Guidance – Page 2 – The Mature Student Nurse

What Nursing School Did Not Teach Me About Nursing, Part 2: Mentality and Mindset Challenges as a Novice Nurse

Welcome to Part 2 from a series of posts about what I learned as a new nurse and the demands of nursing.

It took a while for me to transition into nursing and adjust to my newfound career and job expectations. After working over eighteen years with the same company in a consumer products/manufacturing setting, I grew accustomed to a certain rhythm in my job as an engineer/scientist. I was a salaried employee in my previous career as an engineer and never needed to clock in or out. Some days could be stressful when I was an engineer, but mainly, I could set my day-to-day schedule. I didn’t have a required shift to start by six or seven each morning. I would have project deadlines to meet, but they didn’t necessarily dictate what I did every hour of each workday. I could go to the bathroom when I pleased or schedule my lunch to eat with friends. I had a lunch squad. If I was behind with my schedule, I could stay late. When I wasn’t periodically supporting shift work in the manufacturing plant, I started my days mostly between 8a and 9a and ended around 6:30p – 8p. Each workday as an engineer, I did not have to consider getting my work assignments from a prior shift, passing work along, getting and giving shift reports, nor did I need someone to take over my work during my bathroom or meal breaks.

I work in a hospital now, so my shifts as a nurse are dictated each day. Sometimes, there’s no time for me to pee, drink, or eat as a nurse. I eventually get to do these things, but not necessarily when I want. Hourly tasks (assessments, med passes, labs, and patient ADLs) dictate each workday. My patients and their needs and orders direct my priorities for each day. I have no lunch squad. I can’t go on meal breaks with my co-workers because they need to cover my patients when I go on break. Sometimes, the charge nurse makes me go on my snack and meal breaks when I am not ready to ensure proper coverage. If I think things are a little slow or I have some downtime, that’s when admission or some unexpected event likely occurs. (This is why you never use the “Q” word – “quiet” – to describe the environment or shift around nurses – you jinx them into having a chaotic shift later).

I’ve learned it’s better to accomplish tasks early rather than on-time because one emergency or tricky issue can cause a delay to an entire planned schedule that was once “on time.” For example, when I was in Med-Surge, I had to do unscheduled sacral wound dressing changes for an incontinent, primarily immobile, continuously stooling patient. Each time I’d get help to turn and lift the patient, clean them, replace their diaper and linens, and do the dressing change, the patient would soil themselves and their new dressing. These kinds of time-consuming, unplanned activities aren’t limited to adult patients. More recently, when I was floating to our Pediatric ward, an ostomy bag for a hyperactive non-compliant preschool patient kept leaking and needed continual replacement. The patient would purposely peel off their ostomy bag and then resist having it changed. Even though the patient was a preschooler, one person needed to help hold down the patient and keep the patient still to allow another person to replace the ostomy bag. Such unplanned activities take time and can cause delays in other scheduled tasks. I was used to addressing shifting priorities and non-compliances as an engineer, but I never had hourly assignments that could jeopardize people’s health if completed late or improperly.

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It was hard for me to account for unexpected, unscheduled tasks as a new grad nurse. It can still be frustrating, but I feel I’m not as flustered, and it doesn’t have to thwart the rest of my day. I have learned to do things as early as possible to leave room for the unexpected. My last NICU preceptor also encouraged me to accomplish tasks as soon as possible to be available to help other nurses. Thankfully, nurses in my department jump in and help one another. However, my preceptor warned they may not be as willing to help me if I’m always busy and unable to help them when they need assistance. As I shared, some activities require coordination of availabilities and assistance from other nurses or nursing attendants. I want to be a team player that others can count on for help. Accomplishing tasks early not only makes my life easier, preparing for the unexpected, but it also allows me to help others with their patients or tasks. However, even when I am able and want to accomplish tasks before they are due, I can’t always do this. For instance, I must still ensure meds are given in an appropriate timeframe and not too early to avoid overdosing patients.

Critical thinking and mental alertness cannot be lax as a nurse. (This is also how I justify my caffeine intake). At best, a nurse’s mistakes may cause inconvenience; at worst, permanent injury or death. Any mistake I made as a process engineer could cost hundreds of thousands of dollars, but it would never cause bodily harm or death. There was a lot of oversight, approvals, and quality control with my work as an engineer. I feel like there are fewer checks and balances for nurses for the tasks they complete.

A nurse performs activities based on orders and nursing judgment. There is no constant oversight or approval process when a nurse administers many medications or completes orders. In contrast to process engineering mistakes, a medication error can kill. Not reporting critical labs or assessment findings can cause delays in treatment or interventions. I can’t consult with a weekly project team if I’m behind on my nursing tasks. I have to figure out who to ask for help to catch up with my work or quickly judge if it’s acceptable to be late, reschedule a task, or if I need to escalate issues. Aside from impacting patient care, nursing mistakes and errors can threaten nursing licenses. When I made mistakes as an engineer, I may have received criticism and a poor performance rating, but I never worried that I’d lose my ability to work as an engineer.

Given the pressure and expectations of nursing, my anxiety levels are higher than when I was an engineer or scientist. Some stress is healthy and helps keep my patients and me safe by forcing me to focus, ask for help, or take time with unfamiliar tasks or medications. However, until I became a nurse, I never realized how common it was for nurses to have or develop hypertension, anxiety, or depression. I’ve heeded the warnings of veteran nurses who advised me not to take overtime if I don’t need it, lest I end up with hypertension, like them.

I did not switch careers only to develop medical issues from my job. It’s one thing to manage high blood pressure, generalized anxiety disorder, post-traumatic stress disorder, or major depressive disorder, but it’s another to develop these conditions because of one’s job. Nurses need healthy coping mechanisms, as stated in my last post. I respect that sometimes it’s not enough to have healthy coping mechanisms or rely on comfort wisdom; various conditions require medication. However, Kelsey Rowell, RN Career Coach and founder of @wholelifenurse shared recently on her Instagram, “If your nursing job is requiring you to go on or increase your medication to support your mental health, that is your sign to find a new job, take a break, or do something else.” I wholeheartedly agree with her statement. Since I’ve switched to NICU nursing, my anxiety levels are lower than when I was a Float nurse for adults. Part of that may be due to having more experience or not working the night shift for the moment, but I think my decreased stress is also because NICU nursing is a better fit for me. There are so many opportunities within nursing that if a particular job is causing medical or mental health issues, try changing your nursing job!

What’s also relieved some of the new grad anxiety and pressure is recognizing that nursing is a practice. With more time and experience, I can improve my nursing practice. With more exposure to various units or patients, I learn what I like or dislike about specific nursing roles and can set my boundaries and determine my career goals. With more experience, certain medications or typical treatments will become more familiar. I will more easily recognize the signs or symptoms of conditions I regularly encounter. I can determine which skills are essential to master for various units or roles. (Tip: time management is a critical skill, no matter where you work as a nurse)

I have accepted that I’m imperfect and will make mistakes. Even veteran nurses make mistakes. When making mistakes, it’s essential to be transparent to a charge nurse or provider to correct errors or get help and alignment to move forward. Mistakes can serve as lessons. I’ve made mistakes in my engineering and nursing career that I know I will not make again because I never want to feel as compromised or ashamed as when I made the mistakes.

I want to prevent making mistakes that injure or permanently damage patients. One of my NICU preceptors said to accept that I will make mistakes but to spend time making sure I don’t make medication errors. If I spend more time evaluating an unfamiliar medication, dosage, or route, I accept that I will appear slow because of my uncertainty. I will ask for help or clarification. I will move more slowly and risk falling behind on my tasks rather than harmfully administering medication.

ANY new job or career produces increased stress and mental challenges. Some level of discomfort is healthy and helps us to learn and grow. It takes time to learn the protocols or processes of a new organization or unit. No one is perfect, and we all make mistakes. Sometimes, you understand how to be more efficient or effective by making mistakes or witnessing them. It takes time to learn who to ask for help, what requires escalation, and the chain of command. Over time, we know the methods of communication our co-workers, bosses, or patients/clients prefer. Skills cannot improve until you’ve practiced and done them many times. Understanding all this and having the mindset that I’m still learning (“I’m developing, not deficient!“) has helped relieve some of my new grad/novice nurse anxiety.

I hope this post gave some insight into the mental challenges of nursing and the mindset one has to have to thrive as a novice nurse. If you have any advice on how to handle the pressures of nursing or the mental challenges, please share! Thanks for reading! My next posts in this novice nurse series will discuss how I address the physical and emotional challenges of being a nurse.

What Nursing School Did Not Teach Me About Nursing, Part 1: Time vs. Energy

Aside from an abundance of job opportunities, one of the things that attracted me to nursing was the schedule. Typically, nurses who work 12-hour shifts in hospitals work only three days a week. It seemed ideal to have four days off weekly to have more time with my family. I felt I could manage to work obligatory weekends and holidays when I already had worked weekends and holidays in my previous career as an engineer. I was used to working 12+ hour days as an engineer and would periodically do shift work, working overnight. When I wasn’t doing shift work, I would work weekdays, but work would follow me home, or I’d be on-call 24/7. I could work long hours and focus my energy on launching a product, completing a project, or passing an audit. I learned how to be a hard worker and resilient to get through challenging work assignments or situations in my previous life as a chemical engineer. However, I don’t think I’ve ever had to work as hard as an engineer on a day-to-day basis as I do each shift as a nurse.

Nursing takes a lot out of me. At the end of a shift, it’s common to be mentally, physically, and emotionally drained. Maybe it’s because I’m older, but I genuinely feel the work and energy required for nursing does not compare to when I was an engineer.

I came across a Business Insider article citing well-paying low-stress jobs. Nursing is nowhere on that list. Is it ironic that chemical engineers top the list at number 2? I chose to leave a relatively low-stress job and transitioned into one of the most stressful professions. Additionally, I became a nurse in the middle of a frickin’ pandemic!

While I do not have to work four days out of a week, it takes a lot more time to recover my energy from working nursing shifts than when I was an engineer. Also, when I worked night shifts as a nurse, the entire next day/night off would be a complete wash – I’d spend my day off napping, recuperating, and re-adjusting to my family’s schedule while still feeling like a zombie. Sometimes I’d need two days before I could feel fully functional and alert during the day and meaningfully interact with my family and friends. Just as I’d start to adjust, I’d have to work a block of night shifts and begin my cycle over again. I’m currently working day shifts, but I sometimes still need a whole day to recuperate after working. I have to be aware of my body’s needs and rest on days off, even when I have every urge to pack my schedule with outings and activities. I want to take advantage of my extra days off but recognize I need to spend some of that time relaxing or recovering. I might have the time to do something, but do I have the energy?

Photo by Anastasiya Vragova on Pexels.com

Admittedly, I never worried about having the energy to do something when I was younger. I kept a packed schedule – even on weeknights after work. (I think I also was more tolerant of toxic relationships and hostile work environments and did not realize how draining those could be). Maybe I seemingly had more energy because I was single and didn’t have family committments or time to devote to a spouse or children. It’s possible I had way more energy – or I just felt that way – because I could sleep in when I needed. (I’m a parent to a kindergartener; it’s been years since I slept in late). Now that I’m older, not getting enough rest impacts me more. Or maybe I’m simply more aware of my body’s needs than when I was younger.

Being self-aware helps me determine how to restore my energy. For instance, I’m an extrovert and need to connect and interact with people for my well-being. My introverted husband needs the opposite. Earlier in our relationship, I realized that going from party to party would make him miserable, while I would be happy and energized from the social interactions. As a result, I’m more selective with our social commitments.

When figuring out what to do on my days off, an essential question is: “Do I have the energy?” If not, what do I need to do to regain my energy? One of the ways I recover is by spending time with friends. I try to include social activities on my weekly calendar, even if it’s over Zoom. I did this throughout my pre-requisites and nursing school as well. Because I’m an extrovert, social interactions are crucial to maintaining my sanity and happiness. I felt dates with my friends or family were especially important during nursing school when my schedule would be packed with classes, clinicals, and studying. These dates could be simple lunch outings, coffee/tea, seeing a movie with my husband, or Zoom calls (critically needed during pandemic surges and lockdowns). I needed to make sure I had something social in my weekly schedule to feel balanced. I mentioned it before in other posts, but it helps to know what brings you comfort. I didn’t learn this in school – time and life experience have taught me “comfort wisdom” (a la Brene Brown). Have you developed healthy coping mechanisms? What do you enjoy as stress relief? Nursing school is stressful, but working as a nurse is even more so. Build a foundation of healthy responses to stress before or during nursing school to combat the stress and anxiety that frequently accompanies working nurses.

While being a nurse can be draining at times, I honestly love it. I can feel tired and overwhelmed, but there are moments where I’m interacting with patients and at peace and content with making a difference in someone’s life. People going into nursing naturally want to help people, but they need to understand how demanding nursing can be. Until I started working as a nurse, I don’t think I realized just how stressful a job nursing could be. Prospective and new nurses need to understand what they can do to protect and restore themselves to continue in this rewarding profession. I have so much to share about this topic that I thought I would make this and the next several posts about addressing the mental, physical, and emotional demands of being a nurse. I want to candidly share what it’s like for me and what I do to try and guard myself against being drained or burnt out. And yes, unfortunately, burnout can happen to early-career nurses, too, not just veteran nurses.

I hope what I’ve shared – and what I plan to share – is helpful and provides some honest insight – see you in my next post on this series!

Caffeine + Viagra

Major Update: I Quit My Job!

I have not posted in a while because I have been busy with some life changes. I recently resigned from my new grad RN job and accepted an offer to work at another hospital. What could have possibly taken me away from my #1 choice hospital and my highly pursued new grad program? A spot in my dream unit, the NICU!

It was tough for me to leave my program since I felt like the people were supportive overall. I truly appreciated the environment, community, and staff. I was learning a lot and growing as a nurse. However, my experience as a new grad RN working in the Float pool with adult patients also affirmed that my ultimate goal is to work with babies in a NICU.

My hospital has a NICU, which was a big reason I applied to their new grad program – I had hopes to move into their NICU eventually, especially after having a NICU preceptorship during nursing school. However, after working as a resident, I learned that the NICU at the hospital where I was employed does not accept inexperienced NICU nurses. The NICU manager recommended I apply to an L&D fellowship after my Float Pool residency, and maybe I could transfer to the NICU afterward. That would mean the earliest I could go to our NICU would be 2023, and that’s with the caveat that I would get accepted into a competitive year-long L&D fellowship. I would be competing with other nurses whose ultimate goal is to be an L&D nurse and other more experienced nurses previously rejected from the L&D fellowship.

After learning all this, I had the opportunity to interview during a mass hiring event for another hospital. The hospital already had my application from earlier in the year, one of the 70+ positions I applied to before starting my new grad program. I shared I only wanted NICU positions – there was no other reason I’d leave my new grad program since it was a great program in a good hospital. I interviewed with the NICU manager at the new hospital via MS Teams in between scheduled night shifts. At the end of the interview, she shared she’d like to hire me. I gave my job three weeks’ notice once I passed the background check and received a target start date. I started orientation for my nightshift NICU position at the new hospital on Oct. 1, last Friday.

I know it’s customary to give two weeks’ notice, but I felt obligated to give my old hospital three weeks. I ended up working four more shifts than if I had only given two weeks’ notice. During those four shifts, I had the most brutal shift I’ve had since coming off preceptorship and working solo. If I had left sooner, I could have saved myself from experiencing the most horrendous shift I’ve had so far. Luckily, my last shift was smooth and helped build my confidence after feeling torn down and broken from the week before – I met my patient’s needs promptly, charted everything on time, gave good shift reports, and my patients had no incidents. At my last job, I ended on a good note and had valuable learning experiences. My horrible shift in the week leading to my final shift taught me that when I’m overwhelmed, not only should I delegate, I should escalate to the charge nurse or nurse leaders. I will remember how awful my experience was on that shift to remind me in my nursing practice: “When Overwhelmed, Delegate + Escalate!”

I will remember this lesson as I start my new job. I am excited to have the opportunity to be in a NICU again. The children’s hospital where I precepted during nursing school opened its new grad program about a month after starting my previous job. Various cohort-mates encouraged me to apply, but I decided I needed to give my program and hospital a fair chance. I passed the opportunity to apply to the children’s hospital NICU new grad program before learning that my hospital would not hire me into their NICU for at least two more years. I don’t regret not applying to that NICU program because I’m grateful for my experience and feel more confident as a nurse because of what I’ve learned working with adults. I gave my program a chance and put forth my best effort, and concluded that I wasn’t willing to wait years to reach my goal to be a NICU nurse.

The earnest pursuit of career goals is somewhat new to me. For years, I didn’t know what I wanted. I knew that I was comfortable but not necessarily excited or passionate about my previous career as an engineer/scientist. During performance reviews, I would dread when my manager would ask what 5-year plan was because I wasn’t inspired by what was around me. I didn’t want my manager’s job, and other than becoming more skilled, building my expertise, and gaining more leadership experience, I wasn’t sure what else to say. Now, it’s nice to have a goal (dayshift NICU nurse) and work towards it.

It’s still a little terrifying:
“What if I don’t like it?”
“What if the staff is mean at the new hospital?”
“What if it’s not what I thought?”
“What if I’m not good at it?”
“What if I can’t handle the long commute?”
“What if I can’t last long enough on nightshift to make it to dayshift?”

Sometimes, you don’t know if you’re going to like something or will be able to handle it until you give it a try. I also have to be open to the possibility of failure or making mistakes with this new job – it’s those moments where real growth occurs, however. That’s how I became a better engineer or scientist. I made a mistake and remembered not to do it again. It’s like doing something wrong a couple of times before you figure out how to do it right, or in the most efficient way.

I think a terrifying part of being a novice nurse is mistakes in healthcare can have a profound and permanent impact on a patient and patient’s family. If I made a mistake as an engineer or scientist, many processes and people were in place that ensured no one would get hurt or injured. Delays or mistakes I made may cost hundreds of thousands of dollars, but they would never hurt someone. As a nurse, I no longer have that sense of security or protection. It’s anxiety-provoking. I’ve met many nurses with high blood pressure, anxiety, or depression due to the stresses of this profession. I don’t want to develop health issues because of my chosen career. I went into this profession to help people, so I try focusing on how I can help or improve care vs. contemplating the many ways I can injure someone or how someone may injure me (a genuine consideration with adult patients).

I’m still a recent grad with less than a year of acute care experience and still developing. Fortunately, my employer views me as a new grad and is willing to train me as a NICU nurse. I consider my new position as an opportunity to learn, grow, and be a better nurse. I’m going to try to focus on that and becoming the best NICU nurse I can be. Wish me luck!

Persistence with the Night Shift

I’m still trying to manage my life working the night shift while parenting a young child. While I wish I could engage more with my daughter, I’m grateful that she and my husband are close because of their time together without me. I wish I could give my husband more breaks from caring for our daughter solo. Unfortunately, I can’t participate in family activities like back-to-school nights or family dinners when I work. Truthfully, even when I do NOT work, I’m still exhausted from working night shifts; I can’t participate as much as I want with family activities, even on days off.

It’s a lot of effort for me to focus and maintain my clarity with sleep deprivation. When I started the night shift, I had difficulty sleeping during the day between my shifts and trouble staying alert during my shifts. I’m three months into working nights (7p-7:30a), and I can sleep about 5 hours between night shifts compared to the 3 or 4 I would get before. I am also more alert and have more stamina to last me throughout my shifts compared to three months ago. However, I now have difficulty sleeping at night on my nights off. (It was 2:30 on Monday morning when I started to write this blog post because I couldn’t sleep and wasn’t tired).

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Here is how my day(s) off went after my last shift Friday night:

8:30 a – Come home from work Saturday morning, still stressed after a rough night shift – the third of three-in-a-row.

11 a – After showering, eating, and replaying my night in my head, I finally fall asleep – and miss out on my family’s Saturday brunch outing spontaneously scheduled with a friend that morning.

3:30 p – I wake up later than my 1p target. I feel too tired and groggy to join my husband and daughter for their afternoon pool-time.

7ish p – We have dinner delivered because I’m too tired to help prepare anything.

10 p – Husband wakes me on the couch since I fell asleep somehow. He convinces me to move to our bedroom.

2:30 a – Wake up and have trouble going back to sleep.

4:00 a – Take melatonin, hoping it will help me sleep

6:07a – The time on my clock that I remember seeing before falling asleep

7:35 a – The time I woke up when my daughter turned on all our lights and insisted on noisily searching our room for her lost unicorn.

My husband and I spent the rest of my second day off of work taking our daughter to gymnastics, having family brunch, going to church, and visiting a family friend in the afternoon and again for dinner. I briefly fell asleep sometime in the afternoon after reading with my daughter in her bedroom – before my husband woke me so we could go for the afternoon visit with a family friend. I try to enjoy days off with my family but often feel like a zombie days after I work.

When I work, I’m unable to attain the recommended 7-8 hours of sleep. I don’t think I’ve made up for the sleep debt I’ve incurred and am unsure when, if, or how I’ll make up for it. My sleep schedule is entirely abnormal, and I’m often tired. I schedule myself to sleep during certain times, but my body does not comply. I’ll fall asleep during the day between shifts hoping to sleep 6-7 hours but will often wake up after 4-5 hours. I have blackout curtains, use earplugs, play beach waves as ambient noise, spray lavender mist on my pillows and bedding, and wear a travel eye mask to help me sleep.

Travel Sleep Mask, Lavendar Spray, and Ear Plugs – standard parts of my daytime sleep routine

I don’t have television in my bedroom, and I take all phones out of the room when I sleep. I sleep for longer durations when I eat before going to bed in the morning, take melatonin, and supplement with tart cherry concentrate (which helps regulate melatonin levels). I set my alarm as late as possible before work and try not to look at my clock or phone until that alarm has gone off, even if I am awake and lying in bed for hours. I meditate or pray in bed to relax and attempt to fall asleep again if I wake up before the alarm activates. To stay awake while working, I drink caffeine but avoid it after 2a during my shifts and on days when I’m not working.

I’m not fond of the idea of having to medicate my body to either sleep or stay alert. In reality, though, I live in a caffeinated culture. Coffee and tea helped me survive nursing school. They also helped me in my first job as a nurse working swabbing shifts before 5:30a. Many people I know consume caffeine daily to be alert or as part of their morning ritual, and they are not nurses, nor do they work night shifts. Maybe I should accept that caffeine (and melatonin) are part of my weekly routine as a night shift nurse.

To try weaning off some of the caffeine, I’ve tried replacing some of my coffee intake with cacao. It has helped me during the early morning hours at work (when I think it’s too late to consume more caffeine), keeping me up without giving me jitters or hand tremors. My nursing school best friend turned me onto a brand, Crio Bru. According to Crio Bru:

“Brewed cacao is 99.9% caffeine free, but contains theobromine, a naturally occurring stimulant found in cacao that can be longer lasting, milder, and more pleasant than caffeine.”
-Crio Bru (https://criobru.com/pages/crio-bru-brewed-cacao)

It’s roasted cacao nibs that brew just like coffee, but there’s no caffeine. I like to make Crio Bru drink in a french press and keep it sugar-free.

I’ve also discovered a sugar-free cacao powder by ChocoVivo that doesn’t require a french press to prepare (https://chocovivo.com/collections/cacao/products/100-cacao-full-spectrum-cacao-powder). The hot chocolate from ChocoVivo has a thicker consistency since the cacao is not getting filtered out and is reminiscent of the hot chocolate I had with churros in Spain. It’s like drinking a dark chocolate bar. I sometimes like to add a little cinnamon to it.

I’ve been trying various techniques and methods to sleep or stay awake, stubbornly trying to make night shift work, because I eventually want to move out of my current position working with adults and work in a Neonatal Intensive Care Unit (NICU). I explored switching to dayshift when I met nurses from day shift in my cohort who wanted to work nights. However, I stopped pursuing dayshift with my manager when 1) the dayshift nurses changed their minds about working nights, and 2) I realized working the night shift was more aligned with my long-term goal to work in a NICU.

Because NICU is a specialty that people do not often leave, it is rare for any new NICU nurse to start work during the dayshift. One NICU nurse shared it takes ten years to switch to dayshift in her hospital because people never leave. I have no desire to work nights for ten years, but I am willing to work a couple of years on the night shift to work and gain experience in my dream unit. I know of a hospital in the area that supposedly has their NICU nurses move to the day shift in about 2-3 years, so my goal to to work there eventually. While I’m still adapting to working the night shift, I hope to adjust and thrive in a NICU. I’m using the time in my new grad program to adjust to the night shift, so I hopefully don’t have to struggle so much by the time I land in a NICU. I am making sacrifices now in order to reach my long-term goal to become a dayshift NICU nurse. Right now, the only way I know to get to days in a NICU is to start on nights. Hence, I continue to fight and search for ways to make night shift work for me and my family.

I would love to hear about your sleep hygiene habits and any tips for sleeping. Do you have rituals for bedtime or starting your day (or night)? What are your sleep routines? How do other parents of young children manage night shifts or graveyard shifts? What do you do to ensure you have sufficient energy while you work?

Staying Organized: Brains and Checklists

On my first day in Nursing Fundamentals Clinical, my instructor shared a typical schedule to follow when we’re on the floor and the expected flow of the day. My instructor explained how the nurse has to keep organized to ensure the nurse properly assesses each patient, gives medications on time, takes vital signs as needed, provides education, addresses orders, and documents care. One of my classmates asked how a nurse keeps track of everything, and my instructor responded, “Oh, I use my brain.”

My classmates looked at one another, perplexed. I wondered, “How will I hold all that information and remember everything I have to do in my brain?!?” Only later, with some further explanation from my instructor, did we realize the “brain” on which she was relying to stay organized is a document and not an organ in her body.

A nurse’s “brain” is a document that helps a nurse stay organized and allows the nurse to take notes for shift handoffs, doctor’s reports, or assessments. A nurse can also use a brain to track: treatment or surgery, when to give medications or perform additional tasks, inputs, and outputs, progression of care, or the completion of orders. Of course, the nurse documents care within a patient’s chart. However, a nurse’s “brain” serves as a mini notepad or planner for the nurse between charting.

In nursing school, I was exposed to and used various types of brains. There are numerous templates for brains available, and some are even free. During nursing school, I liked trying the brains offered by nursing.com. (With a subscription, the website provides a brainsheet database of 33 different brains, some focused on specialties like ICU, Peds, or L&D). Often, units in hospitals print specific brains for staff to use. However, it is the nurse’s preference that determines the brain a nurse uses. For instance, my preceptor never uses the unit’s pre-printed brains and writes out her brain every time she shifts. While nurses are not required to use a brain, I don’t believe I’ve ever met a nurse who doesn’t use one.

After attempting to use multiple brains, I decided to design my own. Some brains don’t have enough space, are not organized the way I want, or do not capture the information I need. As a new grad nurse, I find it difficult to track the completion of required charting or documentation unless I note it in my brain. No generic brain template is going to capture the documentation unique to my unit.

As I imagined what I wanted to include in the brain I was designing for myself, I read the book “The Checklist Manifesto: How to Get Things Right” by Atul Gawande. My husband received it as a gift, and he recommended the book to me. He thought it would interest me since the author was a surgeon exploring ways to make surgeries safer. The author worked with the World Health Organization (WHO) to develop a checklist to use for surgeries, to prevent errors (and ultimately, injuries or deaths due to preventable mistakes). It was a quick and fascinating read. He explored how other industries such as construction or airlines use checklists. As in surgery, errors in those industries can be fatal. At its worst, errors in construction or flying planes can be catastrophic and result in mass casualties. Yet, such errors are rare compared to mistakes in surgery. The book discusses how he and others developed a worldwide surgical checklist for WHO and what resulted. The author also shares when checklists are inappropriate and offers tips on developing them, even down to what font one should use. I enjoyed reading the book – it was a nice break from studying or reviewing nursing-related topics, yet I felt it was helpful to me as a nurse.

Considering what I learned from Atul Gawande, I placed a documentation checklist onto my brain template. Since I’ve set the documentation checklist in my brain, I’ve been more efficient in my charting. I can ensure I’ve completed the charting documentation for each patient without spending extra time combing through various sections of a patient’s chart to verify completion multiple times. My preceptor does not have to stay over later to complete missing documentation for our patients as she did earlier during my orientation and training. My checklist lets me know what I’ve done and what’s still missing during my shift. I know I’ve become more proficient at time management since starting orientation, but having the checklist helps me keep organized and manage my time. Plus, as a checklist gal, it feels satisfying when I cross off all the boxes in my checklist by the end of the shift.

The documentation checklist I added to my nursing brain

Are there checklists you use day to day that help you in your personal life or your work? Or, are there brains you’ve used that you like? I’d love to hear and learn what works for others!

Vasovagal Syncope at a Mass Vaccination Clinic

Photo by RODNAE Productions on Pexels.com

I was at a week-long pop-up mass vaccination clinic last month in the parking lot of a sports stadium. We monitored patients for severe allergic and other adverse reactions after administering their vaccine injections. Luckily, we never encountered any patients needing us to treat them with an epi-pen in our tent. However, we did have a patient who fainted almost immediately after receiving their shot. The patient eventually regained consciousness, but not before being attended to by at least five nurses with medics and a doctor along the way. If a patient is going to have an adverse reaction to the vaccine, having one at a mass vaccination clinic prompts attention from an entire team of healthcare professionals!

I had never experienced a person fainting before and it was actually impressive to see so many experienced nurses quickly react and attend to the patient. I didn’t give this particular patient their shot. I didn’t even see the patient faint, since I was opposite end of the tent when it happened. I turned around from where I was and all I saw was a bunch of nurses rushing to care for this patient. Everything happened so quickly. As a new nurse, I want to share what I learned and saw so I don’t forget and can apply it to my own nursing practice!

What is Syncope? What causes it?

Fainting, or syncope, is caused by reduction of blood flow to the brain resulting in a momentarily loss of consciousness. With vasovagal syncope, this can be caused by a sudden drop in blood pressure due to dilation of blood vessels or decreased heartrate. Without knowing this patient’s full medical history, our patient’s syncope was likely an anxiety-provoked reaction to receiving the shot. Some people faint at the sight of blood, pain, or other stressors. It is thought this patient was so anxious about receiving the shot, that the patient fainted and had a vasovagal syncopal episode. I did not follow this patient back to the medic tent where the patient was further monitored and assessed. I also did not administer the shot, interview the patient, or provide the patient with the disclosure statement for verbal consent, so I have no idea if this patient has fainted before. However, what I’ve learned is if a person has a history of fainting, it is recommended for the patient to recognize what provokes the fainting (to avoid or work around triggers) and to also get a medical examination to ensure there are no other health conditions causing syncope. After our patient who fainted, we had a number of patients expressing a history of fainting after vaccinations, so we monitored them more closely and had them sit or lie down after the shot. Luckily, no other patients had a syncopal episode.

A-B-C Prioritization Always Applies

In prioritizing patient care, a nurse assesses a patient and prioritizes airway, breathing, and circulation. This is often referred to as the ABCs.

“A is for airway assessment, observing for airway obstruction which can be seen with a changed sound of voice, “see-saw” respirations, and stridor. B is for breathing assessment, observing for an abnormal respiratory rate, the use of accessory muscles for respiration, and cyanosis. C is for circulation, observing for color of hands and digits, an abnormal capillary refill time, and decreased level of consciousness (LOC). “
Picmonic.com

The patient was sitting when they fainted, and some nurses pulled the patient down from their seated position, in their wheelchair. Other nurses rushed to support the patient’s bottom, legs, and feet. After the event was over, some of the nurses wondered why the patient was pulled down from their wheelchair. After an internet search, I learned one should help a patient lie down and elevate their legs to encourage blood flow to their brain (https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527).

Vasovagal syncope most often occurs when a person is standing or sitting (https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html). Supporting a patient in the standing or sitting position while they have fainted can prolong their unconsciousness and decreased blood circulation to their brain – their blood will continue to pool in their lower vessels. The nurses pulling the patient down from the seated position were trying to improve circulation. The patient did not have a blocked airway and was able to breathe, but had fainted. The nursing intervention of changing the patient’s position was prioritizing circulation, the “C” part of A-B-C prioritization [Airway – Breathing – Circulation].

Techniques to Regain Consciousness

Because the person fainted, the person was unresponsive to verbal commands or requests. I saw a nurse perform the sternal rub in an attempt to “wake” the patient. Luckily, the patient regained consciousness after laying down and getting the sternal rub. Once the patient recovered from fainting, the patient was frightened and did not seem to understand what had happened. The startled patient grabbed at the nurses’ hats and clothing. It’s normal to be confused after fainting. The patient’s caregiver verbally reassured the patient that they were okay. By the time the patient regained consciousness, the medics from the medical tent had arrived accompanied by monitoring equipment and a doctor. The patient was calmed down and taken to the medic tent for further monitoring and observation.

It was not used, but there were ammonia sticks in our supply bin. These smelling salts can be used on a patient who has fainted, in an attempt to increase oxygenation to the brain. In the British Journal of Sports Medicine article, “Smelling Salts”, the author explains:

“Smelling salts are used to arouse consciousness because the release of ammonia (NH₃) gas that accompanies their use irritates the membranes of the nose and lungs, and thereby triggers an inhalation reflex. This reflex alters the pattern of breathing, resulting in improved respiratory flow rates and possibly alertness.”
McCrory, P. (2006)

An experienced nurse shared with me that if the ammonia sticks or smelling salts are unavailable, alcohol wipes can also be used under a patient’s nose in an attempt to startle them into consciousness.

Prevention

If a patient stated they previously fainted after receiving a shot, we monitored that patient closely or had them lay down with medics present. We also monitored patients a little more critically if they had a prior allergic reaction or medical history that would warrant a longer than normal observation time of 15 minutes.

Often, people who experience vasovagal syncope have warning signs that they might faint. Some of the symptoms may include dizziness, nausea, warmth, sweaty palms, or blurred vision. If a patient experiences these symptoms, have them sit or lie down, as needed. If they can’t lie down, they can sit, bend down, and place their head between their legs. Cedars-Sinai’s website also suggests:

“Tensing your arms or crossing your legs can help prevent fainting. Passively raising or propping up your legs in the air can also help.”

Patients who experience vasovagal syncope or who have fainted before should be aware of their triggers so they can avoid them or develop ways to manage their triggers. To reduce the risk of fainting, Cedars-Sinai offers staying away from some triggers such as:

Standing for long periods
Excess heat
Intense emotion, such as fear
Intense pain
The sight of blood or a needle
Prolonged exercise
Dehydration
Skipping meals

I think the biggest impression left from the experience with the fainting patient was how important teamwork is and how quickly every nearby nurse jumped in to help. As multiple nurses were tending to the patient, other nurses were calling the medics for help. Everything happened and resolved so fast, that I didn’t have an opportunity to support them. I was proud of the nurses and what I saw (and ultimately relieved that I wasn’t the one who gave this patient their vaccine injection). As a new graduate nurse, I wonder if I would have known what to do or have been able to react so swiftly. I know for sure I’d be yelling for help. Now that this has happened, I at least have a sense of what to do, if I ever see a person faint. Hopefully, you do too!

References:

Cedars Sinai. https://www.cedars-sinai.org/health-library/diseases-and-conditions/v/vasovagal-syncope.html

Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/vasovagal-syncope/symptoms-causes/syc-20350527

McCrory P. (2006). Smelling salts. British journal of sports medicine, 40(8), 659–660. https://doi.org/10.1136/bjsm.2006.029710

Picmonic. https://www.picmonic.com/pathways/nursing/courses/standard/professional-standards-of-nursing-8246/prioritizing-care-32342/airway-breathing-circulation-abcs_8453

Struggling With Boundaries and “No”

I know it’s been a while since I’ve posted. I feel like I’ve been struggling lately and don’t know what words of inspiration to provide. I find myself working when I didn’t plan to work to please my boss. I recognize that consistently not holding the boundaries I set for myself is unhealthy and causes suffering and resentment. Establishing and maintaining boundaries is a skill I have yet to master. I don’t know if I’d even call myself competent.

Sometimes I find myself working extra shifts, not because I want or need to, but because I want to keep my boss happy. I want her to give me a good recommendation when I put her down as a job reference. (I work as a COVID tester but am looking for an acute care RN role). However, when I work extra days to please my boss, it costs me a chance to recharge myself, spend time with family, job search, or blog. For example, even though I said I was unavailable to work the day after my second-dose COVID vaccination, I found myself working when I didn’t plan on it because my boss was short-staffed and begged me to work. My arm was sore, and I was tired and achy, but I had no other symptoms, so I obliged her plea for me to work. I had hoped to be taking it easy at home the day after my vaccination to fill out my daughter’s complicated kindergarten applications and other job applications for myself. Instead, I wore myself out by working the day after my second shot. By the time I got home, I felt so fatigued that all I could do was shower and lie in bed all evening. I couldn’t even pick up my daughter from her preschool; my husband did. My boss asked me to work again the following day (a day I usually have off), and I said I could not; I felt like I was fighting the flu! I found myself to the point of exhaustion before I finally said “No,” to my boss.

Being short-staffed seems to be a common theme no matter where a nurse works. (There are so many memes about this!) I am not a bad employee if I tell my boss I am not working extra days. Saying “No” is a skill I know I must strengthen to maintain the boundaries I set to keep myself healthy and balanced. [Un]Fortunately, it looks like I will have plenty of opportunities to practice saying, “No.”

Before I became a nurse, I was the type to cram a lot into my schedule. I still am this way. Usually, I enjoy it, but sometimes it’s stressful, especially when running late from event to event. However, since marrying my husband and having my daughter, I’ve been conscious of my family’s schedule and try not to burden them with too much activity. A nurse- and mom-friend told me her life coach suggested she schedule no more than three things in a day. I’ve been good with this for my family, but I am trying to uphold this goal for myself. I accomplish goals I set for myself more efficiently, and I am more satisfied and less overwhelmed when I create a manageable schedule.

I still have many goals and lots of things I feel I need to do or accomplish each day. Fortunately, I realize 1) I do not need to do everything all at once, and 2) Some things (like working or blogging) may fall off my schedule to focus on completing other things (like job and kindergarten applications). Honestly, I should make one of my goals to stop being such a people-pleaser, and I would be able to say NO guilt-free and struggle less. I am working on this, so thanks for your patience during my mini-break from blogging the past week!

Vision Boarding in Quarantine

Due to an unexpected quarantine from my daughter’s exposure to a COVID positive person, I found myself stuck at home for two weeks in January with my husband and daughter. Thankfully, all of us remained asymptomatic and tested negative for COVID. However, I adhered to the health recommendations to quarantine, and I did not work or leave the house outside of medical appointments for 14 days. Homebound, I decided to make my 2021 vision board a fun, creative activity I could do with my daughter.

Below is the result of crafting together that day.

I tend to be a visual learner and have found vision boards to be powerful tools. I’ve shared this before, but years before I became a mom, I made a vision board about being a parent. My husband and I spent over a year trying to get pregnant before I had a miscarriage. I eventually became pregnant with my daughter almost a year after our loss. It was pretty amazing to look back at that vision board, even though my dream of motherhood took some time to materialize.

If you want to try your hand at making a vision board, below are some tips:

Review your goals or vision board from the prior year (or semester or quarter). Reflect on what you’ve accomplished and acknowledge your achievements!
Do you have any remaining goals that will continue into the next year (or another timeframe)? Do you need to remove some obstacles before you’re able to achieve these goals? Consider removal of a barrier to be an initial goal.
Think about your goals for your specified timeframe (year, semester, or quarter). What plans do you have for various areas of your life? You can focus on several areas of your life or many, but here are some to consider: work/career, finances, personal relationships, health/fitness, spirituality/well-being, education & development, rest & relaxation, or hobbies & fun.
Are your goals S.M.A.R.T. ? S = Specific, M = Measurable, A = Achieveable, R = Realistic, T = Time-bound. If not, design them to be S.M.A.R.T.
After you’ve thought about your goals (I also recommend writing them down in a planner or calendar!), gather supplies: paper, scissors, tape, glue, markers, and items with images you can use in your vision board (magazines, calendars, catalogs, or Pinterest photos/pins).
Start cutting out and collecting images or words that inspire you or remind you of the goals you have set for yourself.
Get at least one photo of yourself to place on your vision board. I also included pictures of my family in mine.
Assemble your vision board, making sure to include the year or goal timeframe (e.g. Semester I 2021) and a photo of yourself!
Place the vision board in an area you frequently see. I made my 2020 vision board and hung it on the wall by my desktop all last year. I replaced it with my 2021 vision board this month.

Before I made my 2021 vision board, I reviewed my 2020 vision board (per step 1 above). I posted my board last January on my FB and IG pages:

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A post shared by The Mature Student Nurse (@thematurestudentnurse)

Upon review of last year’s vision board, it was reassuring to see how many things I accomplished or goals I achieved, despite a worldwide pandemic and various stay-at-home orders:

The photo of a mom and her newborn in my vision board was a nod to my much-anticipated maternal newborn and pediatric rotations. I got to attend an emotionally moving c-section birth as part of my maternal newborn clinical rotation last year. My classmate and I witnessed a father cry with overwhelming joy and love for his newborn child – it was so sweet that my classmate and I were both moved to tears. I got to complete my preceptorship in a NICU. I had wonderful experiences during my rotations.
I had a bunch of images related to nursing, education, and graduation. I graduated from nursing school with my BSN and passed my NCLEX last year.
I have “RN” and a pile of money on my board. I started my first job as a Registered Nurse before the year ended.
I have travel luggage, a camera, vacation views, and photos of families having fun doing various physical activities on my 2020 board. My family and I managed to squeeze in two family vacations last year – one to Solvang (thanks to a good friend’s timeshare) and another to Bishop (as a result of tagging along on my husband’s business trip). We did not travel the way I originally envisioned after graduation, but my family enjoyed ourselves and explored new places while safely adhering to health orders.
I have images from “Hamilton”, the musical. I had tickets to watch the musical in-person with my husband at the Pantages in May. The show was canceled due to the pandemic. Luckily, our theatre tickets were refunded. I had to be satisfied (but “I will never be satisfied!”, a la Angelica Schuyler) watching it on Disney+. A benefit with watching the musical at home is that my daughter gets to enjoy it, too. My daughter periodically requests Alexa to play the songs, particularly the ones sung by any of the Schuyler Sisters.

Before the pandemic, I was excited to be part of the graduating class of perfect vision, 2020. I remember being a total dork and declaring this to my classmates well before the pandemic became a reality. After the pandemic started, I forgot about being part of the class of perfect vision. Earlier this year, however, my church’s mothers’ ministry had a Zoom meeting challenging members to think about how 2020 was the year of perfect vision. It was interesting to consider: I had to be laser-focused in my commitment to my goals to avoid distractions and overcome the obstacles of an unexpected pandemic. And maybe 2020 had me re-focus and let go of attachments and what I thought my life should look like. My family did not travel to other states or countries for vacation as in previous years, but we got to experience adventure and explore new places locally and within the state. My daughter speaks fondly of Solvang as much as she does of Spain (we visited in 2019). Even with letting go of attachments and expectations of what I thought things should be like, I didn’t accomplish all my 2020 goals – I still need to add more physical activity in my life and to declutter my home – but looking at my old vision board, I’m proud of what I’ve accomplished in 2020! Now, onward to 2021!

Interview Tips and Tricks for Nursing School, Clinical Volunteer Roles, or Nursing Jobs

Some of you might be applying and preparing for nursing school interviews. December is when I began my nursing school interviews a couple of years ago. Out of the schools to which I applied, only two required in-person interviews as part of their application process. Luckily, I wasn’t a stranger to interviews by that point. Before nursing school, I interviewed for a competitive clinical volunteer program and eventually helped interview and screen applicants when I became a leader. It seems to be that time of year again for interviews because I landed my first new grad RN interview this past week for a local hospital. Since it appears to be interview season for myself and others, here are some of my suggestions for interviews, based on my experience and advice from friends and professors. They include anecdotes of my interview blunders, so you hopefully learn from my mistakes!

Research the organization

Do your research before the interview:

Research the organization by reviewing its website and doing an internet search. You can research companies and hospitals and see what their current and former employees have to say about them on Glassdoor.com.
Review mission statements. What can you share about yourself that matches or aligns with their mission statement?
If you know any current or former employees/students, ask them about the unit, program, or culture.

Doing this research will help you prepare a more specific answer to the interview question, “Why do you want to be part of this school/hospital/unit/organization?” You’ll also be able to find information about considerations you might have to reduce the number of questions you ask during your interview.

Anticipate the questions and prepare your answers

Be prepared to answer questions from your application essays and be able to speak to your resume. You should be able to discuss or explain anything you have provided in your application. Be prepared to talk about yourself and give them an idea of who you are. Interviews with nursing school, volunteer programs, or entry-level positions do not typically ask many technical questions – people want to learn about YOU. (Although, I did have a couple of clinical-type questions in my latest interview).

What I found interesting is that nursing school interview questions were not much different than job interview questions or even questions from my volunteer program. Below are some common questions one should be prepared to answer or discuss during an interview:

Tell me about yourself
Why did you become a nurse? or Why do you want to be a nurse?
Why do you want to be part of this school / hospital / unit / organization?
Why do you want this position?
What are your strengths?
What are your weaknesses?
Tell me about a time you made a mistake.
Tell me about a time you managed a challenging situation or overcame a challenge.
Describe a time you had a conflict or disagreement with a colleague.
What do you have to offer? / What makes you different from other candidates? / Why should we hire you? / What can you bring?
What would you do if you had a difficult or agitated patient?
What would you do if you had a difficult preceptor?
Where do you see yourself in 5 years? 10 years?
Do you have any questions?

For my volunteer program and nursing schools, other questions I encountered were:

How have you prepared for this program?
How have you ensured your successful completion of this program?

Finally, for additional interview questions, there are some great ones listed online. I found other nursing school interview questions at https://allnurses.com/common-nursing-school-interview-questions-t553788/. I looked at job applications for new grad programs, even ones to which I wasn’t applying, and I pulled some of the following questions from an application:

What academic, clinical skills, and personal attributes do you have that will enhance your success in this program and your professional role as a nurse?
Cultural competence and respect for others are important in nursing practice. Describe a few ways that you have incorporated cultural sensitivity and competence into your own nursing practice.
Please briefly describe your professional/career goals.

Allnurses.com also has forums for people applying to specific nursing schools or hospital new grad programs – the discussion boards usually give you an idea of interview schedules, formats (in-person vs. virtual), or questions. When applying to specific programs, it’s helpful to know if candidates are already interviewing to assess if the program is still considering your application. It’s also good to keep in touch with your cohort after graduation for this same reason. My classmates received interview invitations and job offers to join a new grad program I applied to, while I heard nothing. It took over a month to receive my official program rejection, but I anticipated it since my classmates had interviewed for the same program a month prior.

One of my friends recently finished her first year and a half working as a nurse and interviewed for a new RN job. She shared possible interview questions with me. For more seasoned nurses, a potential employer may ask the following questions:

What do you look for in a leader? How do you emulate that?
What do you like about nursing? Dislikes?
What do you find rewarding about this profession?
How do you deal w/someone unsatisfied w/ your care?
Tell me a time about a clinical emergency and how you reacted.
Tell me a time you had to deal w/ difficult MD.

Here’s another great interview question I found in a Facebook group: Tell us about a time you had an error in judgement. What happened, what did you learn, and how has this shaped you into the nurse you are today?

Practice and use prompts

One interview preparation technique my friend used was to write out her responses to potential interview questions. She placed the questions and notes about her answers on the wall behind her computer and camera. During her virtual interview, she was able to glance at her notes, when needed, to help her answer questions. I think this idea is genius!

I do not recommend reading word-for-word written answers to interview questions. However, writing answers may help clarify what you want to convey about yourself or allow you to draw upon stories and examples to share more readily. I love my friend’s technique because little notes or prompts help prevent blanking out during an interview. This technique is similar to giving speeches or presentations: Never recite notes or slides, but use them as prompts to remind you what to say or share.

After writing out your responses to potential interview questions, practice sharing your answer out loud. Practice with yourself in a mirror, and later, practice with another human being. I am planning to do this with friends and former classmates. Mock interviews serve as dress rehearsals and allow for feedback for improvement and adjustments before actual interviews.

Dress professionally

Photo by Andrea Piacquadio on Pexels.com

For my clinical volunteer program, applicants were instructed to dress professionally for their interview. I dressed in business casual clothing and opted not to wear a blazer. It wasn’t until I became a leader that I discovered that they docked points for applicants not wearing a blazer or suit to their interview. After learning this, I made sure to wear a blazer (or business suit) during future clinical interviews.

The following year, for one nursing school interview, I spilled tea all over my blazer as I drove to the interview. I set my tea on the passenger seat (it didn’t fit in the cup holder), and somehow my tumbler tipped and spilled its entire contents onto my blazer resting below it. Luckily, my blazer was black, and it was difficult to tell it was even wet. I dried it as best as I could once I arrived and parked at my interview location. I was able to wear my blazer during my interview, even though it was damp. It just smelled fragrant – like lavender earl grey tea! My lesson from this is never to drink colored beverages going to an interview and maybe carry a Tide pen!

For nursing job interviews, job applicants typically do not wear scrubs to an interview unless they arrive directly from a shift or are interviewing during a break in their workday. If you’ll need to wear scrubs to an interview, explain that to your interviewer beforehand.

Bring copies and material for notes

For your interview, bring extra copies of your resume or your nursing portfolio to share with interviewers. Bring material (ex. pen, blank paper) to take notes. Collect the contact information or business cards of your interviewers.

Arrive early

Arrive early enough to park and walk to your interview! Unfortunately, I was about a minute late to my top choice nursing school interview. I arrived at the interview location 40 minutes early but was unable to find parking. I had been to the site twice before and easily parked at the adjacent parking structure both times. I thought arriving 40 minutes before my interview would give me extra time to park elsewhere on campus if needed. I was wrong.

All lots, even the farthest ones on campus, were full. It was raining and a Tuesday of the first week of the semester; most students were attending class or petitioning themselves in courses. I drove around multiple times and tried parking on all parking lots listed on the campus map. I even went through the nearby neighborhood, but the residential area required permits to park. I finally found street parking outside a restaurant blocks from the campus beyond a freeway entrance. Only 60 minutes of parking was allowed per street signs, but I was willing to take my chances. I could go over a little time and possibly get a parking ticket over missing my interview at my top school!

After I parked, I ran as quickly as possible and called my interviewer to let her know I was on my way but running late. I arrived at the front office out of breath and wet from the rain. Fortunately, I was only a minute late, and they allowed me to interview. Lucky for me, that school accepted me into their program!

These days, because of the pandemic, many interviews are done virtually. Get yourself set up early enough to allow your computer to load, log in to the program used for the interview, and be comfortable. Make sure the background the interviewer is seeing is free of mess and clutter or anything distracting. A trick an old co-worker of mine used was to ensure she seated herself in front of a wall of her awards and certificates during a virtual interview. If you have a place where you hang your diploma(s), awards, etc., consider that wall as your background.

Be confident and calm

If you’ve prepared for your interview, you should be confident. You have made it farther than other candidates by even getting offered an interview! If you don’t feel confident or are anxious for your interview, practice slow deep breaths. Inhale over 4 seconds, then hold your breath for 4 seconds. Exhale for 4 seconds and hold your breath for 4 seconds. Repeat this breathing pattern to calm yourself. (I learned this breathing exercise from a live talk from Brene Brown, but I guess this is something first responders also practice)!

Hopefully, you arrived to your interview early. Go to a restroom beforehand, look at yourself in the mirror, compliment yourself, and practice wide-stances. Put your hands on your hips. Keep your back straight, shoulders back, and chest up. Make sure you are not physically sinking inward, which can give the impression of insecurity. Do your pep talk and superhero wide-stance practice immediately before your interview. (I learned this superhero confidence-building trick during a training workshop in my previous job). During the interview, remember to look your interviewers in the eyes as you talk to them.

Ask Questions

If you’ve done your research, but you still have questions, make a list and bring it to your interview. The interview also allows an applicant to discern if a position or organization is right for them. “Do you have any questions?” is a common question asked at the end of an interview. When prompted, you can draw from your list of questions.

Below is a list of possible topics one could consider before or during an RN job interview. Ideally, you would research these topics ahead of time and discover most of the answers before your interview. Some job considerations are from my friend while others are from a nursing school professor:

Training process?
Scheduling?
Performance expectations?
Employee performance review process?
Support in education? CE? Conferences?
Opportunities to teach/mentor?
Involvement in shared governance
Why do you like working here?
Work environment?
Is this a magnet hospital?
When was your last accreditation? May I see the report?
Is this physical facility a place where I’d want to seek care?
Take a tour to see staff working. Are they happy?
Ask to visit unit(s). Observe the number of patients per RN on the board.
What are the benefits?
Is a contract expected?
When are people eligible for raises?
When does vacation start accruing?
Is childcare available or offered?
Meet with staff who will be in charge of you.
Are nurses allowed to do advocacy?
Is quality improvement top-down or driven by nurses? Do nurses drive performance improvement?
If in a clinic, is the medical director strong and stable?
What is nursing turnover like in the unit?
Care coordination?
Do finance people speak same language as nurses? What are their priorities?
What partnerships does the nursing departement have with patient families? What resources are available across the continuum and community?

Some questions to consider asking during nursing schools interviews are:

What is the NCLEX pass rate of your graduates?
How do you prepare your students for NCLEX? Are students required to do HESI or ATI or purchase UWorld?
What is the rate of people graduating in the recommended timeframe? How long does it typically take for people to get their degree in this program?
What is the clinical and lecture schedule? What is a typical day like for your students?
What is the size of the cohort?
What are the traits or practices of your most successful students?
What are the hospitals or clinics where clinicals have been held?
Are there student or faculty mentors?
Do you help with job search or placement?
How quickly do your graduates find jobs after graduating?
Where do your graduates typically work?

Write Thank You Notes

After your interview, write thank you notes to your interviewers. (You collected their contact info. during the interview, right?) Reiterate unique traits and strengths or clarify any uncertainties about yourself. You want to do this to be memorable and to give your interviewers confidence in choosing you. Express your gratitude and appreciation for the people that took the time to interview you. Emailing the thank you messages ensures quick delivery.

I wrote this blog post as a resource for others but also for myself. I need these reminders, too! I like that I can now review this list before every nursing interview. Do you have interview questions to share or tips to add? I would love to hear them!

Thank you for reading! If you found this post helpful or appreciate anything from it, please like and share with others! Good luck to you and your endeavors, and good luck with your interviews!