NOT the night before.
- Carry a small personal hygiene bag with you always so that you can ‘freshen’ up midday. This will revitalize you, especially if your clinical days are long.
- Most importantly, don’t forget your necessary equipment: pens, stethoscope, penlight, scissors, etc.
4. Be Professional.
- ALWAYS address your patient by Mr. and Mrs./Ms. unless they say otherwise, especially with patients who are older than you are. This is not only professional but also respectful.
- ALWAYS introduce yourself to your patient when you enter their room and let them know that you are a student nurse and will be a part of their care team for the day.
- Most importantly, SMILE. Patients and staff will appreciate it.
5. Be an Active Participant.
- It’s OKAY to say ‘I don’t know but I will find the answer for you.’
- It’s important to ASK for help when needed. As we all know, there is no I in TEAM.
- I encourage you to ASK questions and ANSWER questions. This shows that you are not only prepared but eager to learn.
- Whenever possible, volunteer to observe as many procedures as possible. The more you can observe the better!