With medical errors making national headlines, it is no secret that both training and experience are integral to success as a new nurse. Almost all nurses enter the field with a college degree, but recent research shows that novices make a large percentage of the errors caused by nurses. To avoid mistakes and build a strong foundation for your nursing career, here are three essential skills to prioritize during your first year as a nurse.
1) Developing Strong Instincts for Patient Safety
Patient safety is one of your primary responsibilities as a nurse. Safe medication administration is an imperative skill to master in your first year. You are the final check between the prescribing provider and the administration of a medication to the patient. If something feels “off”—maybe the dose seems too high based on doses you have given before or the medication doesn’t seem to fit your assessment of the patient—take a timeout and ensure the prescription is accurate. Mistakes happen even in computer-driven processes, whether a decimal point is missed, a duplicate therapy is accidentally prescribed, or a medication is placed in the wrong slot of a medication dispenser. Before giving any medication, ask yourself, “Are all of the correct pieces in place for me to give this medicine right now?”
Learning to safely calculate medication dosages goes far beyond a textbook. Learning tools like UWorld’s Clinical Med Math allow students to practice and perform dosage calculations without the risk of patient harm if they make a mistake. This tool is meant to be a hands-on resource to help students study for drug calculation exams during school, but it also provides fantastic experience to prepare you for real-world nursing.
Another major safety concern is patient falls. Precautions here may include rounding on older patients more frequently or enabling a bed alarm for high-fall risk patients. You should also utilize a mental checklist every time you walk into a patient’s room, such as:
- Is the floor clear, especially the path to the bathroom?
- Can the patient reach the call light?
- Is the bed in the lowest position?
Adding these seemingly small things together develops a strong instinct for safety so when you enter a room, you automatically sense if something is out of place.
2) Forming Clinical Judgment
Your first year as a nurse builds clinical judgment on the foundation of all the knowledge you acquired in school. The ability to recognize potential or current complications that could cause harm is a strong asset to cultivate. This skill involves understanding the pathophysiology behind different disease processes and identifying the signs of improvement or decline. From there, the priority is determining the most important action you can take in the moment to ensure the best outcome for your patient. A textbook cannot teach you how to anticipate patient needs or develop clinical reasoning. You develop clinical judgment by applying your classroom knowledge to the actual patients in front of you.
As you refine your ability to assess patients and interpret clinical data, you reach the point where you can look at a patient and know something is not right—the monitors might look fine, but your assessment and instincts say otherwise. This is an important part of clinical judgment, and it is your job to dig deeper and advocate for your patients. Of course, this critical thinking must occur while also keeping up with scheduled medications at the same time that you are admitting a new patient and discharging another. Developing clinical judgment to juggle these moving pieces takes time.
3) Mastering Time Management
Time management is another key skill to learn in your first year of nursing. You should be able to look at your whole shift and plan a timeline based on medication schedules, planned procedures, and provider rounds. If all four of your patients have medications due at the same time, how do you organize your time so everyone receives their medications within an appropriate window? Many nurses have their own system of handwritten notes that they keep in their pocket to help organize their day. Asking to see your preceptor’s note system is a great way to get ideas during your clinical rotations in school or during the internship at your new job.
Structuring your day in the most efficient way possible helps develop a “clustered care” mindset where you complete a few tasks together so you don’t leave a room, only to return 15 minutes later. These organizational choices help you accomplish tasks in a seamless, resourceful way. The skill of effectively planning an entire shift comes with time. Do not be afraid to ask questions and learn from other nurses. Pay attention to colleagues who seem particularly organized and solicit their advice—even the smallest tip or trick can make your nursing practice stronger!
If you’re a nursing student, now is a good time to start thinking about your post-college budget. Believe it or not, finding a budget plan that works for you now will help you stay on track financially after graduation.
What can you do now that will make a difference when you are out of school? Educating yourself and trying out different methods of saving (and, yes, even spending) money is the first step in a successful post-college budget. There are many approaches to budgeting and what works for your parents, your best friends, or your classmates might now work for you.
Here are a few things you can do now to help get you ready.
1. Know Your Student Loan Amounts
This means more than knowing you have a certain dollar amount that you will owe once you are done with this round of school. You’ll need to take a look at your loans to understand when you need to start paying them back and what kind of interest you’re committed to. Some loans are fixed, meaning the interest rate you pay will remain the same for the life of the loan. Others are variable, meaning the interest rate can fluctuate over the course of the loan, and that means your monthly payments aren’t always going to be the same. Know the total amount you owe, when your payment begin, and how many months your loan is expected to take to pay back. Even more importantly, understand how much money it is going to cost you every month to pay your loans.
2. Think About Cost of Living
Once you know how much you’ll owe every month, start planning for other costs for your post-college budget plan. Think about what you spend money on every month now and if that will change. How much will it cost to find a place to live (including utilities and parking)? Figure out how much you will need for necessities like groceries and transportation (public or a car). There’s also the less fixed costs of entertainment, travel, clothing, and toiletries and household supplies to consider.
3. Plan for an Emergency
Unexpected costs happen. Cars break down, Living situations change. Health issues crop up. It’s a good idea to have the equivalent of three to six months of living expenses in a fund you can access. It’s probably hard to think of getting that amount now, but starting to build up that emergency fund now is good. Even five dollars a week will add up.
4. Consider Job Options
What’s the job market like in the area you plan to live? If you’re in an area where there are few options, consider looking at other locations. Decide how much of a commute you’re willing to have or if you want to move to an area where you can have more choices at jobs and salaries.
5. Estimate Your Salary
Now that you have a target amount of your costs, that helps you decide on how much of a salary you’ll need to live without going into debt. You should be able to make enough money to cover your expenses, have some savings, and (hopefully) have some left for fun. If you’ve got sticker shock from the first amount, this gives you some time to think of alternative ways you can still have the life you want. If you live in a high-rent area, getting a place with roommates can drastically reduce your living costs. With rent and utilities divided among many people, the savings is likely significant. Is there a way you would get a second job to make up the slack if you need to? What would work for you?
6. Look at Budget Styles
Get online and poke around to see what kinds of post-college budget plans are out there. From Pinterest to Debt.org to Money Under 30, you will find plenty of options to try out.
Budgeting isn’t the most fun task, but it makes an enormous impact on your life. The more you know before you graduate, the more control you’ll have over your choices.
With their state-of-the-art medical technologies and outstanding nursing programs, the United States has long been one of the most desirable destinations for international nursing students to enroll. As an international nursing student studying in the U.S., you’ll have the opportunity to receive a top-notch education that provides hands-on experience under the guidance of world-class nurse faculty members.
But before you can begin learning from leading experts in the field, there are a few important things that all international nursing students should know. Below, you can find out the crucial skills you need before enrolling in a U.S. nursing school, and how to set yourself up for career success.
1. Strong English skills are a must.
One of the most frequently asked questions of any international nursing student is, “Do I need to have good English to succeed in my program?” To put it simply: Yes, you need to have a good grasp of the English language to enroll in a U.S. nursing school.
Most nursing school programs will require you to take the Test of English as a Foreign Language (TOEFL) to ensure that you understand the language well enough to complete the coursework. This is true whether you’re a first-year nursing student or an experienced RN enrolling in graduate-level studies in the United States.
2. You need to complete prerequisite coursework first.
Before you can apply to nursing schools in the United States, you need to show proof that you have completed the necessary prerequisites for the program. International nursing students must fulfill these prerequisites in order to obtain an F-1 visa, which allows you to take up foreign residence in the United States for the duration of your program.
Once you’re accepted into a nursing program, your school admissions office will issue you an I-20 application form. The next step is to fill out this form and take it to the U.S. Embassy or Consulate, where you will pay a fee to submit your application for a student visa.
3. Take advantage of scholarships and financial aid programs.
Even for in-state students, the cost of nursing school in the U.S. can be steep. In-state nursing students can expect to pay anywhere from $3,000-$8,000 per year, depending on the type of education, location and the type of school (i.e., public vs. private).
As an international nursing student, you can expect to pay more than an in-state American student. Don’t forget to factor in the cost of housing, food, and all the basic nursing supplies you’ll need for nursing school. To help ease the financial strain, be sure to apply for financial aid and scholarships that are available to international nursing students. You can find out which financial aid opportunities are available to you by getting in touch with the admissions office of any nursing school you’re considering.
4. Buy everything you need in advance.
Studying in the United States for the first time can be overwhelming. With so much to take in, it’s easy to forget all the supplies you need before your first day.
Depending on when you arrive, you’ll want to figure out which medical supplies for nursing students in advance and order them sooner rather than later. This includes at least a few sets of scrubs, a good pair of slip resistant shoes and compression socks, note-taking supplies, a stethoscope, and a clipboard, just to name a few.
5. Study groups are key to your success.
Though you may prefer to study solo, don’t immediately dismiss the idea of joining a study group. As an international student, being part of a study group can make all the difference in your success. Studying in a group can help you retain more information from class, improve your test scores, and provide you with moral support from your fellow classmates. Additionally, working with a group builds teamwork and social skills, which are highly valued in the field of nursing.
6. Don’t be afraid to ask for help.
Nursing school is challenging even for those who are accustomed to U.S. teaching styles. If you’re struggling to keep up with the coursework or to understand a certain concept, don’t hesitate to reach out to your nurse educators. After all, they were once nursing students as well and have been in your shoes.
Though they may not know the exact challenges of being an international nursing student, they can help make your life a lot easier in several ways. Be sure to make use of their office hours and let them know what you’re struggling with. They may post their lecture slides online to help you study or work with you one-on-one to help you better understand the lesson.
7. Get comfortable with NCLEX-style testing.
Don’t wait to begin preparing for the NCLEX test. Instead, start studying for it while you’re enrolled in nursing school. This challenging test—which is required to become a nurse in the United States—can throw many students off with its different styles of questions. The format ranges from multiple-choice, order response, calculation questions, and select-all-that-apply questions, which can take some getting used to.
Fortunately, there are ways for international nursing students to prepare for the NCLEX test early. In addition to challenging yourself with a daily NCLEX-style question, you can also invest in practice resources offered by Kaplan, NRSNG and UWorld.
Being an international nursing student can be challenging. On top of social and cultural barriers, you’re also faced with undergoing a rigorous program that will put your skills to the test. Don’t let this dissuade you from pursuing your dream of studying nursing in the United States. By keeping the above things in mind, you can ace your nursing school program and go on to become a successful nurse.
If you are a nursing student, I would like to welcome you to the fabulous field of nursing! There is nothing more rewarding than serving in this meaningful profession. I anticipate you plan to practice in this arena upon graduating and passing the state board exam. However, be cognizant that one of the most challenging transformations your nurse educator will be responsible for will be in assisting you to become a professional in the medical field.
I know that you think that your instructors are always nagging you about your appearance, but at the end of this process, you will understand how important this transition is in order to socialize you. You have certainly heard educators discussing first impressions and how important they are in establishing credibility and rapport with your patients and with the health care team. As health care professionals, our demeanor affects everyone around us while we are on duty. Since I am a nurse educator, I would like to disclose some of the dos and don’ts of your daily conduct that you should be aware of as a student entering the nursing profession.
Let us start with the basics: punctuality. Have you ever heard the statement that when you are on time, you are late and when you are early you are on time? This applies to both the classroom and clinical setting. It is disturbing and disruptive as latecomers arrive to the classroom once lecture or testing has begun. As you enter the room tardy, open and close the door, remove extraneous clothing (coats, scarves, etc.), retrieve necessary items from your book bag… Well, you get the idea. While you catch up with the rest of the class, your colleagues have preceded you in doing so. Consequently, the energy in the room shifts as you now settle in for a long day of studies. Have you considered how your lack of punctuality affects those around you? Maybe it is time you do so.
You may ask, “How about makeup? How much is too much?” My answer for this is that if you are putting false eyelashes on before attending class and clinical, you clearly have too much time on your hands. Why not spend those extra 10 minutes reviewing notes taken during lecture or take a quick peek at those index cards? Why not work on those intravenous drip calculations you have been struggling with? It only takes a few minutes out of your day to commit to tackling the less desirable tasks. Facial makeup now takes second place once you realize that the extra minutes you use to embellish your outward appearance would be better spent on nurturing critical thinking skills.
Do you ever have downtime? By this I mean the time you have during breaks and lunch. How do you spend this time? Watching kitten videos, catching up with the celebrities, or perhaps finishing a movie or television show? I tire of overhearing the latest on the pop stars—the Kardashians, etc. You must know that your instructors are observing you and that we are very much aware of what occupies your time. No, we are not telepathic. We know by the incomplete homework you turn in (or not) and by the multitude of excuses you have for late assignment submissions. We know by the test scores that you feel are acceptable, even when we, as instructors, know you can perform academically better. I implore you to spend all the time that you have honing your skills for nursing. There is plenty of curriculum to embrace, so do so every moment you have. I promise you will not be disappointed.
It is not cool to have your shoelaces or velcro straps untied. This look appears anything less than professional. It is hard to take anyone seriously who has not taken the time to attend to such details before entering the clinical arena. Another detail worth addressing is gum chewing. Along with the former offenses, it is difficult to accept that the person who is chewing gum is focused on anything other than smacking idly while passively listening or speaking to their audience. In my profession, potential candidates for employment were simply dismissed during an interview because of gum chewing. Do not let this be your fate while seeking employment.
Confine all cracks, cleavage, tummies, and tattoos for activities aside from nursing. Let me be clear: cover all external crevices at all times while in uniform. Having these body images in view is unprofessional and if you want to be taken seriously, save this look for socializing (e.g., dating, clubbing, or spending weekends with friends). Your patient nor your instructor desires to be distracted.
While we are noting external appearances, there is a reason for us to request that you not wear jewelry larger than stud earrings and a wedding band. The focus on you should not be about your taste in jewelry. Jewelry is a vehicle for the transmission of germs, and while I am addressing the chain of infection, allow me to broach the topic of nails. Remember your lecture on infection control: hand washing in between patients, before and after meals, after smoking and toileting? You discovered how microbes harbor under long nails and in cuticles. The studies have been done, and the results are in. Nails are to be no longer than one-quarter of an inch. You cannot effectively palpate or percuss body contours and abnormalities with long nails.
Uniforms: the glorious look of a uniform, but only if it is clean and ironed. No wrinkles are allowed on uniforms or lab coats. Your first impression from your mentors and patients should exude professionalism as noted in unsullied and tidy apparel. Your patients want to know that they are safe with you—that you will protect them, not infect them. Not only does appearance count but so do scents. I will take the fresh aroma of antiseptic soap from thoroughly washed hands any day over the stench of cigarettes. While you are observing your patients, let it be known that they are observing you, too. Leave them with an impression you can be proud of. Think about your appearance this way: when you are practicing in the clinical setting, you are interviewing for potential employment.
When you are in class or clinical, you are in a work zone. No cell phones allowed! Please stop checking them. Instead, check the cell phones at the door and place them on silent, in your pocket, or in your car. I am looking forward to the day when administrators will mandate that cell phones be left with the instructor or outside of class and clinical altogether. I am aware of the potential family emergencies, children, health-related issues, etc. There must be arrangements for emergency calls. If a protocol does exist and despite this, we find our students clinging to these electronic devices making it difficult for instructors to maintain our students’ attention. For example, during clinical orientation (I am ashamed to say) students and educators are now being in-serviced regarding prohibiting cell phone use. Cell phones are not to be used in the facilities while practicing. It should be common sense that when you are at work, you should not have time for texting, checking emails, or Instagram. You should be working, which means meeting the needs of your patients.
In meeting patient needs, how do you communicate with them? Do you use “honey,” “sweetie pie,” or other affectionate terms with your patients? This is unacceptable as it is highly probable that your patients are older than you and as such, deserve your utmost respect. Along with respect for your patients, I would also like to add appropriate communication to use with your instructor: never use obscenities. You will develop a plethora of new words in this profession, none of which is profanity. Good communication skills entail proper dialogue with your instructor, among colleagues, patients, and health care providers. Using the last name with the prefixes Miss, Mrs., or Mr. is acceptable unless your patient has given you permission to call him or her otherwise. And how will you know how you should address your patients? If the patient does not inform you that they would like to be called by another name, simply ask them after having addressed them formally. You will always gain the respect of your patients by being respectful.
Did you know that your posture and gait say so much about you? Walk like you have purpose. Strut up that hallway and answer those call lights as if it were necessary, because it is. Exhibit energy and enthusiasm as opposed to being lethargic. You may be tired, but keep it moving! Your patients want to know that you have the vigor required to take care of them. For this emotionally and physically exhausting profession, I would advise you to follow the Beatitudes: be well rested, be fit, and be well nourished. Nursing is a taxing profession. Take care of yourselves so that you can take care of others.
When Carolyn A. Chow, MA, currently an HR recruiter and inclusion program lead at Cornell University College of Veterinary Medicine, was the director of admissions and student diversity at the University of Washington (UW), she co-founded their successful UW Nurse Camp, which still continues today.
“For schools and colleges who want to make a longitudinal difference in the future of nursing and health equity, a program like UW Nurse Camp is a win-win for high schoolers, current nursing students who are mentored to be leaders, and nurses who want to make a difference in the lives of the high schoolers who shadow them,” says Chow. “Costs to run the program are completely covered by community donations.”
Chow took time to answer our questions about the camp.
You co-founded the UW Nurse Camp in 2009 while on staff. Why did you start it? Had you been thinking about it for a while?
We had a very dedicated team of student leaders who wanted to create a group that was for building community and mentorship opportunities among students of color in the nursing program. In 2007, we sat down to talk about ways we could do that. So, UW Nurse Camp became a way we could have underrepresented students have professional mentors, be mentors to fellow students and high schoolers, build community through a specific year-long project, and to provide a pipeline of “first in their family to go to college” as well as underrepresented-in-nursing applicants who would get support from UW School of Nursing through the program. It took two years of fundraising in the community and organizing before we launched the camp in summer 2009 with 24 campers. In 2018, the camp expanded to hosting 36 campers.
What is nurse camp, exactly? How long does it last and who attends?
UW Nurse Camp is a five-day, Monday to Friday, 8:30 a.m. to 4 p.m. day camp. This year’s camp is July 15-19, 2019. UW Nurse Camp accepts applications from February 1 to April 15. High school sophomores and juniors who are underrepresented and/or first in their family to go to college are encouraged to apply. While most applicants are from Washington state, the camp has also had campers from California, Oregon, Maryland, and Illinois.
UW Nurse Camp is run completely by staff, nursing students, and community volunteers. Former campers who became UW BSN students are mentored to be UW Nurse Camp Leads, where they run the program so they can “give back” by sharing their success stories and serving as inspiration to future campers.
What do the high school students learn at UW Nurse Camp?
The curriculum for UW Nurse Camp is designed to introduce high schoolers to the profession of nursing and everything it has to offer as a meaningful career. We focus on what a powerful difference diverse high school students can make in the promoting health equity. The sessions are taught and supervised by current and diverse UW Nursing students, alumni, staff, faculty, and community members. Campers also shadow nurses taking care of real patients and their families at the University of Washington Medical Center (UWMC).
From the UW Nurse Camp website:
- Shadowing nurses at UWMC in various hospital units
- Completing CPR certification and HIPAA training
- about infection control and proper hand washing techniques
- how to take blood pressure and vitals
- how to prepare for college and getting into nursing school
- in the School of Nursing learning and simulation lab and UW Medicine’s WWAMI Institute for Simulation in Healthcare (WISH) Lab
- Participating in nursing “speed rounds,” where you will meet and talk with nurses working in all areas of health care, including forensics, public health, emergency and research
- Touring the UW Seattle campus
Why is it important to have this? What does it bring to the students that they may not get otherwise?
UW Nurse Camp is so important for students at all levels. Campers have access to a program that supports and teaches them about nursing and college educational opportunities. They get ongoing mentorship throughout camp and then continued support beyond from UW nursing students and alumni who are professional nurses. They meet diverse nurses in all different areas of nursing. In addition, they are continually advised by admissions staff on how to apply successfully to the UW BSN program and ways to prepare themselves to be competitive nursing applicants.
Current UW students are mentored with UW Nurse Camp as a leadership program. As UW Nurse Camp Leads, the students volunteer their time and efforts through the entire academic year to plan the UW Nurse Camp experience, including engaging in professional communication with camp speakers and instructors. They are mentored by School of Nursing staff in advising and youth program risk management. Additionally, the nursing students conduct the UW Nurse Camp admissions process.
Would you like to see this branch out and be something that other nursing schools offer? Why?
Absolutely. This is an incredibly successful program that supports underrepresented and first in their family to go college high schoolers in their journey to become professional nurses. They get to see diverse nursing students and professional nurses in action. The students also have inspiration and validation that they can make it through the nursing admissions process, and they gain networking contacts to support them throughout their process of graduating from high school, getting volunteer opportunities, completing prerequisites, and applying to college and nursing school.
Do most students who attend end up going into nursing? How do you think that UW Nurse Camp influences them?
According to a survey of former UW Nurse Campers, 50% of attendees pursued or are pursuing nursing. Another 30% pursue other health care careers. Finally, 20% opt for non-health-related majors. UW Nurse Camp influences them because as high schoolers they get access to professional nurses and clinical situations at the UWMC as well as support from UW nursing students, staff, and faculty. They gain access to role models in nursing who are committed to helping them to succeed in the profession. UW Nurse Camp demystifies the journey to becoming a nurse.
Interested in learning more about UW Nurse Camp? Visit here.
With the recent groundswell of the MeToo movement concerning sexual harassment and power inequity, it’s no surprise that industries across the board are reevaluating their working cultures. Health care is no exception and the recent Time’s Up Healthcare movement is gaining attention.
The movement began as a response to the Time’s Up Foundation’s widespread success at promoting safe and healthy work environments and calling attention to how power plays a role in harassment people experience in the workplace.
Time’s Up Healthcare’s website states a mission “to unify national efforts to bring safety, equity, and dignity to our healthcare workplace.” The organization, in partnership with organizations such as the American Nurses Association, American College of Physicians, and the Council of Medical Specialty Societies aims to call attention to the disparities in health care workplaces and the undue burden that kind of culture can carry.
When nurses work in an environment where they are concerned about their own safety or that of their colleagues, the quality of care they can give to patients can be disrupted. The distractions caused by an environment where sexual harassment is either accepted or present but expected to be ignored are enormous. Health care workers in those situations can feel the implications of that stress physically, mentally, and socially.
Instead of being able to concentrate on giving the best care possible, health care workers must constantly weigh the risks. They are required to take the temperature of their workplace and wonder what kind of retribution might happen if they speak up. The cost of speaking up could mean losing their job or even enduring additional threats.
Workplaces like this are entirely unacceptable. Time’s Up Healthcare is shining a spotlight on what’s happening and why it needs to change. The movement is hoping to also build a support network where people who are impacted by harassment at work can go for resources and direction. They also hope to promote an awareness around the issue and exactly the kinds of situations or scenarios that might fall under this kind of problem.
With that aim, the organization hopes to help eliminate this problem. Through education and trainings, harassment and power inequity can be challenged, examined, and eliminated.
Harassment is not okay. Nurses and other healthcare workers deserve better. Their patients deserve better. Time’s Up Healthcare is taking that big leap.