This is the time of year when soon-to-be-graduating nursing students start to panic. Their college years are almost over. In two short months, they will be graduating and preparing for the NCLEX exam - It’s time to get a job. As if there isn’t enough going on, they are faced with the critically important task of writing a resume. I am posting some suggestions I offer to them below: 

Some ways to describe student nurse /PCA duties:
Instead of  "I gave baths and assisted with ADLs"
Say I assisted patients in meeting their personal care needs and provided individualized attention/interventions while encouraging patient involvement in self-care, promoting independence,  and maintaining dignity

Instead of:  "I was a float"
Try:  I have experience adapting to any hospital unit / a variety of clinical areas /changing situations/environments.  I have the ability to quickly establish rapport and a positive working relationship with nurses and ancillary staff. I can quickly orient myself to unit, independently take initiatives/ require minimal assistance/ encouragement/ instruction…

I can function as an integrated member of the staff/team in any situation and deliver the safe, effective/efficient care to complex pts. I can readily/easily adapt methods/ interventions to a wide range of situations.

Instead of  "I was a sitter"
Try: I have experience providing focused, one-to-one care and ensuring a safe, nurturing/caring/positive environment for patient’s who are at a significant risk for injury or complications.

Other descriptions of duties
-Acted as pt advocate, expressing pt concerns/needs/desires to nurses and other staff who were unable to devote/ spend as much time with patient

-Utilized the time spent providing personal care/bathing to: perform thorough skin assessments, assess nutrition and hydration, look for signs of neglect and abuse, spot early signs of skin breakdown and/or identify pts who were at risk, promote measures to prevent skin breakdown, initiate toileting schedule,  etc

- Ensure adequate nutrition and hydration, assess for problems with chewing and/or swallowing /eating difficulties that may increase risk of aspiration/ poor nutrition.  Assisted pt/family with increasing safety awareness/promting a safe environment;  set-up meal, encourage independence/feed self,  ensure proper positioning to promote adequate food absorption and digestion, prevent aspiration, etc.

-Accurately monitored/assessed and reported/recorded intake and output, nutrition/hydration status.

-Educated pts/families on fall prevention, safety risks, use of call bell, importance of calling for assistance, etc.

-Ensured adequate lighting, clear pathways, safe transfers, promoted/reinforced proper positioning, transfer techniques, use of assistive devices.

-Ensured that all items were within reach and pt was comfortable, adjusting temperature, lighting, clothing, bedding/ linen was clean, dry and wrinkle free.

- Assisted with communication with families, making pt/family needs known, answered questions, directed to appropriate sources to answer questions, etc. 

- Promote socialization, conversation, allow patient to express concerns in a non-judgemental, non hurried environment.

- Assessed level of orientation, ability to read and understand written material (menu, paper) and comprehend what was read, ability to make decisions (meal choices), etc.

 
 

I have been an RN for nearly 20 years and in many ways, I still practice “old school” style. Back in the old days, there was a manual sphygmomanometer at every bedside. When I began teaching a few years ago, I was shocked to find that the new standard of practice was to use automated cuffs on all patients. It is difficult to even find a manual cuff on the unit. I was initially very strict and insisted that the students only use a manual cuff when assessing blood pressure. After awhile, it became impractical and for the sake of time management, I allowed the use of automated cuffs.

Last semester,  a senior nursing student was caring for a patient  who became very tachycardic in response to a medication. As the patient’s heart rate increased, the blood pressure plummeted. As we were waiting for the physician and doing the usual interventions for a hypotensive patient (i.e., wide open fluids, trendelenberg, etc), the automated cuff continued to cycle, but was unable to get a reading. I grabbed the manual cuff and instructed the student to get a blood pressure reading “the old fashioned way.” She was completely unable to perform this basic nursing task. As she was fumbling around, the physician came into the room, followed by a couple of residents and some other staff members. I pushed her out of the way and quickly got the reading myself. Afterwards, she was in tears. She felt horribly embarrassed and felt helpless that she could not help her patient when the patient really needed help. I agreed.

From that day forward, I went back to my old ways. Manual blood pressures on every patient. In a critical situation, the automated cuff won’t cut it. In a patient with Afib, the automated cuff won’t cut it. I was pleased to see an article out of the U.K. yesterday that confirmed what I already knew – manual cuffs are better and more accurate. I hope this leads to a shift away from reliance on automated cuffs. Technology is not perfect, and is not a replacement for good old fashioned hands-on skills. Sometimes, old school is better!


 
 
Nursing scrubs are wonderful. When I was in nursing school, my uniform was a bright white dress. It had two front pockets, was uncomfortably stiff and scratchy, and was very hard to work in. Paired with bright white stockings and white nursing shoes, I felt like I practically glowed in the dark. Compared to that, nursing scrubs are a dream - comfortable, colorful and loaded with storage space. I have found that despite having the room, many nursing students have no idea what to carry in their pockets. This list is something that I go over with my students on the first day of clinical, and usually several times throughout the semester. By the time they leave me, it usually sinks in.

Ten Things To Keep In Your Scrub Pockets:

1) Scissors: Carry a pair that are small and not pointed. Medical scissors are best because they are easy to clean and curved. These will come in handy to open pills in blister packs or trim arm hair stuck to the tape of an IV, etc.
2) Tape: The most versatile tape is one-inch sized, paper tape. It is easy to tear, "skin friendly" and easy to write on. It can be used to secure or reinforce a loose dressing, make a temporary label, and many other things.
3) Sharpie: It should be BRAND NAME sharpie. Sometimes the no-name brands will either smear or smell too strong. A sharpie is very useful to add dates to supplies, label patient belongings, mark the location of a pulse, etc.
4) Gloves in YOUR SIZE: Carry two or more pairs in the size that fits you best so you can quickly and easily put them on when needed. At Yale, gloves are kept in the hallway and there are no gloves in the patient's room. You don't want to have to leave the room to get gloves.
5) Alcohol swabs: These are very useful and can be used to quickly disinfect many things. For example, to clean your pen, the earpieces or diaphragm of a stethoscope, the telephone receiver on the patient's phone - tons of stuff.
6) A pen light: A pen light is not just for pupils. It is a flashlight that comes in handy when lighting is poor. For example, to find a pill dropped on the floor, inspect skin in hard-to-see areas, check ID bands or IV sites in dark room, etc.
7) Tape measure:  In most places, you'll find them with the dressing supplies. The disposable paper ones are best. You never know what might pop up that will need to be measured - skin breakdown, drainage on a dressing, circumference of a swollen limb, etc.
8) Pens: Carry at least 3 or more cheap, disposable black pens in your pocket.  Pens are always "borrowed" and easily lost. Plus, it's nice to have one available if a visitor, patient, or colleague needs to jot something down.
9) BLANK paper: You should always have something to write on. It can be some sort of stickies, a tiny pad, index cards or whatever. It's important to write down questions, unfamiliar terms, vital signs, measurements, etc. You won't remember everything.
10) Tissues: Trust me on this one. These will come in very handy.

Being well prepared is important in nursing. If you carry these items in your pockets, it will be one less thing to worry about as you go about your day. Nothing is worse than fumbling for something at the wrong moment, or having to run out of the room to fetch something simple. You will look organized and resourceful to others, even if you feel like a nervous wreck on the inside!