Memorizing Content for the NCLEX

Many graduate nurses who are preparing to take the NCLEX are wondering to what extent it is necessary to memorize content. There is a strong emphasis on critical thinking in nursing programs, and rightly so. Nurses are often in novel situations with patients that they need to be able to reason through, because every patient and hospital are different. However, in order to be able to critically think, one must first have acquired the requisite background knowledge. For example, before answering the question below, it is important to know where the mitral valve is and what happens when it becomes stenosed, as well as the sequelae for a heart attack and the effects of long cancer and high blood pressure on the heart. So, the general advice to students is to focus on weak areas in pathophysiology and pharmacology. Use flashcards, videos, notes, worksheets and whatever other means are most helpful to review content. Only then should one move onto practice questions, making sure to also review the rationale for questions that were answered incorrectly. Memorization might not be fun, but it is necessary to pass the boards.  

1. Which of the following patients are MOST at risk for developing heart failure? Select-all-that-apply:

A. A 69 year old male with a history of alcohol abuse and is recovering from a myocardial infarction.

B. A 55 year old female with a health history of asthma and hypoparathyroidism.

C. A 30 year old male with a history of endocarditis and has severe mitral stenosis.

D. A 45 year old female with lung cancer stage 2.

E. A 58 year old female with uncontrolled hypertension and is being treated for influenza.

Teamwork Makes the Dream Work

One of the most important attributes of a successful nurse is his or her ability to not only collaborate inter-professionally with physicians, respiratory therapists, physical therapists, pharmacists, and many other healthcare professionals but also to work well with the other nurses in the department. As a new nurse, this can look like offering to help your new colleagues when you are not busy with your own assignment. You can also volunteer to join a committee on your unit if your hospital participates in shared governance. This not only shows them that you are interested in being a good team member but also offers you the opportunity to learn something new. As an experienced nurse, working well with the other nurses on your unit can look like volunteering to preceptor new nurses, offering to give a colleague a hand with a particularly difficult assignment, or even offering emotional support after a loss, poor outcome, or difficult family interaction. It is never wrong to offer help instead of sitting at the nurses' station and to make it a point to check in with your coworkers. Remember, there might be a particularly challenging shift when you are the recipient of assistance and realize how valuable it can be.

Nursing is a hard job, both physically and emotionally. But, there have been some very challenging shifts that have gone quite smoothly because the entire team put aside their differences and worked for the benefit of the patient and each other. There is no place in nursing for gossip, talking behind a colleague's back, snapping at one another, or any other negative behaviors. Not only does it destroy morale on the unit, it also impacts patient care. Research has shown that effective teams have better outcomes.

"Patient safety experts agree that communication and teamwork skills are essential for providing quality health care. When all clinical and non-clinical staff collaborate effectively, health care teams can improve patient outcomes, prevent medical errors, improve efficiency and increase patient satisfaction"-  from the American Heart Association Website,efficiency%20and%20increase%20patient%20satisfaction.

Passing the NCLEX

Another student success! One of my students took the exam on Tuesday and just found out that she passed. I shed a happy tear on her behalf. I am happy to have spent this summer working with many students who are second-time and third-time NCLEX test-takers. They have studied hard and applied themselves to their studies in order to pass the exam this time around.

My best advice to nursing instructors is to encourage your students, and also help them to learn how to approach NCLEX-style questions. It can be so helpful for students to go into the exam with confidence in themselves, and understand how to break down the questions. Students whose confidence has been shaken in nursing school are more likely to doubt themselves during the exam, so it is important to give them encouragement as well as constructive feedback on their learning.

My best advice to students is to make flash cards (or use whatever other memorization techniques you find helpful.) The NCLEX questions expect you to be able to apply your knowledge, but it starts with knowing the meds, lab values and diseases. There is no shortcut except to memorize! My other piece of advice is to work with an experienced NCLEX tutor to develop a personalized study plan and focus on the specific areas that need attention.

Becoming a New Nurse

Many nurses are entering the workforce for the first time. There are many people to meet and nursing skills to learn. Remember, though, that anyone can learn to drop an NG tube. What you bring to your unit and your patients is much more valuable. You bring YOU! Every single person on your unit has something to contribute, including the newbies. You can help your colleagues to realize new ways to think about a clinical problem, or approach an inefficient task, or handle a patient situation. Some of the most important skills in any job are "soft skills". These include the ability to lead, handle conflict, inspire, motivate, and communicate effectively. Think about what makes you unique, and what you bring to the unit. Then, remind yourself of this before each shift. There are going to be many instances during the first six months when you do not know what to do and have to ask for help, and that's okay! 

Your colleagues may or may not be supportive of new nurses. We are all aware of the reputation experienced nurses have for "eating their young". Sometimes, they become defensive because a new person on the unit means that they are challenged to think of and do things in new ways. First, please don't accept poor treatment. Talk to your leader, and if they are not responsive, then talk to someone who will be supportive. Second, remember that you do have skills and knowledge to bring to the table. Your knowledge is current because you just graduated from school. You have lived experiences that are different from anyone else's. Your way of relating to a patient family may be just what they need during a particularly hard day. Finding a supportive mentor can make all the difference, but even if you cannot do that, you can remind yourself before every shift that you are a valuable part of the team whether others recognize it or not. Now, go out and learn with confidence! 

Pediatric Nursing

Pediatric nursing is a specialty that is both unique and specialized. It can be daunting to start caring for a child, especially if you do not have much experience with them in everyday life.  Some students come to pediatrics with vast experience with younger siblings or have babysat quite a bit. Others have had little experience with young children. Becoming comfortable working with children in a healthcare setting can take a while, so do not be surprised if this is not something you feel you've mastered by the end of the semester.

Caring for children and their families holistically can cover the entire spectrum from providing health advice to the parent of a newborn over the telephone or at well-child visits to caring for sick children in a clinic or outpatient setting,  all the way to providing acute and intensive care in a pediatric hospital.  At the core of pediatric nursing is the care of the entire family unit and a love of teaching. Since the parents or guardians will be the ones taking care of the child at home, nurses spend a lot of their time across all settings teaching skills, from supporting child development to recognizing and treating a fever, to advanced skills such as taking a blood glucose reading and administering insulin. Learning to assess the families' strengths and teach to these strengths, adapting the care plan to meet the needs of both the child and the caregivers, and providing teaching in different ways (written, visual, videos, hands-on) are at the core.

Assessing younger children is also very different from assessing adults.  Most adults can hold still while a blood pressure or other measurement is being taken. However, with young children, distraction, cuddling with a caregiver, and other techniques are often used to help the nurse to complete the assessments and cares needed. Learning how to play with children and being attuned to their interests (cartoon characters, sports, etc) is helpful. Ask any pediatric nurse, and I'll bet that they know who Bluey and Bruno are!

I hope that you enjoy your journey into pediatric nursing. Be open to learning more about children and their unique needs, and it will serve you well no matter which specialty you may find yourself in, because children are an integral part of all of our lives.

What is Community Nursing?

Community nursing is a unique specialty that often does not receive a lot of attention. If you ask a member of the general public what they think of when thinking of a nurse, they usually say that it's someone who works in a hospital taking care of patients. However, community nursing has a rich history tied to public health in our country. New York City was one such example. Near the turn of the 20th century, nurses began providing care in the poor sections of the city where recent immigrants lived. Their goal was to help improve the health, living conditions, and knowledge around how to prevent the spread of diseases. At that time, infectious diseases were spreading quickly through crowded living conditions, and sanitation measures were not readily available. Essential interventions like hand washing, cleaning, and proper food storage were used to prevent the spread of infections in an era before antibiotics or the widespread availability of vaccines.

Today, community health nurses practice in areas such as clinics, schools, places of worship (parish nursing), and at public health departments. They focus on health education, care of chronic conditions, and preventative measures such as vaccine administration. 

Waiting for permission to test

In many states, there can be considerable delays from the time that a school of nursing submits the names of its graduate who are eligible to sit their board exams and the time that the graudate can test.  Many states have limited personnel, limited technology or other factors that make it difficult to process paperwork promptly. Once the test is complete, there is another delay for the license to be issued.

It is important to make the best of this time while waiting. Some graduates choose to work as certified nursing assistants or nursing interns while awaiting their licenses.  Others choose to take time off of work to devote exclusively to studying. There is no correct answer in this case, but make sure to use this time to your advantage to continue learning or sharpen your bedside skills. Your future self will thank you!