Reflection: A Difficult Preceptor

I attended an ICU clinical rotation yesterday and experienced my most difficult nurse “preceptor” I’ve ever had. A preceptor is a nurse to whom you are assigned during your clinical rotation that serves as a teacher/mentor of sorts. I used quotes because technically during clinical rotations, you are assigned a nurse to follow/shadow/help but not all are “preceptors” or teachers. Even though this particular rotation is one that is directly tied to my Advanced Med-Surge Lab (we have been going to this hospital pre-pandemic and go to this hospital as students as part of our course requirements), the nurse to which I was assigned didn’t want the role of preceptor. The other nurses were already assigned students, clinic nurses, or had COVID cases, so this was the nurse they assigned to me.

My nurse was in a room with a patient when my instructor announced to her from across the patient’s room that I would be the student with her that day. After my instructor left, I entered the room to introduce myself to her and the patient, and the nurse “shushed” me. The nurse whispered she didn’t want me to agitate the patient as her heart rate goes up whenever she interacts with her. Ok. I wasn’t there earlier. Maybe she just spent all this time getting this patient’s heart rate under control. I didn’t want to undo that.

After we left the room, my nurse asked me to be completely transparent if I’m uncomfortable about performing any skills. She asked me to perform a number of tasks, including Foley care. I shared with her I had never performed Foley care on a live patient. I peformed the skill first semester (last summer) on mannequins. I’ve never had a patient that required me or my nurses to do this for a patient. (Not that Foley care didn’t occur when a Foley was present – CNA’s can peform Foley care. Also, many hospitals avoid the use of in-dwelling catheters due to risk of infection). While I go to open skills lab to continue to practice my skills, skills lab access has been suspended due to the pandemic. Even though I hadn’t practiced in a while, I knew I could do the skill and wanted to do it. However, because I shared I never did it on a live patient and wanted her to watch me to make sure I was doing it right, she did the task herself and declared, “I am not your teacher. I am not here to supervise you. YOU are here to help ME.”

Wow. Uh, ok. This is a great way for me to start my morning. I know how to do a lot of things, but I don’t get tons of experience doing certain skills on live patients. I’ve practiced numerous times on mannequins, read instructions, and watched videos. I’ve done lots of skills once or twice before on patients with a nurse or instructor present. However, I’m not super confident in all my nursing skills yet – even though I passed all my skills exams. I recognize that getting a pass in skills lab doesn’t necessarily translate to being flawless in doing the skill with real-life patients. I don’t want to do anything that could jeopardize a patient, which is why I just wanted to her to briefly oversee me.

Shortly after she performed Foley care, my nurse asked if could spike a bag and hang a Lactated Ringer’s (LR) solution. I said, “Yes, ” but as I was preparing and doing it, she stopped me and asked me to talk her through the process. I hadn’t even finished explaining when she stopped me again and took the bag and just did it herself. I was a little stunned as I’ve hung a number of IV’s already. She said I should hang the bag first before spiking it. I was used to spiking a bag before hanging it. I’m short and don’t want to have to reach up to the IV pole or adjust and readjust a pole every time I hang a bag. I am also used to checking an IV line and flushing it before connecting anything to it, but my nurse did not do this. She connected the line to the patient after priming it with LR and flushed it from a port upstream. I had never seen this before. As I was trying to assess the IV sites, my nurse motioned me to leave the patient alone, again with the intention of not wanting to bother the patient, I suppose.

Maybe half an hour later, the patient seemed agitated and kept raising her arm. It turns out the chuck (an absorbant pad typically placed underneath a patient’s hips) was wet by her left side. She had a Jackson-Pratt (JP) wound drain, so my nurse figured the drain was leaking, added a dry chuck on top of the wet one, and re-positioned the drain and patient. A little while later, when I was alone with the patient, the patient was agitated again. The chuck was wet again with clear liquid. I tried to find the leak. It couldn’t have been urine because she was connected to a Foley, and the patient’s urine was dark yellow. I couldn’t see a leak from the JP, and the liquid in the JP drain was red and serosanguinous. She had three IV sites on her left side, by where the leak was: her hand, her wrist, and her forearm. Two were running and one was on saline lock. Which one was leaking? I couldn’t find the leak so I placed a towel underneath her left hand to keep her dry and determine if the towel would get wet. If the towel would get wet, it was one way to confirm and isolate the leak to the IV sites. I couldn’t see where the drops of fluid coming directly from any line, but because of the pattern of the leak and where it was wet, I determined the leak was from IV site where my nurse connnected the LR.

When my nurse entered the room, I shared with her the site was leaking and asked if we could switch sites. She switched the LR to the other IV site not being used and then gave me a tip not to use a towel for a patient because it can cause skin breakdown versus a chuck. I silently wondered, “If she had flushed the line before connecting the LR, could we have discovered the leak sooner?” I asked if we should DC (discontinue) the IV site that was leaking and she said why would she if she could save it? When I later told my instructor about the leak and wondered how it could be saved, she said maybe it was kinked or not hooked up correctly. A leaking IV could be saved if the hub was replaced or reattached. I clarified with my instructor if I could do skills on patients, even though I’ve never before done it beyond skills lab. She said I could and shouldn’t need any supervision. With that assurance, I knew I had to give myself a pep talk to be more confident in my own skills and just do things I know how to do, even though I haven’t had a lot of practice doing it in real life.

I also clarified with my instructor if my process for hanging a bag (spiking before hanging) is acceptable – it was. I followed up with the my preceptor and asked, “Why did you stop me from hanging that LR bag?” The nurse shared I was talking too much and not “doing” enough, and she didn’t see me do an assessment. I was frustrated because this nurse asked me to talk her through things, didn’t allow me to do things I normally do, and kept discouraging me from interacting with the patient. I had an entire day in front of me, and I needed to find a way to ensure I was able to do things. So I talked less, did assessments without my nurse present, and eventually got to push IV meds, administer oral meds, empty urinal bags, colostomy bags, and JD drain, witness a CVAD (central venous accesss device) placement, and spike and prepare an NS bag. It didn’t feel good, but I fought to have a day where I could practice my skills and learn.

Around two in the afternoon, my nurse asked if I wanted to eat. She had kept offering me to go on break and eat all morning, but I kept turning her down. I finally agreed I should probably eat as it was now 2pm. She said I could leave early if I wanted and not return from lunch. I was leaving the floor around 3:30pm, so if I was gone one hour, I could just leave. However, I wasn’t planning to be gone an entire hour since most nurses get only half an hour. When I asked to verify if her lunch was only half an hour and how I wanted to match that (how else am I going to get used to the work schedule of a nurse?) she replied saying someting about time management and how she doesn’t know me or my schedule but that I should do what I need to do to manage my time. I explained I would return from my lunch and that I still wanted to learn and do things. We had a patient that had urinary retention so I anticipated needing to do a straight cath (in & out catheter) on the patient. I didn’t want to miss the opportunity to insert the catheter; I had never done this on a live patient.

I ate lunch and returned to the floor. The patient who was unable to pee refused the catheter. However, the same patient needed to have a CVAD inserted so we helped prepare the patient for the procedure and monitored him while the doctors inserted the device into a jugular vein. I held the patient’s hand, helped monitor him, and used therapeutic communication to keep the patient still and reassure the patient throughout the procedure.

I had to reflect on the day because while it was rough, I fought to have a valuable clinical experience, and I got it. It’s not often that students get to see a CVAD inserted and sutured to a patient. I wouldn’t have seen that if I left early, as my nurse seemed to encourage me to do. I also got to practice adjusting to different personalities. As a nurse, I’ll need to adapt and adjust to different conditions and personalities. My nurse kept saying multiple times throughout the day, “I am not your instructor”, but I took that in stride, accepted her feedback, adjusted, and performed more and more skills that day. I also learned I need to have more confidence in my own abilities.

My experience reminded me of a Winnie the Pooh quote from a book I’ve been reading my daughter “Pooh’s Grand Adventure”. Christopher Robin tells Pooh, “You’re braver than you believe, and stronger than you seem, and smarter than you think.” I have to remind myself of this. No growth is without challenges. I have to think that my difficult preceptorship experience just helped me to be stronger and forced me to reflect and be more confident in my abilities. Whether she wanted to teach me or not, I learned something.

One last thing my nurse told me before I left the floor. “Be kind when you’re preceptor. Always be kind”. Okay, I’ll remember that.

Return to the Hospital Setting

This past week, I returned to the hospital setting with my cohort after nearly a month being off the floor, away from any direct patient care. We were at a hospital to volunteer and support various departments in whatever capacity they needed. Eagerly and without knowing much detail, we got assigned to various units that day, attended a brief orientation, and assigned ourselves to numerous 12-hour shifts through mid-May.

Wearing the hospital-provided surgical mask over my personal cloth mask and glasses for some eye protection.

To give some background, all my clinical rotations were indefinitely suspended on March, Friday the 13th, due to the global pandemic. I would have never imagined that the pandemic would cause life-altering changes here in the United States for so many. For me, I still wanted to be nurse, but without the patient-interaction provided by my clinicals, my ability to graduate from nursing school was threatened . (The California Board of Registered Nursing (BRN) requires at least 75% of clinical hours to be with patients). As news of the pandemic began to worsen, however, I was relieved to be able to stay safe at home and not have to be in the hospital setting.

Honestly, during the first couple weeks of “stay-at-home” orders, I couldn’t prioritize school or graduation requirements when I felt like I was scrambling to survive and keep my family safe. After the orders were announced, my daughter had come down with a high fever (105 degrees) and started vomiting on an evening my husband was asked to go into work. My husband was sent home, thankfully, and my daugher seemed to gradually improve. A couple afternoons later, however, my daughter’s fever spiked again to 104/105 and she began coughing in her sleep. I listened to her lung sounds with my stethoscope, and I was convinced I heard wheezing in her upper lobes. Her fever broke early that morning, before dawn. I was still worried, so I reached out to her pediatrician. We were able to conduct a tele-visit with her doctor’s office who wrote a prescription, and my daughter has been well the past three weeks. The week after my daughter got sick, I took my 77 year old father to urgent care (for completely separate symptoms). In those first couple weeks, I used my nursing skills and tools to take care of my family. I prioritized family over school or studying for my future career. I was happy to use my nursing knowledge to focus on my family because I did not want to jump back into clinicals with all the uncertainty and seemingly unsafe conditions.

There was so much unknown about the virus and what was required to keep people safe. Should droplet precautions or airborne precautions be used? Even if the type of protection needed was consistently defined, personal protective equipment (PPE) was not readily available. A month before my cohort was called off the floor, hospitals were already asking their staff (and nursing students) to reuse their N95 respirators when dealing with airborne precaution patients. I preferred not to work with these patients because it made me uncomfortable to see a piece of intended-for-single-use equipment used repeatedly. I didn’t want to have to re-use a mask and increase my chances of contamination. With the pandemic, it has unfortunately become normal practice to re-use a mask or have a single mask in a 12+ hour shift because of the PPE shortage.

With what I was witnessing, hearing from the news, and learning from personal accounts and advice of nurses, it seemed best to stay away from direct patient care. I was willing to accept that it might take me longer to get my BSN than I planned. The health and safety of my family is more important than graduating with a BSN on an earlier timeframe. I was okay with taking classes online and patiently waiting when we could safely return to the hospital.

Then, at the end of March, the governer of California called for student nurses to join the Health Corp. I felt compelled to join and signed up. While I’m not a licensed RN, I am a nursing student about to graduate this year. I recognize I have a special set of skills and training that can be useful in caring for patients compared to someone without healthcare experience or education. I signed up with the comfort of knowing I could turn down a deployment. I also signed up because my school (and the BRN) said the volunteer hours could count towards the required direct-patient care clinical hours. I reasoned, “They wouldn’t put student nurses in unsafe conditions, would they?” In reality, the BRN is not set up to protect nurses; The BRN exists to protect patients. Ultimately, I know I need to rely on myself to be protected and safe.

I want to keep my family safe and not expose them to this virus or other illness because of my chosen line of work. Being a nurse lends itself to some risk, however. Nurses and other healthcare professionals are exposed to patients with communicable diseases. Before, the level or risk was acceptable because we had proper PPE available, vaccinations for most things we could be exposed to were offered, and effective treatments known. With COVID-19, the safety measures that made the risk acceptable of working with contagiously ill patients were diminished. After serious thought, I determined I still wanted to be a nurse; I hope that once I’m an RN, conditions are greatly improved.

As a student nurse, I’m fortunate to have the choice to stay home and not go into the hospitals. Because I’m not yet an RN, I’m privileged: I can’t lose a license I don’t yet have, and I can’t lose a job by refusing to work with patients at this time. I figured, if I’m truly uncomfortable and feel compromised, I can walk away from a volunteer position. My school isn’t forcing us to return to the hospital but explained that if we do, we can have our hours count towards our missed clinical hours. They presented us an opportunity to return to the hospital setting, separate from the California Health Corp. We were told we would have PPE provided for us, and we would not be on the COVID units. With all of that under consideration, most of the students in my cohort (including myself) decided to return to the hospital setting last week.

I was conflicted; I cried and prayed over my decision to return to the hospital setting. I love my family and want to do what I can to protect them. I have a husband with diabetes and a preschooler. I have parents over 65 for whom I’ve become their personal shopper to enable them to stay in their home. People for whom I am responsible and love dearly are considered vulnerable populations for COVID-19. I also feel strongly that I am supposed to be a nurse, despite the risks involved. God put in my heart a desire to help people and this is the best way I know how at this point. I am not yet a nurse, but I’m asked to use my training and nursing skills I’ve learned to help others. I don’t want to do it foolishly, and I take this opportunity to serve very seriously. I pondered over this opportunity with my husband and parents. Nurses are short-staffed and could use help. My classmates and I can offer that.

I miss working with patients; I am simultaneously excited and scared. I am anxious about the chaos I might encounter, but also hopeful to help fight this pandemic and support healthcare workers and other patients. At times, I get a little panicked, but mostly, I’m at peace with the choice I made to return to the hospital setting and continue with my pursuit of becoming a nurse.

These are such extraordinary times. The news and what we know about the corona virus keeps changing. I have additional training this week and will start my first shift later this week. The opportunity to be in the hospital gives me more reason to focus on assignments and overall learning to be more prepared once I’m on the floor. Who knows if I will change my mind and want to leave the hospital setting as a volunteer student nurse? A fundamental part of the nursing process is asseessment, and I’m constantly assessing my situation. Either way, I will continue to proceed with caution, but also with the confidence that I have skills and training that can help other nurses and patients.

If you pray, I would appreciate prayers for me, my classmates, and my family’s continued protection and safety. Also pray for guidance for nursing students as we apply our training into practice to support the current workforce. Thank you, be safe, and please continue doing what you can to flatten the curve!

How I Scored in the 99th Percentile for TEAS – and how you can too!

If you’re pursuing Nursing, you may have heard of the TEAS because some Nursing programs require applicants to take it and submit their score as part of their application. TEAS, or the Test of Essential and Academic Skills, is a standardized, nation-wide exam administered by Assessment Technologies Institute (ATI). Like many nursing programs, my BSN program uses the TEAS as a screening tool for their candidates. The minimum TEAS percentile my program considered was 80. However, some of my cohort classmates shared that they scored 95-99 percentile overall on their TEAS, well above the minimum for my school. If you want to apply to a competitive program and be an attractive applicant, you must do well on the TEAS. For this post, I’m sharing my tips for how I scored in the 99th percentile when I took the TEAS in Fall 2018.

My Biggest, Most Important Tip: Know Your School’s Requirements!

My most important tip is to know your school’s requirements. If a school in which you’re interested in applying is offering a Nursing forum or information session, attend the session to understand the admissions requirements and clarify questions you might have. Some schools do not require the TEAS for admission. Other schools do not require the TEAS until you submit an application and they give you an invitation to take the TEAS. Some schools require the TEAS but will only allow students to take it once in a six month period. Some programs will not take your best TEAS score in their application timeframe; they will take the first score in the allowed timeframe. Understand your prospective school’s admission policies.

One other perk I discovered while attending Nursing School Information sessions before taking the TEAS is one school offered a discount code for ATI TEAS study packages. However, the biggest reason to attend an information session (or speak to an admissions officer) is to clarify admissions requirements and any stipulations the school or program may have regarding the TEAS exam. This is particularly important if you’re applying to multiple schools since each have their own admissions policies.

Tip: Complete your Pre-Requisites

When I took the TEAS, I had completed all my Nursing School pre-requisites (except for Philosophy and Religion). My Anatomy & Physiology and Chemistry prerequisites definitely prepared me for the exam. Completing my pre-requisites was particularly helpful because the TEAS emphasizes Science. (The TEAS covers Science, Reading, Math, and English and Language Usage. For more information, visit https://www.atitesting.com/teas/register/). I had taken the pre-requisites within the year so a lot of the material was recent for me, and I was grateful that the exam material was a review of what I already learned.

If you’re not done with your pre-requisites, do not get discouraged – other students online said they took the test and did fine without completing their pre-requisites. However, they spent a lot of time teaching themselves and learning the material for the first time.

Tip: Use a study guide practice exam to focus your efforts

I invested in the yellow Mometrix study guide since it was so highly recommended by people online. My time was limited, and I had no intention of reviewing and reading the entire study guide. Instead of studying each chapter, I took a practice exam in the book to identify my weak areas so I could focus on them. I only reviewed the topics or areas where I scored low from the practice exam. After I felt I studied sufficiently, I would take another practice exam. I would continue to use my lowest scores (and wrong answers) to guide me on what I should study. After studying some more, I would take a different practice exam. I would continue this process until there were no more exams in the study guide to take.

My answer sheets for all my practice exams. I would time myself and give myself the same amount of time as the TEAS for each section. I would then review my incorrect answers and study those topics a little more.

Tip: Use your library to access study guides for FREE

I eventually ran out of practice exams in one book, so I used multiple study guides to prepare for the TEAS. My library had TEAS study guides available both online as ebooks and hardcopies. Take advantage of your public library since it is typically a FREE resource! Research availability and reserve your TEAS study guides early because these books can be in high demand! There was a waitlist, but I was able to place some study guides on hold and have them sent to my local branch weeks before my TEAS exam, which gave me plenty of time to prepare.

Tip: Use study tools according to your style of learning

Take advantage of any or all the tools that will help you learn or retain the material you need for TEAS! I know I’m a visual and kinesthetic learner. Flash cards are often an effective way for me to study. I do well when I write/design my own flash cards and study from them. I kept my flashcards from Anatomy & Physiology and used some of them again when studying for TEAS. Another study tool that I thought was helpful was “The Anatomy Coloring Book”. I actually used this during Anatomy & Physiology pre-requisites. It helped me learn and understand various systems of the body. I think it’s a great resource to have regardless of the TEAS, and I even referred to it recently while in Nursing school to review the kidneys and urinary system for Pathophysiology.

Other learning tools I found useful were YouTube videos from Khan Academy and
Armando Hasudungan (a doctor who is also an incredible artist). Many students today use YouTube to supplement their learning, so take time to explore which channels best complement your learning style. Another popular tool is Quizlet, where you can create and share electronic flashcards and quizzes for yourself, but also where you can view other people’s flashcards and study guides. (WARNING: Be cautious when using shared content or YouTube – sometimes material other students post is not the most accurate).

Now that I’m in Nursing school, I watch the YouTube channels for NRSNG and RegisteredNurseRN. While these are resources geared for Nursing students, take advantage of their Anatomy & Physiology reviews in preparation for the TEAS. If you are an auditory learner, you could also listen to NRSNG Radio.

Since starting Nursing school, I have also discovered Picmonic – a great tool for visual learners and for folks who can use stories and pictures to remember concepts. It would have been nice if I knew about them earlier because they have lessons for Anatomy and Physiology! You can try Picmonic for free with one lesson per day. If you want to view more lessons, a subscription fee is required.

There are many tools beyond study guide books to help you prepare for the TEAS – take advantage of them and use the ones that suit you best!

Tip: Invest in practice exams from ATI

While the study guide practice exams were certainly helpful, I found the ATI practice exams to be a little more detailed than what was in the Mometrix or McGraw Hill study books – which helped me on my actual TEAS exam. The practice exams also summarize the areas needed for review and provides a study plan. The review topics correlate directly to chapters in the ATI Study Manual (which I did not have), but still gave me enough information for me to focus my review using the materials available to me.

The online ATI practice exams are structured the exact same way the computerized TEAS exam is structured – with flags, countdown timer, and calculator embedded into the exam. Like the online exam, you can flag questions you would like to review in your practice exams before submission.  The actual TEAS test and practice exams allow you to easily revisit flagged items at the end of a section so you don’t have to toggle back and forth through all the other questions. I’m the kind of person who always double-checks my exam and doubtful answers prior to final submission, so I found the flagging feature helpful. I also liked that the practice exams were modeled after the actual computerized TEAS exam, so I had an idea of what to expect on exam day.

Tip: Find out if your TEAS exam will be computerized or not. 

The TEAS was offered at one of the universities to which I was applying via computer. For my TEAS, I was in a computer lab with a proctor, and each student had a computer. What’s nice about the computer version is the sections can all be taken at your own pace, within the allowable timeframe. Currently, students get 64 minutes to complete the Reading section, 54 minutes for Math, 63 minutes for Science, and 28 minutes for English and Language Usage. Each student gets the same amount of time to complete each section. However, if you finish a section early, you don’t have to wait for the time limit to end before moving onto the next section. The times are all tracked on your computer so you can’t exceed the alottment, but you can easily move on once you’re done with a section.

Some people I know hate taking tests via computer, so they purposefully signed up for a test center offering the paper version of the TEAS. (However, if you plan to continue with Nursing, I believe the NCLEX is on computer, so you might as well get used to computerized tests)! It’s always good to minimize surprises on test day, so find out if your exam is offered on paper or computer to set expectations. Plus, if you take a paper exam, you’ll need to find out what kind, if any, calculator you’re allowed to bring!

Tip: Follow ATI on Facebook

ATI offers live video tutoring sessions for the TEAS. They also offer TEAS workshops via Facebook. If you can’t join live, you can view recordings. This is another FREE tool I recommend you use to prepare for the TEAS.

Tip: Do NOT take the TEAS as practice

I discourage students from taking the TEAS for practice. For some Nursing programs, you are unable to retake the TEAS until six months after your prior TEAS. Some students think they will take the TEAS for practice and simply retake it if they do not do well. They may come to find this is not possible for the program to which they are applying. Use the study guides and ATI practice exams for practice – not the TEAS! Your goal is to do well when you take the TEAS the first time. Save yourself the agony from having to study again and save money on your test registration fees! It is possible to take the TEAS once and do well. I did, so I believe it’s possible for anyone.

Personally, I relied on doing well on my TEAS (and pre-requisites) because my undergraduate GPA was low. It was so low, it fell below some school’s admissions requirements. I got a 4.0 GPA on my pre-requisites, but I knew I also needed to do well on my TEAS to get into my accelerated BSN. I guess it worked, because I got into my top choice nursing school! If I did it, you can too!

Hopefully, my tips and experiences are helpful and encouraging. I didn’t number them because I don’t think any one is necessarily more important than the others (except for knowing your nursing school’s requirements – definitely do this first)! If you have found something useful in this post or on my site, please share it with others! If you’ve taken the TEAS and have other TEAS tips to share, I welcome them! Please also let me know if there are other topics you’d like for me to discuss. Thanks for reading!

My Encounter with Discrimination in Healthcare

On my volunteer shift in the Emergency Room recently, I (along with many other staff members) overheard a heated discussion between a male patient and one of the charge nurses behind patient curtains. The patient was trying to clarify he wasn’t demanding a white nurse, but that he insisted on having an older female nurse. He did not want the black male nurse assigned to him. After the charge nurse explained his request would not be granted, he passionately responded that he wanted someone with more experience; to him, that implied an “older” nurse. The charge nurse assured him that his nurse had many years of experience. The patient assumed his nurse would be a woman because he thought all nurses were women. He argued he had been to the hospital numerous times and proclaimed, “I’ve never had a male nurse!” After some back and forth, the patient confessed he didn’t want a man handling his penis to insert a urinary catheter.

The whole interaction was interesting to me because I am an an older nursing student. When I become a new BSN grad, I will have relatively little experience but will be older than many new graduates. Age does not correlate to relevant work experience or skill-level. Many working nurses I encounter while volunteering may be younger than me, but have many more years of nursing experience. This patient erroneously believed an older nurse would automatically have more expertise in a common procedure than a young nurse.

The encounter was not only an example of ageism, but sexism. Yes, there seems to be more female nurses than male nurses. The patient was adamant that he never knew male nurses existed. The patient was an older man, so it’s quite possible his earlier experiences with nurses in a doctor’s office or hospitals were with female nurses. The demographics are changing, however, and quite frankly, I think that’s a good thing. We need healthcare professionals to be as diverse as the patients they serve. This patient needed a gentle reminder that experience, not gender, make nurses more skilled at procedures.

The black male nurse eventually did what needed to be done for the patient. A while later, the man graciously reported to the charge nurse, “He did a great job!” The patient continued to loudly and excitedly share what a surprisingly wonderful experience he had with his nurse. The same staff that overheard the earlier conversation and I looked at each other and smiled in amusement. Happily, it was a great teaching moment for the patient, but also for myself.

Photo by rawpixel.com on Pexels.com

I’ve read about patients getting discriminated against or experiencing implicit bias from their providers, but healthcare professionals also experience discrimination from their patients, and the interaction I witnessed was a reminder of that. I have yet to have a patient make discriminating remarks directed towards me, but I know that may happen one day. I’m not quite sure how I’ll react, and I wonder if I’ll learn anything about this in my ABSN program. I want my patients to have the best experience and outcomes possible, but does that mean I should ask to be removed from their case if they don’t like me and are therefore uncomfortable due to my race, age, gender, or orientation? In accommodating a prejudiced patient’s request, are we enabling discrimination or giving them better care by making them comfortable? It’s a complex issue.

Luckily, the interaction I witnessed de-escalated and had a good outcome. What if the patient became more hostile instead of agreeable? Would he have been assigned another nurse? What if the patient thought his nurse did a terrible job? Are there hospital policies for situations like this? I really respect the charge nurse and nurse in the situation, who remained professional and respectful throughout the whole interaction. For me, I learned how a nurse should respond to a prejudiced patient: Be respectful but firm, and assure the patient they are in good care. I hope to maintain my composure and act the same way, should I ever encounter a similar situation with a patient.

Called to a New Plan

I went to church Sunday morning with my family and saw the devotional booklet “Our Daily Bread” offered in the vestibule. I hadn’t seen one in a while, but became familiar with them through my mother and relatives from the Philippines, who used them regularly as a daily devotional. The booklet highlights a bible scripture each day and provides a reflection based on that reading. Feeling like I needed to focus more on my spirituality beyond church (it’s so hard sometimes to focus in mass with a rambunctious defiant toddler!), I grabbed one. The bible passage and reflection for that day (April 28, 2019) spoke to me. Because of that, I wanted to share it and invite you to read it at https://odb.org/2019/04/28/gods-retirement-plan/# .

At this moment in your life, what might God be calling you to do for His greater purpose? What new plans has He placed in your path?

Our Daily Bread (April 28, 2019)

The reflection was a great reminder of my second-career journey. Becoming a nurse is the new plan God has placed in my path. I feel I am called to become a nurse to better utilize my talents for His greater purpose. Do you ever feel like you’re on the right path because of the all the “signs” God places before you? You may not have the sign of a burning bush like Moses, but do you feel called to do something, even though you’re uncertain of how exactly you’ll accomplish what you sense you must do? Are you continuously driven towards a vocation without knowing how or if you can really make it happen? And, somehow, a path reveals itself? I feel this way about Nursing – really, I do!

Every step of the way, I feel like God has aligned things for me to allow me to get into Nursing school. If I had waited even one month to look into pre-requisites, I wouldn’t have been able to take the classes I did or complete them before the application cycle. If I had waited one week before researching how to get volunteer clinical experiences, I wouldn’t have become a COPE Health Scholar in a local hospital. If I were in a different volunteer program, I wouldn’t have been able to take patients’ vitals, witness biopsies, circumcisions, C-sections, vaginal deliveries, or perform chest compressions on patients who have coded. God placed people and experiences in my life, to allow me to grow in my compassion, abilities, and skills as a future nurse. Somehow, things aligned or confirmed and re-affirmed my choice to purse a career change. God placed the desire in my heart to consider nursing years ago, but He did not call me into action until now -when I have the social, emotional, and financial support I didn’t have before. His timing was perfect. I prayed to be able to serve God in whichever way He willed, and nursing is where I have now been lead. I have a peace and joy in my heart when I think about my [future] career, but I am still open to God’s vocational plans for me in my life.

Are you called to something new or to continue when you were about to quit? I encourage you to be open to new possibilities or to where God might be calling you. Explore what or where that is, and if you’re called to act, pursue it whole-heartedly. Like Dr. Warwick Rodwell discovering the ancient statue in the Lichfield Cathedral in the “Our Daily Bread” reflection, you could be surprised with the treasure you uncover.

Pathways to Nursing

If you have wondered about becoming a registered nurse (RN) but have not started to really look into it, you may not know what kind of education or degree you need to become an RN.  There are various pathways to nursing.  Each individual must consider which path is best for his or her unique situation.  However, all pathways (in the US) eventually lead to the National Council Licensure Examination (NCLEX), which is the exam that ultimately determines whether or not someone becomes a registered nurse.  Regardless of your background or degree, all aspiring RNs must pass the NCLEX in order to become a licensed registered nurse.  Now that you know the NCLEX is the common gateway to obtaining an RN license, let’s discuss the three pre-licensure degrees you could obtain prior to taking the NCLEX: the Associate Degree in Nursing (ADN), the Bachelor of Science Degree in Nursing (BSN), and the entry-level Masters Degree in Nursing (MSN-E).

Rn_degree

ADN

You do not need a BSN in order to become a nurse; you may become an RN with an Associate’s Degree.  Many ADN programs are only a couple of years long and are a fraction of the cost of BSN programs.  Unfortunately, many ADN programs are known for their two-year waitlists and are just as competitive to enter as any other nursing degree program.  If you can get into an ADN program, however, this is a great affordable option to become a nurse.

Many wonderful and established nurses I know have ADNs.  Numerous facilities and hospitals do indeed hire new-grads with ADNs.  However, certain hospitals have (or desire) magnet status and require a large percentage of their nurses to have a BSN, and thus prefer BSN graduates.  Other hospitals may require nurses with ADNs to pursue a BSN  within a certain timeframe from their date of hire or require 20 years of experience for ADN graduates.  Some hospital nurses with ADNs acknowledge that they are able to work in their hospital or hold their supervisory role because they have many years of experience.  They notice that most of the new hires in their hospital are BSN graduates.

ADN to BSN

As a result of this push to have a nursing workforce filled with BSN degree-holders,  there are many RN to BSN programs designed specifically for nurses with ADNs.  There are hospitals that will reimburse or partially pay for their nurses with ADNs to pursue BSNs.  If you do not mind working while going to school or extending the time you spend in school to get a BSN, getting an ADN first may be the most economical way to eventually getting a BSN.  It is not necessary to have a BSN to work as a nurse, but having an advanced degree may make you a more attractive candidate when applying for competitive jobs against those with similar work experience.

BSN

If you decide to get a BSN directly, you can apply to traditional 3-4 year programs.  Program costs vary and depend on whether or not you attend a public or private school.  There’s a general sentiment that nursing programs in public schools have lower acceptance rates than their more expensive private school counterparts.

If you have a bachelor of science in a non-nursing field, consider applying to an accelerated BSN program, which lasts only 1-2 years. The shorter program time can be worth the cost if you start working as a nurse sooner.  Your opportunity cost of income lost while you are in school could be minimized with a shorter program length.  However, such condensed programs are intense and “accelerated”, as their name implies.

MSN-E

If you have a non-nursing bachelor of science degree, you also could consider applying to entry-level Master of Science in Nursing (MSN-E) programs, which are typically two years duration.  Maybe you don’t want to spend time getting a bachelor degree in Nursing; you’d rather go straight into a master’s program because you ultimately desire to be an advanced practice nurse.  If you want to be a nurse educator or clinical nurse leader, many entry-level master’s programs are perfect for you.  However, if you want to become a nurse practitioner, entry-level master’s programs that I’ve reviewed are not applicable towards becoming a nurse practitioner – a second graduate degree would be required.

If you want an MSN, do not feel pressured to obtain one immediately.  You can become a registered nurse with a lower degree.  Just as ADN graduates can get their BSNs after becoming an RN, BSN graduates can also further their education after obtaining their license to get advanced degrees in nursing.

Begin with the End

It’s important to think about your longer-term goals as you consider the various pathways to Nursing.  Always “begin with the end in mind”, as Franklin Covey suggests.  If you want to work in a magnet hospital as a new grad, perhaps you will want to bypass the ADN option for nursing.  If you want to work as an RN as quickly as possible, consider the ADN or accelerated BSN options.  Take into account private schools without waitlists.  Research the job requirements for RNs at the places you would like to work or the requirements for your dream nursing job.  Job postings typically list education and experience required for each position and can give you an idea of the degree(s) you should target.

Very simply, an RN is someone who has passed the NCLEX with either an ADN, BSN, or MSN-E.  You now know there are many degree programs that can lead you to become an RN.  Knowing what you want to do as a nurse, how quickly you want to get there, and how much you are willing (or able) to spend will help decide which route may be best for you.  Regardless of what route you take, please ensure the nursing program you choose is accredited.  Good luck on your journey!

Disclaimer:  I speak only from my own personal experience and am not an expert in all things Nursing.  If you know of other pathways to nursing and becoming an RN, I would enjoy your feedback.  I invite readers to share any information or comments that would be helpful to others!