When I decided to go into nursing, I did so to help people. To heal and educate, to give some compassion to those that are in need of help, to lessen the effects of disease. Helping people has always been my calling. It has never been about the money. I would never and could never make a decision for my patient based on how it will affect my pay or my financial outcome. I make a decision for the best of the patient. When I was new to nursing, I believed the doctor did as well. I admit I used to have an unusually optimistic view of people and the world around me. Unfortunately, over the last few years I have seen things that have forced me to change my views, and all I can say is that humanity has a price, and the cost is rising.

At one job I was asked to give one IV anti-emetic over another because the price was lower and/or the reimbursement was higher on one versus the other. I also worked for a doctor that would tell the patient a treatment wasn’t a good option because the patient’s insurance wouldn’t pay for it. I would also be asked what insurance the patient had prior to the doctor seeing the patient.

I wish I had known this before going into medicine. If I had, I may have made a different choice. Seeing this has really made me lose faith in humanity. I see it everyday in stores and on the road, people indifferent or rude towards one another. However, in a setting where I expect compassion and respect, I am seeing something quite unexpected. It is disheartening and frustrating. It makes me lose respect for the people I have looked up to my entire life. I understand not all doctors are like this, but unfortunately, there are enough that I need to speak up.

Doctors took an oath to help those in need. They have people looking to them for help in getting better and giving them all the information they need to make informed medical decisions. They have a moral obligation to their patients. Doctors have to put their patients health above their cash filled pockets. Unfortunately, many patients cannot see this and think the doctor is giving them all the information, when, in reality, that isn’t always true.

Patients need to advocate for themselves and, as nurses, we need to educate and advocate for our patients as well. These doctors need to ask themselves why they got into medicine. Our doctors should be in this field for the love of people and medicine, not for the paycheck they see each time a patient walks in the door.

CyberKnife technology is truly amazing. I hadn’t really known what it was or what it could do until I accepted my new role. CyberKnife performs stereotactic radiosurgery. Big fancy words for using very high doses of radiation to obliterate tumors in the body. Not to be confused with Gammaknife, that is only approved for intracranial use. Also, not to be confused with standard radiation therapy. CyberKnife is used on tumors in the brain, spine, lung, prostate, live, pancreas and other tissues in the body. Not yet approved for breast tumors, but studies are being done presently to see if it will be approved in the future. Not only does it obliterate tumors, it does this with sub-millimeter accuracym which means that we can treat the tumor with radiation without damaging the healthy tissue surrounding the tumor.

The linear accelerator (machine that produces the radiation beam) is mounted to a robotic arm that is linked with multiple computer programs that can track the movement of the tumor during treatment. It is hard to explain in a few sentences, so I will link you to our website to learn more. Let me tell you though, it is truyl impressive to watch. The success rate is huge and to do this with no pain or blood and minimal side effects is amazing!

Our commercial will be playing on local stations starting July 6th, but you can view it here: http://www.youtube.com/watch?v=s7vUbbK5kNE

Our website is very informational www.denverck.com. We have videos that can show the process the patient goes through as well as the treatment itself. It is truly amazing to watch in person.

We have named our CyberKnife robotic arm Ray, and you can follow Ray on twitter at www.twitter.com/denverck. He tweets often about the  occurences in the office and educates it’s followers about the treatments.

You can also become a fan on facebook http://www.facebook.com/inbox/?ref=mb#/pages/Lone-Tree-CO/Denver-CyberKnife/114495996141?ref=ts

I am so excited to be a part of this cutting edge technology that looks like it should be in the new Star Trek movie. Please learn more about where the future of medicine lies…

I see a lot of nursing students wanting to be spoon fed the information, wanting to do very little work to learn this information. Granted, there is A LOT of information to know, however work needs to be done to incorporate and apply this knowledge into many different settings and scenarios. I don’t see the students going that extra step to apply the knowledge. This scares me as an instructor and as a potential patient.

This is the mind set that no nurse or nursing instructor wants to see. This action tells me that the students that I am teaching are in the wrong mindset. They are not interested in learning all they can to be a great nurse. They are only interested in passing the test, scraping by and being mediocre nurses. So I pose this question to you? Do you want to be taken care of the nurse that tried their hardest to learn as much as they could or those that did as little as they could to just get by?

As a nursing instructor, it makes me cynical as to the new generation of nurses that we are breeding. Will we have a generation of nurses that can acquire the critical thinking skills needed to be a proficient and skilled nurse? Who is to blame for this next generation? Is it our fault as instructors or is it the mindset and work habits of the students?

I don’t want to see the students sitting around during lab practice or in clinicals, not taking every minute to practice their skills or soak up every opportunity to learn something new. I don’t want to see the bored faces of those that think they have practiced enough or say they know how to do it, and then come finals time, show me that they cannot do the skills and just barely pass.

I no longer want to see my nursing students with a sense of entitlement, saying “I paid my tuition, so give me my diploma”. A diploma is not just a piece of paper, it is a symbol of the education you earned. I want to tell my students that they don’t need to know this for the test and for their pencils to keep frantically writing.

I want to be a proud instructor of the students that are graduating. I want to feel safe, that if I were to open my eyes while laying in an ER and see a former student standing over me, that I can lay my head back with the confidence that I will be well taken care of. I don’t want the feeling of worry that the former student would say “that wasn’t on the test” and therefore they didn’t need to know it to take care of me.

Let me further explain this concept. Why do we put a larger gauge needle in the AC when we are giving Vancomycin? Why do we give our second NS flush at the same rate as our IVP med? Why do we aspirate before giving the IM injection? Why don’t we crush certain medications? In nursing school we were always taught to perform a task a certain way, but did anyone ever teach us the reason and rationale as to why we are doing it that particular way. Most instructors are great at telling us how, but very frequently leave out the why. I think we fail our students by leaving out the rationale behind the lesson. This is what will make the difference between task oriented nurses and nurses who can critically think and reason through a problem.

I was told once that if we explain to our patients why they need to take a certain medication or why they need a procedure, they are more likely to consent or be compliant. Shouldn’t this be true for nursing students. I think nursing students will perform better in their skills if they understand why they are doing something and comply more readily if they know the importance behind it.

As a nursing student, you should always ask yourself why. “Why am I doing this and why am I doing it this way?” If you can answer the question of why, you are well on your way to being a fully competent nurse. If an instructor asks you why, please do not be content in saying “I don’t know”. That is not the right answer. Think through and give it your best shot and then go look it up. Nurses should and will always have a reason as to why they do something. If you ask them their reasoning behind a certain task, and they can’t tell you, think long and hard if you want to trust what they are doing.

I always try to educate my patients as to why they are getting a medication, what to expect while it is infusing and the side effects that may occur later. One of my patients went to the local emergency room for urgent care and his wife asked the nurse what medication he was getting and why he was getting it. The nurse actually replied, “I don’t know”. How crazy is that? Do you ever want to look as stupid as that nurse looked to that patient and his wife? The answer is ‘no’.

Please realize that most things nurses do have good reasons behind it and knowing those reasons are the true key to being a great nurse versus a mediocre one. Those ‘whys’ are difficult until you get used to them, but as challenging as they may be, they are imperative to the independence of your skills as a professional nurse and a nurse that thinks critically and thoroughly.

If they are offering huge bonuses and large amounts of money for you to work for them, there is a reason. Not to say that you might find a job that pays more than another, but if they are offering $10,000 sign on bonus for a 2 year commitment, be wary. I was offered that much to go work for a  local hospital fairly recently after I graduated. I did some more research and it turns out they have a very high turnover rate. You don’t want to be stuck in a place for years, unhappy and itching to get out, just because the front end offer was too good to be true. It is really hard and costly to break those contracts and it is just better not to get involved to begin with, unless you know what you are stepping into.

In most cases, you are only trying to impress the employer you are trying to get a job with. At this stage, with nurses being in high demand, they should be trying to impress you as well. Prepare some of the big questions you have on your mind prior to your interview and make sure they get answered. What is the patient to nurse ratio? Are they rotating shifts? Pay and benefits? How is the schedule made? Anything that is a big deal to you, get the answers up front and to your satisfaction. Don’t ever think that you have to take the job and the pay they offer you or you won’t find anything else. That isn’t true and don’t let them make you think that. As a side note, as a new grad you may not be able to dictate or negotiate your starting pay as easily as a veteran, but if it is really low in comparison to other jobs, you may be able to at least get a comparable wage.

Always remember that most employees don’t leave jobs, they leave managers. If you interview with a manager and the two of you don’t see eye to eye or there isn’t at least a cordial bond, it may not be the right fit for you. People are different and some people you can get a long with and communicate easily with and others may turn you off. You can also ask some of the current employees if they are happy where they work and if they think he/she is a fair manager. You can tell a lot by the atmosphere on the floor of how it is run and how happy the employees are. Which leads me to my next point.

Ask if you can follow a staff RN around for at least a couple of hours. You can see and hear a lot on the floor during a shift. If people are complaining the whole time or it is chaos and there isn’t enough support, that is a tough environment to be in, especially as a new grad. You can also get a feel for how the staff works together. Is it a team environment or is it every man for himself? As a new grad, you want all the help you can get. Even after a few hours, you will be able to tell if it is the place for you. If you bond with the staff and you can’t wait to get back, then it is a fit. If you can’t wait to get out and never come back, then move on.

Find out if the facility offers a new grad program. This is something that is becoming more common at the hospitals and I think it is invaluable. I wish I had the chance to enroll in a new grad program. Not only does it give you a built in support system, but it helps with ongoing education as well. As a new grad, you really cannot get enough support and resources to help you grow into the professional nurse from a nursing student. It is a hard transition and anything your employer can do to help make that transition easier is important. Take advantage of it.

If you keep in mind the tips for finding a job in the nursing field, you should hopefully find a job that fits your needs and can help you grow into a happy, confident, competent nurse. Please don’t just take the first offer if it doesn’t feel right to you. There are plenty of jobs out there; you need to find the right one for you.

It was then I was on a fast track into medicine, originally wanting to become an MD. I decided after college and seeing a lot of my friends in medical school that I wanted something different. After some tough questions and some soul searching, I decided to go into nursing. The following is a true story that started the year I began volunteering and concluded many years later…

Mr. Gillespie
When I was in seventh grade, I was a candy striper at a local hospital in my town. I volunteered about thirty to forty hours a week during the summer. Most of the time I spent there was with Mr. Gillespie. He never had any visitors, and nobody seemed to care about his condition.

I spent many days there holding his hand and talking to him, helping with anything that needed to be done. He became a close friend of mine, even though he responded with only an occasional squeeze of my hand. Mr. Gillespie was in a coma.

I left for a week to vacation with my parents, and when I came back, Mr. Gillespie was gone. I didn’t have the nerve to ask any of the nurses where he was, for fear they might tell me he had died. So with many questions unanswered, I continued to volunteer there through my eighth-grade year.

Several years later, when I was a junior in high school, I was at the gas station when I noticed a familiar face. When I realized who it was, my eyes filled with tears. He was alive! I got up the nerve to ask him if his name was Mr. Gillespie, and if he had been in a coma about five years ago. With an uncertain look on his face, he replied yes. I explained how I knew him, and that I had spent many hours talking with him in the hospital. His eyes welled up with tears, and he gave me the warmest hug I had ever received.

He began to tell me how, as he lay there comatose, he could hear me talking to him and could feel me holding his hand the whole time. He thought it was an angel, not a person, who was there with him. Mr. Gillespie firmly believed that it was my voice and touch that had kept him alive.

Then he told me about his life and what happened to him to put him in the coma. We both cried for a while and exchanged a hug, said our good-byes and went our separate ways.

Although I haven’t seen him since, he fills my heart with joy every day. I know that I made a difference between his life and his death. More important, he has made a tremendous difference in my life. I will never forget him and what he did for me: he made me an angel.

Author: Angela Sturgill, A 5th Helping of Chicken Soup for the Soul, pg. 6

I actually feel that a lot of nursing students that have a medical background (CNA, EMT, MA, etc) are at a disadvantage in nursing school. They have learned a different discipline in the medical field and when asked to change their way of thinking, sometimes it is a difficult task to do. Let me give you an example. Say you are a waiter for 5 years and then get promoted to manager, you have a different set of tasks that must get done, a different way of thinking and you must look at the restaurant in a different way. You are now not just concerned with getting your customers food out on time and making sure their needs are met, but you now need to make sure that the whole restaurant’s needs are met and that the restaurant is making money. Some managers can’t see past their customers food getting out on time, and therefore, they struggle to be good managers.

People with prior medical experience also have a lot of opportunity to pick up bad habits at their current medical job and sometimes that will spread into nursing school. They are constantly comparing school to “how it is done in the real world”. Just because it occurs in the real world doesn’t make it the right way of doing things. A lot of nursing students will fight the way things are done in nursing school, because they see how nurses do things at work, and want to do it that way. It becomes frustrating for the students as well as the instructors.

Some people that have prior medical experience coming into nursing school have a preconceived notion that nursing school will be easy because they see it and may even do some of the tasks that RN’s do. They can have somewhat of an attitude, if you will. This is a difficult mind set to overcome as a nursing instructor, as these students often feel and treat you like they have nothing to learn from you.

One more thing, students with prior medical experience sometimes have a harder time on written exams. This is due to their being exposed to more experiences and therefore they may read into the question more and come up with exceptions, rather than just reading and answering the question at face value.

So to sum it up, you do not need any formal medical experience prior to entering a nursing program, however, some volunteering or shadowing of an RN to see if this is the right choice for you is a good idea. You don’t want to spend a lot of time and money to realize that you don’t like nursing and all the tasks that go with it. So good luck and don’t ever feel like you are the one at a disadvantage because you don’t have medical experience, you are and will be just fine.

• A med/surg floor can offer up the most opportunities for the general nursing skills. All those skills you learned in nursing school that you never got to practice in clinicals? The med/surg floor is the only place that will give you the opportunity to practice them all. Some specialties might have some skills, but overall, the med/surg floor will have almost all of them. So you can practice and get good at those skills.
• In addition to practicing your skills, you will also just be able to increase your general nursing knowledge on med/surg floors. We all graduate from nursing school feeling like we know nothing. Nothing about skills, nothing about diseases, nothing about meds, etc. These floors have basic and complicated diseases, disorders and procedures. You will gain a general knowledge of most diseases on this floor other than the same disease I deal with everyday in my current job, cancer. It will make you a more rounded out nurse, and possibly open your eyes to a new specialty you can pursue later on in your career.
• It is a great place for time management. In nursing school they taught you about time management and then gave you a maximum of  3 patients. And even then, you weren’t solely responsible for those patients. If something happened, there was always someone to back you up. You weren’t admitting and discharging and taking orders off the charts. In school, it was different. In the real nursing world, time management is very different. You are juggling 5 patients with different tests and appointments and medications and schedules. Then you have an admit and a discharge and you transfer someone all while one of your other patients is going down the tubes. This is when prioritization and time management become key. You will not get the best experience in any other specialty as in med/surg nursing.
• Going along with time management comes organization. You have to organize your patient information and keep 4-5 different sets of  medications, report info, appointments separate and not mix them up. It is really easy to mix up patient information and give incorrect medication, chart on the wrong patient, etc. Organizing your priorities and the cares for your day. Lumping activities together so as to not go into the room 10 times when you go in once. That is a big lesson your first year out of school.
• Medical/surgical floors are where the true shortage in nursing is. Everyone in school now wants to specialize. So then everyone is fighting for specialty opportunities and everyone on the med/surg floor is making double time and more per hour to fill the extra need for nurses. I was called almost every day off I had while working on the med/surg floor to see if I wanted to come in for extra pay because they were short staffed. If you want job security in nursing, you will find it on the med/surg floor.

Even though I spent my first year on a med/surg floor, I wish I had known why I was being told to go. It would have made me more excited to know what valuable information I would be gaining from it, and it probably would have made me pay a little more attention. I hope this info helps a little bit that when one of your instructors tells you it is a good idea to spend at least your first year in med/surg nursing, you will know why and not think they are getting compensated for saying it. And no, I am not being paid to say it either.

1. Read each question carefully and identify and qualifiers. A qualifier is a word that will change the answer to the question. A big qualifier is “except”. For example: All of the following are signs and symptoms of COPD, except? That will change your answer. A lot of people overlook that word and get the question wrong, when it might be an easy question of read correctly. Other qualifiers: all, none, always, never, except, including, priority, etc.

2. Don’t read too much into the question. Sometimes we over think the question and then we confuse ourselves and talk ourselves into an answer that could be right only if…Ask yourself “What is this question asking?” Don’t go deeper than that. If you need more information to mark the answer you are thinking, chances are, it is the wrong answer.

3. Don’t second guess yourself, go with your gut. Studies show that most students, when changing their initial, change it from the right answer to the wrong answer. If you marked an answer to a question, do not change it. Chances are it is correct. You spent all this time studying, and some of it you have buried deep down in your brain. Your instincts on an answer is really your knowledge coming through discreetly. Trust your instincts and don’t change that answer.

4. Visualization. When getting ready for lab check-offs or clinical skills check-offs it is important to see yourself doing the task at hand. There are a lot of steps in these skills and missing one key step could cause a failing grade, so visualizing the steps and process of a clinical skill can be helpful. First, write out the order in which you are to do the skill. Then, read through it a few times, then close your eyes and see yourself performing the skill. This will transfer the skill into your memory, so when check-off time comes, you will have it memorized.

5.Give yourself a break. Studying too much right before a test can defeat the pupose you are trying to accomplish. By the time the test comes around, you are so sick of the information you have been going over and reading, that you really cold care less about that subject and therefore, do not care about your answers. Of course this happens subconsciously, but it happens none the less. Take the night off the night before the test. Do something relaxing and fun. Stay away from activities that might interfere with concentration the next day, such as alcohol, or staying up too late. Your brain needs a break every so often and the constant studying and worrying will fatigue your brain making it less astute for the big test.

All these tips should help you on your quest to become a nurse, and that includes the BIG test…the NCLEX. I hope they make your test taking less stressful and more successful!

They can be your advocate, helping you find your way. Help you find that perfect job, or give you an in where they already work, keeping an eye and ear out for you. They could write you a letter of reference, helping you get the job of your dreams.

Sometimes, family and non-nursing friends are hard to talk with about nursing school and/or the profession of nursing. Your mentor can be an listening ear, letting you talk about all you concerns and fears, and answer any questions you may have.

Most nurses have lots of advice and thoughts and opinions about many things nursing and we are more than happy to give those thoughts. I had a few instructors and a few preceptors I wish I had done this with. I regret not keeping in touch with them as I would have learnd a lot. However, I did meet some wonderful, caring “seasoned” nurses in my first year, who became my mentors and who were in valuable to my success. I still keep in touch with some today.

Always keep it in the back of your mind, who might be a good mentor to you, and I always say, you can never have too many mentors, as they will all offer something different.