February 5 through 11 is a national observance of National PeriAnesthesia Nurse Awareness Week, sponsored by the American Society of PeriAnesthesia Nurses (ASPAN). Nurses who help transition patients pre- and post-procedure are there to offer intensive medical care and equally essential caregiving. They especially want patients to know they are there for them. They are their advocates throughout the process.
If you are interested in a career as a perianesthesia nurse, you’ll find the challenges of the position range from using your advanced nursing skills in urgent situations to incorporating the most basic hands-on comfort skills. Charged with caring for patients at critical pre- and post-procedure points, perianesthesia nurses must be able to multitask, to identify and respond to patient conditions immediately, and to do this all with a calm demeanor to help keep patient stress at bay.
Perianesthesia nurses especially enjoy their work caring for patients before and after procedures that require any anesthesia. Before a procedure, they are the nurses who are there to find out any information that could have an impact on the anesthesia care. With more and more patients appearing with several health conditions, they have to factor in variables like medications, physical condition and limitations, and emotional stability in their patient assessment. While they are assessing and gathering information, they are also providing a calm and unwavering support to help nervous patients know they are in trusted hands.
Perianesthesia nurses are also there when patients come out of anesthesia and are sometimes confused, uncomfortable, or even nauseated or vomiting. Post-procedure, nurses are once again continually monitoring a patient, assessing vital signs, reassessing existing health conditions, and at the same time, offering that hands-on caregiving that helps patients feel safe. Perianesthesia nurses then help determine how a patient can safely move to their next place whether that is to home, another hospital, or another care facility.
Many perianesthesia nurses say they have perfected a way to develop a rapport with patients that can build the trust necessary for completing such a long task list in a short time and under pressure. Once a nurse has identified a topic that helps the patient relax, they can begin conversations about family, pets, schooling, movies, or books that are both informative for nurses and distracting for patients. Many nurses also say they use those nuggets in the conversation to help bring a patient out of a drowsy and sometimes confused anesthesia.
For those considering this branch of nursing, ASPAN offers many resources and is an excellent reference to find out information about certification (through the American Board of Perianesthesia Nursing Certification, Inc.) that must be renewed every three years, scholarships for education, career resources, mentoring opportunities, conferences, and up-to-date anesthesia information.
This week, recognize and appreciate the perianesthesia nurses on your team. Their skills often help the entire procedure proceed smoothly and safely.
Nursing education is done a little differently at Linfield College. We pride ourselves on creating innovative methods in which aspiring nurses can learn and grow into strong and competent professionals. One of the many ways in which that is done is through our simulation program. Our simulation program is run out of our experiential learning center (or ELC); it includes low, mid, and high-fidelity simulations. With these simulations, our students go in one by one to care for the patients individually for ten to fifteen minutes at a time with each student picking up where the other one left off. They plan the care together using what’s called a mega brain and prioritize the patient’s needs within the plan prior to the start of care for the patient. We have not witnessed this method being used at many facilities.
The students have the option of continuing care as the previous student or changing the plan; they are all the same nurse so if they are in the middle of a task then they are able to continue with that task without starting the steps over again, which saves time and enables them to carry out the task. In the past, we had found that having each student start over took away from the simulation experience and that the students were more focused on the task instead of the patient. This brought about the solution of one mind nursing. The students have found this to be extremely helpful and have verbalized how this increases the realism of the clinical simulation by having them think like a nurse, especially with the situation of end of shift or hand-off. In this situation the students have to consider what is the best option if they receive hand-off in the middle of a nursing task. This is one of the aspects that increases realism.
Another method of increasing realism comes from the use of alumni. We use alumni as family members during the simulation (we have a manikin or a standardized patient as an actor). During the simulation, the alumni act as though they are the family members dealing with that situation. After the simulation is complete, they help with debriefing after we walk through the case and ask high-level critical thinking questions to stimulate reflection, retention, and transference. They tie in clinical examples of how it relates to their clinical practice and emphasize why the clinical reasoning and actions based on clinical judgement are so important. The students enjoy having the alumni because they have shared their experience and have gone through what they have experienced and have become successful after it. The alumni serve as additional mentors and role models in this way, offering advice and further insight into the role of nurses. With this addition to our clinical simulation program, we have created a more realistic and enjoyable experience for our students.
There have always been challenges facing nursing students. What are the biggest ones today, and how can students deal with and overcome them? Some experts weigh in.
Frederick Richardson, a BSN student and the Breakthrough to Nursing director for the National Student Nurses’ Association, had no doubt about how much of his time would be taken up when he began attending nursing school. Yet, he says, this seems to be one of the toughest aspects of attending nursing school that students struggle with.
“One of the biggest issues that nursing students face is time—making time for everything,” explains Richardson. “Nursing school is very demanding, and when you add in the coursework, reading for homework, and the clinical work, there usually isn’t time for anything else.”
Richardson says that he was fortunate enough to learn about this before choosing to attend nursing school. His older brother had attended nursing school, and Richardson saw firsthand how often he didn’t see his brother during that time. “He would be at the library studying, at class, or at clinicals,” recalls Richardson. “When I’d see him, it would be late at night. And he would be out of the door first thing in the morning. At the time, I recognized that when I would get to nursing school, I would probably have a similar schedule, and sure enough, it’s been exactly the same way.”
To overcome this, Richardson says that students need to have perspective and be realistic regarding what they can accomplish in their lives while attending such vigorous programs. “Our schedules can get really hectic. But I think that when you get into nursing school, you have to recognize that you’re going to devote the majority of your time to your nursing program. A lot of students don’t realize that,” he says.
Students need to set their priorities straight and decide how they are going to organize their time. Richardson, for example, says that he had to learn how to plan his time, organize his life and tasks on a calendar, and then follow that calendar every single day. From his perspective, quite a lot of students expect to attend nursing school and still have an active social life and do everything they did before, like watch all their favorite television shows.
“I think that the trouble students run into is they believe they can have everything—do well in nursing school, have an active social life, et cetera. If they go in with that kind of view, I don’t think they’re going to survive nursing school,” says Richardson. “They’re going to have to sacrifice a lot of that time, but once you get into it, it gets a bit easier.”
Martha A. Dawson, DNP, MSN, FACHE, assistant professor and coordinator of Nursing and Health Systems Administration at the University of Alabama at Birmingham School of Nursing, as well as the current historian for the National Black Nurses Association, agrees that having enough time can be an issue for nursing students. Traditional nursing students still face challenges that relate to study time, finances, and part-time work. In addition to the challenges of traditional students, however, second degree nursing students, such as those in a BSN to MSN bridge or other accelerated degree program, may also have immediate family obligations, explains Dawson. For instance, some may be primary caregivers for older parents. “Many students in these new and emerging programs are older, and these added life demands can lead to both high stress and exhaustion,” she adds.
Money, Money, Money
Richardson and Dawson agree that financial issues can also be a big challenge for nursing students. Dawson says that with the varying nursing programs and the older student population in them, these students may have greater financial obligations besides school, like a mortgage. “The current economic climate is making it more difficult for students to gain access to scholarships, trainee grants, and other forms of funding without going further into debt,” says Dawson.
In addition to taking out loans to attend nursing school, Richardson says that there are a number of scholarships available for students. Believe it or not, though, not a lot of students are applying for them. “There are a good number of scholarships available,” says Richardson. “After speaking with some people who have scholarships or who fund scholarships for students, I’ve discovered that they’re not getting a lot of applications. One reason is because of the time. A lot of students don’t know that the scholarships exist, and a lot who know they exist feel like they don’t have the time to fill out the applications because of the high demand of nursing school.”
The reality, Richardson says, is that studying takes up so much of the students’ days that many don’t think they could take the time to do what some scholarships may require in their applications—like get a letter of recommendation, write three essays, get transcripts, and the like.
Recently, Richardson had a heart-to-heart talk with a student who was frustrated because of going to school, clinicals, and a part-time job. “I said, ‘If you took about three hours applying for a scholarship, you would get more money to help you out with your school fees,’” says Richardson. He continued to explain to the student that he was working twice as hard and putting in twice as many hours at his part-time job to make the same amount of money that he could get if he applied for a scholarship—which would ultimately free up more of his time. “It would help the student more in the long run,” says Richardson.
Along with not getting enough financial support, some nursing students don’t have as much family support, says Rebecca Harris-Smith, EdD, MSN, BA, dean of Nursing and Allied Health at South Louisiana Community College. “Nursing classrooms across the nation are filled with an intergenerational, multicultural group of students that range from millennials to baby boomers,” explains Harris-Smith. “This nontraditional classroom of students has many that are parents who frequently do not have siblings, parents, or other relatives to assist them with child care. The expense of child care, transportation, and after-hours coverage often impacts the nursing student’s classroom, clinical, and study time.”
Richardson says that family support and encouragement is often needed, but not every student has it. “I noticed immediately that I needed a lot of support,” says Richardson.
“In my personal experience, soft skills as they relate to interpersonal people skills have become an issue for nursing students. The ability to communicate both verbally and in writing appears to be a challenge,” says Harris-Smith. She says that because Gen Xers and millennials have grown up with a lot of technology, they have spent a lot of their early years communicating that way.
“Basic socialization has changed in that the younger generations would prefer to text over having a verbal conversation. The lack of appropriate communication skills has an impact on the students’ ability to work collaboratively with physicians, fellow nurses, and other members of the health care team,” explains Harris-Smith.
“Effective communication is essential due to the intra- and interprofessional team collaboration essential in the health care arena,” Harris-Smith explains. “Additionally, nursing students must learn flexibility, professionalism, and a strong work ethic—which are essential to the development of the new nurse graduate. Being able to adapt to an ever-changing environment is important as health care facilities have staffing issues often requiring nurses to work beyond their shifts.”
Challenges for Minority Students
Although the challenges for nursing students are often the same for students of color and those who aren’t, “students from underrepresented groups in the nursing profession and in society . . . have them on a much larger scale,” says Dawson. “There are barriers and biases that these students experience such as academic skills, perceived perceptions about their abilities, lack of faculty role models, limited peer support, and major financial issues that ‘majority’ students do not have to deal with on a daily basis. Many minority students also struggle with the very basics of housing and food.”
An additional burden that minority students face, says Harris-Smith, is that of access and equity in education. “A selective admission process is used by schools of nursing across the nation, and this very process can serve as a barrier for students of color. Academic profiling of students ensures admission of the most academically prepared students that rank highest among their peers, but students from underrepresented populations are often the first-generation college students that struggle with the issues of being the first in the family to attend college. This situation places a heavy burden on the student because s/he may be dealing with the pressure of being the ‘savior’ for the family. These students are generally not savvy enough to apply for multiple college programs, have difficulty completing financial aid forms, and generally come to college with limited resources,” says Harris-Smith.
“Nursing programs tend to address diversity in their mission statements but fail to explain how this is accomplished. Merely placing the statement in the mission statement does not explain how the school of nursing addresses the issue. To ensure transparency, each school of nursing could better address this issue by providing information on the way in which this mission is accomplished,” says Harris-Smith. For example, she says, schools could use a statement that’s more explanatory: This school of nursing addresses diversity via academic profiling of students but is careful to admit a diverse student body that resembles the demographics of the community in which we live.
“There is a need for schools of nursing to restructure their admission process to address the lack of the underrepresented students in attendance at their colleges and universities,” Harris-Smith adds.
Richardson says that’s why he is a part of the Breakthrough to Nursing committee because its goal is to increase diversity in the nursing profession. Another challenge he’s seen is that some minority students don’t last in nursing school because they have different ways of learning. “Culturally, students from different backgrounds learn differently. I’m a kinesthetic learner. If you show me how to start an IV, I will know how to start an IV more efficiently than reading three chapters about how to start an IV,” Richardson explains. “A lot of nursing school is geared toward your textbook. But a lot of students are visual, auditory, and kinesthetic learners.”
He says that there are also students from various cultural backgrounds who don’t know how to study. “For students who come from the other side of the world to America to learn, their views are different from yours, and when you have a different perspective, you’re able to become more aware. You’re able to see a different view. It actually makes us stronger and allows us to become smarter to look at the way that other people do things,” suggests Richardson.
“With diversity, we need to recognize and communicate to understand what the other person’s thinking is and allow them to realize that though their culture is different, it’s not a bad thing,” says Richardson. “It’s just a different view and perspective for them.”
When you’re a nursing student, thinking about your finances seems almost like a pointless task. With the immediacy of paying for school and the almost universal need for student loans that you pay back after graduation, thoughts of your future financial plans stay where they are – way in the future.
Believe it or not, this is actually a great time to think about your future and your finances, which includes retirement but also might include big-ticket things like a car, a house, travel, or additional educational costs. When you start working right after graduation, you’ll want to develop good financial habits right from the outset. If you can begin planning for your future early, you’ll be much better prepared.
You may not be able to set aside money when you’re still taking courses and during clinicals, but you can learn how to make good financial choices.
Set a Budget
As a nursing student, get comfortable with the funds you have, the funds you earn, and the amounts you owe. Don’t guess at how much your food costs are each month—add them up so you know. Use an online budget app like Mint (it’s free!) to calculate that in with your rent or mortgage, any insurance costs, student loan payments, transportation, and costs for entertainment, pets, or clothes.
Balance that with what you take home each month and you’ll get a good idea of your cash flow. If you get comfortable doing that early on, you’ll have an easier time making sure you make solid, financially stable decisions in the future.
Learn Where to Save
When you have a budget, you’ll know what you have and don’t have. You can figure out if you can cut back on one thing to make some extra money for something you want. Eliminating a take-out lunch once a week and you can easily save another $50 to $70 a month. Add that to an emergency fund until you have enough to cover three to six months of expenses. Then start putting it in a retirement fund. You’ll never notice the difference.
Pay Your Loans
This one is simple, but can be difficult. If you have student loans pay them on time every single time they are due. Defaulting on your student loans or being late on payments can wreak havoc with your credit score. And you’ll need good credit to secure a car loan, a loan for a home, or even future student loans if you return to school. Don’t let a mistake limit your life that much.
Plan Your Next Steps
Set some financial goals. Do you want to save $1,000 this year? Do you want to commit to saving 15 percent of your income? Figure out how much that breaks down to save each week and then do that. Either have it automatically withdrawn and placed in a different account or fund or do it yourself each payday. Setting concrete goals complete with amounts and the steps you have to take to reach your goal is half the battle.
Start implementing steps toward setting good financial behaviors now and you’ll be thankful years down the road.
When young children and young adults don’t hear about nursing as a viable career choice or learn about how to pursue a nursing career, the world loses an untold number of excellent potential nurses.
Mona Clayton, MSN, RN and CEO of Nurses 2 Roc Pub, knows all too well how some dreams need a little nudge. She is making sure that will happen with a goal to reach out to 100,000 people worldwide to tell them that a nursing career might just be the best career for them.
As a kid growing up in South Central Los Angeles, Clayton didn’t have the encouragement she needed to even think of nursing as a career. “You could say nursing chose me, I didn’t choose nursing,” says Clayton. “I didn’t think about nursing as a career at all. I didn’t like blood, and I didn’t like math. And I never had anyone tell me I could do this.”
She didn’t have professional role models telling her that her fascination with health care and the medical dramas she watched on television might mean she had a passion worth pursuing. They could have told her she could overcome her queasiness about blood and that improving her math just meant she had to practice.
Clayton aims to be the inspiration and mentor for those who might want to follow the same path. With seminars in person and online, casual discussions, a blog, and a pure determination to have good people become good nurse, Clayton spreads her message.
Clayton’s path changed when her cousin became a nurse and when Clayton herself worked in a trauma unit while attending college. After forays into journalism, pharmacy, computer science, and business, Clayton went back to school for her nursing degree in her mid 30s. As an older single mom who was also a minority and didn’t consider herself great in math, Clayton says the unknown was scary. “I think the main barrier for many people is the mindset that they think nursing is an impossible venture,” she says.
In fact, Clayton says when she is running a seminar, the young adults she is speaking with invariably ask her the nuts and bolts of how she achieved her goals. They want to know how she applied to a nursing school and how she even knew which one to apply to. They ask how she was able to pay for classes and did she work and go to school simultaneously. They want the details on how she managed while being a single mom and how hard her classes were. They are all hungry for information on how to make their dream become reality.
Clayton admits the road for her wasn’t always smooth. Her daughter was active in lots of school activities, and Clayton relied on extended family to help fill in the gaps as she continued to work and go to school while raising her daughter. When the going got tough, Clayton says she just looked at her daughter. “She kept me going,” she says. “I wanted her to see the importance of education. I wanted her to see how I did it and then they think, ‘If she did it, I can do it, too.’”
And while Clayton’s message connects her with people worldwide, you’ll also find her talking to people in Target or at the gym. She talks to kids who are curious about nursing and older people who are thinking about going back to school for nursing. And she recruits men and women believing a balance of genders is necessary in the workplace.
“I could go and work as a nurse and not do this,” says Clayton, “but this is a passion and drive I have. It feels great when I see someone succeed.”