Top 10 highest paying nursing specialties (via http://scrubsmag.com/)
After you finish nursing school, or if you’re considering going back for more training, choosing the right nursing specialty becomes your chief focus. With so many specialties to choose from, many prospective nurses find it difficult to just pick…
Everyone who’s anyone know about the new technological issues we are facing with workplace professionalism and social media. The debate over what employers should be able to judge you on when you are “off the clock”, and what is your personal and private life is a hot topic. So is there are growing movement to counter this on twitter? I think so! Many people see social media as a way to communicate their thoughts or feelings with others who they may or may not know. They find commonalities in agreements and disagreements, but somehow, this new outlet of self expression is now being censored because people are afraid of what their employers may see, think or act upon. So in stifling this self expression has caused an emergence of those who call themselves “anons”. They are individuals in the medical and healthcare field who create accounts under a medical theme and feel free to talk about anything they want without threat of their words biting them in the ass later.
There is now a whole community of Anons on twitter: Doctors, RNs, Nursing Students. Much of what is posted is nursing advice, sarcastic jokes, banter, vague but hilarious stories. I follow several Anons and enjoying catching up on my tweets every morning in place of a newspaper – trust me the tweets are much more amusing.
So is this a good thing, or a bad thing? I am pro-anons. I feel that this is a great outlet of self-expression and a perfect answer to the employment bombardment on our private lives. Yes using social media is allowing your private life to be shared, but I don’t believe that your personal life has anything to do with your professional performance. Looking back into history we have had many great leaders who were struggled with demons in their personal lives, and yet, they got the job done.
Are you thinking about becoming an Anon, or following some? Search for names like Nursing Anon, Premed Student or Nightshift MD – there are so many. Follow one and see the similar options provided by Twitter, that is a helpful way to network the anon community. If you are becoming an Anon, think about you name, that is what people will be basing their decision to follow you off of.
So join the community, reclaim your self-expression and live without fear! Social media is a powerful and wonderful thing, lets share the knowledge and love around in the healthcare community!
This has nothing to do with tampons in the heart ok! Just an FYI.
When blood or fluid accumulate in the sac which surrounds the heart it exerts pressure against the heart, making it harder for the heart to pump. As you can imagine, if the ventricles cannot fill fully or contract effectively then cardiac output decreases. Decrease cardiac output is not good news!
So how do you know if someone has this?
Well the symptoms are nothing unusual: chest pain, restlessness, quick shallow breathing, palpitations, pallor, tachycardia, weak peripheral pulses, pulsus paradoxical, distended neck veins, low BP… (do these all sound a little familiar? MI anyone?) Well causes of cardiac tamponade can be MI, Dissecting aortic aneurysm (thoracic), end-stage lung cancer, heart surgery, Pericarditis caused by bacterial or viral infections, or direct wounds to the heart.
How do we diagnose? Echocardiogram is the usual diagnostic tool, but MRI, CT, CXR or EKG can also highlight or confirm this.
Can you see the halo of fluid around the heart?
This is an emergency! The fluid must be drained to reduce damage to the myocardium and reestablish cardiac output.
Pericardiocentesis is a procedure that uses a needle to remove fluid from the pericardial sac, the tissue that surrounds the heart. The patient will be hyperoxygenated, given fluids to maintain blood pressure. It is important to note that a pericardiocentesis may have to be repeated because cardiac tamponade can return. With fast treatment the outcome is usual good, without treatment death is immanent.
A pericardial draining tube may be placed during surgery to keep in place postop. The drainage will be measured every shift and documentation on the color, amount and consistency is very important! The tube will usually be removed slowly over the postop recovery weeks at the discretion of the cardiologist.
Say it with me: AIRWAY, BREATHING, CIRCULATION!
If you have renewed CPR with AHA recently you’ll know that they have changed that to CAB from ABC, but for NCLEX you need to stick with the ABC.
So here comes that irritating priority question. You try to apply Maslow but all options are physiological, so there is nothing to eliminate. What do you do? You apply the ABCs.
Airway will always be the most important factor to take priority: anaphylaxis? Choking? So look for it, if it isn’t there, look for breathing, it could be simple like raising HOB to decrease dyspnea in a CHF pt – keep focused on the “B” until you can rule it out. If no luck at that point, move to circulation. Hemmorhage? Potential for bleed? Change in vitals (↑HR, ↓BP)?
Look at the big picture and apply all the ABCs and use them to lead you to the right answer! Priorities will always contain ABC/Maslow or combination! Use your question answering skills! 🙂
So I thought I’d write about chest tubes this week because I had a patient with two chest tubes and was post removal of a pericardial tube also. Not only that, but a colleague had a young pt in his 20’s whose chest tube popped out on the same day! Needless to say I thought it would be a great topic to cover. I’ll break it into three postings
Firstly, chest tubes aren’t as scary as they appear: sure, they are stuck in someones chest but there are many different reasons for a chest tube so knowing a thorough background on your pt is very important.
The procedure for placing chest tubes is called a Thoracostomy.
Reasons for inserting a chest tube:
Pneumothorax: This is when air collects in the pleural space; can also be referred to as a “collapsed lung”. The air pressure in the pleural space does not allow the lung to reinflate.
Pneumothoraxes can occur after central line insertion, after chest surgery, after trauma to the chest, or after a traumatic airway intubation. It is very important to remember that if the air continues to collect in the chest, the pressure in that pocket can increase and push the whole mediastinum over to the other side – this is called a “tension pneumothorax”, and is life-threatening.
Hemothorax: This is is when blood fills/pools in the pleural space and reduces the area for lung expansion. This can happen due to trauma or surgery. There is a possibility of having a hemo-pneumothorax which means air and blood fill the cavity. Also there remains the risk for medialstinal shift “hemo-tension-thorax”, this would be an emergency.
Pleural Effusion: This is the accumulation of fluid in the pleural space. This can be caused by CHF, liver failure, kidney failure, peritoneal dialysis, pneumonia, lymphoma or breast cancer. Though most pleural effusions are caused by congestive heart failure, pneumonia, pulmonary embolism and malignancy.
Empyema: This is when pus is the substance which fills the pleural space. This is clearly cause by infection, but the pressure of pus in the pleural space makes it difficult for pts to breathe freely, they will likely have fevers and chills, malaise and chest pain.
While in clinicals I met a lot of other students from other schools. I was always amazed at the camaraderie and closeness of their clinical groups, unfortunately mine was just not like that. There were times when I thought that it was me, maybe I wasn’t embracing my classmates or I was distancing myself; then over time I realized that I just so happened to be put in a group of people which just didn’t work well together. 
Very much like some of the units I worked on – sometimes the characters just don’t mesh and it alters the whole atmosphere of the unit.
I know friends from other nursing schools who have made life long friends through the bonding that nursing school fosters, but for me, I’ll probably never see or speak to my clinical group classmates again.
One thing I believe is that nursing school is what you make of it. I chose to buckle down, fight through it and stay focused. I have never been a slacker, and so I couldn’t connect with those in my clinical group who would slink off the unit for a long trip to the cafeteria or for a quick cigarette outside. I was there to learn, and would totally kick myself if I missed a learning opportunity. This mentality automatically separated me from the group, and ultimately caused a cold and nonchalant ending at graduation.
So why am I writing about this? Well because there may be someone reading this who feels the same way about their clinical group or nursing class. They have no-one in there that has their back, and in nursing school that really can make all the difference.
Luckily for me I had a very good and loyal friend in a different clinical group who I had all my other classes with, and together we helped each other through. I am so happy that my friend and I are such good friends and have shared our nursing journey together. She now works as a Med-Surg nurse in a huge healthcare system in South Florida and I’m a Telemetry nurse – we still call each other to celebrate our nursing triumphs!
Although my clinical group was a letdown, the fact is that sometimes you just have to make the most of a situation knowing that your apart of a dysfunctional team. Nothings to say that you won’t walk out of nursing school and find the same situation on your unit – the mix of people make the culture of a unit, so hopefully the former experience will lend some guidance. I feel that I learned a lot from my letdown, and even so I still wish all my old classmates much success in their nursing careers.
It is true that healthcare is a fantastic career direction. Guaranteed employment, flexibility, variety, self-fulfillment and the list can go on… BUT, as a new graduate still wet behind the ears soon finds out, getting your foot in the door is the biggest challenge you’ve faced yet. Now there are always exceptions to the rule, and those who have an “in” at a facility or family member to help etc; but for those of us who have no helping hand, we are greeted by the cold hard fact that all healthcare employers want EXPERIENCE.
So how can one gain experience without securing a job requiring experience? Hence, our dilemma.
Getting around this is a difficult task, and demoralizing for most. Though, I have found that the main aim in this challenge is for your personality to jump off the resume page and get yourself into an interview. Many things can change during an interview: a face to a name, an impression, professionalism, self-expression, presence etc. All of these things can expunge the need for “experience” if you can give the employer a presentation of your competence and comportment during an interview. You build faith in them, that “you got this!”
So why then do some sink and some swim? Well there are two points of failure in my eyes: 1. Getting the interview, 2. Failing the interview.
1. In order to secure an interview you have to be aggressive about it. Yes, that may mean a little stalking, hounding, whatever other creepy adjective you want to use. I advise if you are seeking employment at a hospital, bug the switchboard. Call and ask for the name of the nurse manager, nursing director, or other title for the area you desire. Once you have the name ask to get put through to their phone line (more often than not they will not pick up), if you get to speak to the person, make a good introduction. If you have to leave a voicemail, introduce yourself and state that you have recently put in an application at HR and would love to talk further about opportunities available in [whatever area you desire]. At the end thank them for their time, request that they get back to you at their earliest convenience and repeat your name and leave your number. A voicemail is almost better in this case because it allows the contact to save the message and look up your application later when they have time, rather than trying to write down your information whilst talking with you. Furthermore, Google the name of the contact you got from the switchboard, maybe an email address will pop up. If so email the address in a formal, professional manner, stating the same as in the voicemail, include a copy of your cover letter and resume (personalized to the individual).
2. Sealing the deal in the interview comes down to a couple of things: looking the part and saying what they want to hear. Depending on your career choice, make sure you have your information straight before sitting in front of a potential employer. For nurses, find out the motto and mission statement of the hospital. Go over some common interview questions prior to the interview; think about your weaknesses, strengths, stories which display these, where you see yourself in 5 years, and why you are a good fit for the hospital/facility. Remember this cannot come across as rehearsed, but that something will spring to mind when you are under pressure. Giving account of good customer service is always a positive thing, particularly because hospitals are relying on this element for reimbursement. Lastly the best price of advice I can give for an interview – remain true to who you are. Lying increases pressure and will likely be noticeable, if there is an awkward question, it would be better to avoid a controversial topic rather than lying. I know that my honesty, enabled me to come across as natural as possible when interviewing, and it definitely worked in my favor.
So let the battle commence, don’t ever give up or lack self-confidence because you cannot find a job, it is simply the nature of the beast, and no one can prepare you for it. If you are currently in clinicals, I advise you start cultivating relationships with the nursing managers and other staff there, to make a pathway for a job after graduation – it will cut out a lot of hard work and crap in the long run.
Now when you look at job postings and they state a requirement of 1 year, screw them! Send in that app anyway! Why? Well because you only need to get to the interview, then you got this in the bag! Persevere, be tenacious, stay positive and never give up!
I’m gonna give you a little insight into my first experiences in nursing as a student. Some of it is funny, some of it is sad and some of it it plain ole’ X rated haha! I’m mainly writing this because when I first switched my major to nursing I tried to do a lot of research into what it really is like to be a nursing student: what’s difficult? What’s the best bit? Worst bit? Etc. I worked with a girl who was currently in an AS nursing program, but she wasn’t much help to be honest (I realized when I became a nursing student, that no-one really understands what a nursing student is going through except a nursing student, so she flat out didn’t even try to scare me with the deets).
So let me begin by hoping that my insight through this blog can help everyone, but particularly those nursing students or pre-nursing students who have NO medical background at all – I was one of you. (Yes you smarty-pants CNA‘s you already know all about it, this isn’t for you guys lol!). My pharmacology prior to nursing school consisted of Tylenol and Motrin. I had been to the ER three times as a child, but never for anything major, the usual kid stuff: sprained ankle, needing eye wash and I trapped my fingers in a car door – yes that sounds stupid now, I know. I honestly knew zero about nursing. No family members had even finished college, let a lone entered a medical profession. I really had no idea what I was getting myself into.
The biggest shock hit me on the first day of clinicals, those of you already in clinicals can probably guess what I’m going to say.
The biggest shock was – NAKEDNESS!
Seriously, I was bombarded with saggy boobs and more abdominal rolls than I even thought anatomically possible. As someone who enjoys my personal space and certainly maintains other peoples, I found myself really uncomfortable touching all these body parts and all that skin. The best part was that most of the old people didn’t care at all! Old men would ask me to put their penis in the urinal and I had to be OK with it, they couldn’t do it for themselves. Many of my first patients were stroke patients, and by being thrown into mostly total-care situations, I learned very quickly to be comfortable in other people’s personal bubbles, but still being sensitive that I was touching someone. I tried to use empathy in every situation, and somehow the nakedness began to blur into the busy day and eventually I didn’t notice it at all.
When patients come into the hospital, many of them are not prepared for the amount of “touching” that is necessary to fulfill nursing care. It is so important to ask permission to touch someone and ensure they are comfortable with you assisting them in personal tasks. For the majority of my patients it was not their first rodeo and they quite enjoyed the help, but for those who are admitted for the first time or have cultural differences, this can be a big shock therefore, as nurses we need to show sensitivity and cultural competence in these situations.
For those of you which are pre-nursing – Congratulations, if nursing really is for you, it will be the most patience testing, trying, exhausting and fulfilling thing you ever do in life. For those of you that are in it for the money? I’ll be generous and give you a year at it. If it’s not for you then don’t waste your time, you have to have a genuine desire to qualify. Period. Just wait until your first anal suppository! *High five!
So embrace the nakedness! Let’s face it, we’re all naked under our clothes anyway! 🙂
EKG TIME! (For basic understanding)
Ok so for many the EKG is a weird and wonderful map of squiggles, but actually each little squiggle is very important in translating the conduction of the heart. From your A&P course you should know that the normal conduction of the heart starts in the SA node in the Right Atrium, it travels to the AV node in the wall of the right atrium (middle of the heart), then through the Bundle of His/Left & Right Bundle Branches and down through the Purkinje fibers. The EKG is basically a map of that scenario. Imagine that you are in a car in San Antonio (SA node), you need to drive to Aventura (AV node), then you go through the spaghetti junction (Bundle of His) while heading to Pittsburg (Purkinje fibers) – if you were to use Google maps, you would have the route highlighted out on the roads you have to take, right? Well that is basically what an EKG is! It is the highlighted route the conduction took through the heart.
I hope that has given you a little clarity on those squiggly lines, haha!
Now what does the map tell us?
As you can see we use letters to signify different areas of the squiggle. You can see that P is a little bump at the beginning. This is showing us that the atria of the heart are depolarizing (another fancy word for compress or pump). The atria is pushing the blood into the ventricles. P shows that the car has left the SA node in the Right Atrium and is traveling to the AV node in the middle of the heart. From P to Q (called PR complex), the car then leaves the AV node and travels down through the Bundle of His. One the car travels out from the Bundle of His down the Bundle Branches, through the Purkinje fibers and the rest of the heart so a QRS complex occurs. The QRS shows that the ventricles have received all the blood from the atria and pumps it back out to lungs (right V) and aorta (left V). And with that you have just witnessed a heartbeat.
Well what about the leftover squiggles…
So between the S and the T (called the ST segment), we see the heart recovering from the heartbeat, otherwise known as Ventricular REpolarization. Think about clenching your fist really hard and then relaxing, that is in essence what the heart is doing. The ST segment is very important to monitor on an EKG strip because if you are looking for something pathological, such as an MI, you might just find it here with ST segment elevation. This would mean the patient would be diagnosed as having a STEMI. We could continue this further, but we’ll save the pathological changes for another time.
So following the T wave, the heart is now ready to complete another beat! We have come full circle!
I hope you found this helpful, it is purely for basic understanding, EKG’s can be much more in depth! My best advice is so search YouTube for videos, as visualizing this is the best way to learn what it going on inside the heart!
Good Resources:
http://www.youtube.com/watch?v=7b98JcGIGyE
http://handwrittentutorials.com/
Rapid Interpretation of EKG’s 6th Ed. – Dale Durbin (really good book)
Hello One & ALL!
I have created this blog as a way to connect with other RNs and become a resource of learning for nursing students. I remember when I was a nursing student. I knew nothing about nursing. I wasn’t one of those people who was a 5th generation nurse, no-one in my family was medical, or had even finished college to be completely honest. I needed a place to ask questions, I needed to ask “stupid” questions without being judged. Some of the forums I used for a while, but even there I found there were some of those “eat their young” bullies, so I quit using them.
I hope to make this a place where anyone can ask question or learn. If you are thinking about getting into nursing, are a student, or are a well seasoned nurse we all need your questions and your wisdom.
One thing that I have found so beautiful about nursing is the learning element – you really do learn something new every day! It is such a vast and versatile field that there genuinely is something for everyone. In nursing school there were things which I knew flat out was not for me, but I didn’t let it put me off nursing. Nursing school is just one of those things you have to get through, to get to where you want to be.
So there is my little introduction. I hope this is the beginning of a wonderful journey. Please tell others about it – the more the merrier! I would love to have guest posts in the future from experienced nurses in specialty areas, as well as giveaways etc. I am looking forward to the future of this blog!
Much love,
JaeJ,RN
The RN Hangout 