Let’s simplify things!
As the semester goes on, somehow it feels like the more you learn, the less you know. This week, I want you guys to focus on simplification. With projects coming up, all your tests and quizzes, lab checkout, your med math checkout, and clinical, you might feel like you’re drowning in work, and you don’t know how you’re going to finish everything by the end of the semester (spoiler alert: you will).
Let’s take a breath and slow everything down. We’ll start by preparing an overview of the next few weeks. This is simple and achievable game-plan so nothing catches you by surprise as the semester starts to slow down. The goal is to finish on a strong note with momentum to carry you into the next semester.
Do whatever you have to and don’t let other people stress you out. People have a tendency to project their nerves onto others around them in stressful situations. If you find yourself being asked to carry someone else’s anxiety, practice exuding confidence. More on this later.
Avoid the rabbit hole of information
I know earlier I told you to be curious about everything and anything while you’re studying. It’s also important to know how to shut off the part of you that wants to hyper-focus on every little detail.
See, the thing that took me a little while to grasp was that we’re going to be nurses. Not doctors, not surgeons, and not scientists. As nurses, we just have to know a little bit about just about everything. We’re the Jacks and Jills of all trades.
We’re not the ones prescribing or dosing the medications or ordering the tests or performing the procedures or surgeries. We just need to know a little bit about all of those things. Your goal leaving nursing school is to become a safe, competent practicing nurse.
So, as you review your notes, try your best to zoom out to the big picture. You’re not going to need to know every little detail at the cellular level in heart failure or ulcerative colitis, but you do need to understand the overall concept and what the goal of treatment is. And when you see Mr. Wannabe Derek Shepard taking an absurd amount of notes in pathos, fear not and remember Nurse Duda says you’ll be fine. He goes braindead anyway.
As you’re studying, stop once in a while and imagine that you have that exact patient in front of you and they need an explanation of their diagnosis (This happens all the time in real life after the team is done rounding) You should be able to give the patient a summary of their disease, treatments, and medications on a 6th-grade leve.
This forces you to step outside the textbook, medical jargon, and word-for-word note regurgitation. It forces you to paint a whole big picture of what is happening that doesn’t feel so overwhelming for the patient.
If you really want to see where you stand, practice this exercise with someone who doesn’t even know medicine. See if you can explain a complex concept so well that they can teach it back to you. (We love the teach-back method in nursing).
Think about it like this: we’re the one’s spending the majority of time with patients. We should be able to educate them well enough so they can can safely leave the hospital and properly take care of themselves.
End of semester game-plan
Let’s start to draft what your next few weeks will look like. Take an honest look at your 11-week calendar and start planning for due dates. Get your papers and projects out of the way. Rewrite those study guides. And really make the effort to keep your notes organized for easy reference when you having palpitations before the Foundations final.
Simplify that lab checkout!
As the semester starts to wind down, I’m sure you’re worried about that physical assessment and skill check-off that is creeping up on you in lab.
For both the skill and assessment check out, if you can force yourself to develop a preset monologue that requires very little actual thought, you’ll begin flying through and your hand motions will just start to follow. And the beauty of this lab assessment check-off, is that you are all healthy and perfect. Not a single flaw. No confusion, no heart murmurs, no crackles, no edema, and no incisions. Simply flawless. So, your responsibility is to belt out how perfect your partner is (also a cute exercise for your next romantic relationship).
Seriously though, try and zoom out to the big picture. This is part of your education. This controlled, low-stakes environment is where you can make mistakes and learn from them without hurting someone. The lab mannequin won’t scream while you straight cath her, nor will her trach not come flying out of her throat the second you insert the catheter and they start coughing up a storm. Lab is a perfect world and the people are plastic. Live it up.
Nurse Duda’s Physical Assessment Script
Here’s my script that I’ve narrowed down to the basics for this purpose. Of course, you should only use this as a basic outline. Medicine changes and you should be aware of any updates as well as what’s expected of you in your specific program. But this can be a start!
*Knock, walk into room, hand hygiene.*
“Hello! My name is Lindsey, I’ll be your nurse, and I’ll be doing a full assessment on you today. “
- Can you tell me your name and date of birth?
- Can you tell me today’s date?
- Can you tell me where we are?
- Can you tell me why you are here?
“Patient is awake, alert & oriented x3 and is responsive to verbal stimuli”
- Are you having any pain?
- Do you have any allergies?
- Have you had anything hot or cold to eat or drink in the last 30 minutes?
- Have you exercised in the last 30 minutes?
- When was your last bowel movement and when you last voided?
- Do you have a particular arm to use for blood pressures?
“Blood pressure is 120/80 in RUE”
“Heart rate is 70 beats per minutes”
“Respirations are 16 breathes per minute, even and unlabored”
“Oxygen is 99% oxygenation on room air”
“Temperature is 98.6 degrees Fahrenheit orally”
“No pain present”
Skin Hair, Nails
- Your hair is evenly distributed
- Your skin is warm moist and matches your ethnicity with no lesions present
- Your mucous membranes are pink and moist
- No signs of edema
- Skin turgor is good with no signs of dehydration
Neurological
- PERRLA– your pupils are equal at 4mm, round and react to light and accommodation
- Your sensation for sharp and light touch is intact
Musculoskeletal
- Your muscle strength is 5 out of 5 in upper and lower extremities which is normal
- You have +2 normal deep tendon reflexes
Cardiovascular
- Your pulses are +2 normal amplitude, regular rhythm and rate
- Capillary refill brisk <3 seconds bilaterally
- APETM “Regular heart sounds, S1 and S2 auscultated at all locations”
- There was no signs of murmurs, heaves, lifts or thrills
- Your apical heart rate at 5th ICS, midclavicular is 72 beats per minute
Respiratory
- You show no visible signs of distress
- Your lungs are clear to auscultation anteriorly and posteriorly with no adventitious breath sounds
GI
- Your abdomen is flat and symmetrical with no pulsations present with skin color uniform.
- Positive bowel sounds are heard in all 4 quadrants occurring 5-30 times per minute.
- Abdomen is soft and non-tender with no palpable masses.
- No muscular resistance and no guarding present
Health Promotion: tailor it to your partner (exercising in the cold, tanning, drinking, healthy eating, getting enough sleep while in school etc.)
- I hear you like to run. Just be sure that while you’re exercising outside, that you still drink lots of water even if you’re cold to stay hydrated. Also, wear lots of layers that can be easily taken off as your body starts to heat up.
In the next couple weeks, try adding this into your daily routine. Skim over the rubric when it’s posted and start writing and rehearsing your own script. The more you hear yourself saying your “perfect” findings or report, the easier it will be to say come day of checkout.
It’s like listening to your favorite song on repeat for weeks and then jumping up during karaoke and rocking out. You COULD even record a voice memo of yourself on your phone and listen to it a few times per day. So, when the week of checkout comes, and everyone is freaking out and forgetting to mention that the abdomen has no palpable masses and no guarding present, you’ll already have that ish memorized, down pact, and ready to ramble.
The dreaded skill.. can my hands please stop shaking?
I don’t know about you, but I could do the entire skills checkout with no problems in lab, in my apartment, with my friends, literally in the clinical setting on real patients, and also probably in my sleep. However, as soon as I knew a professor was watching, I became a nervous monster with a crackling voice and sweaty, shaky hands (a very calming presence for prospective patients).
So how do we get over the stage freight of performing in front of the prof? It all starts with building confidence. Mentally remove yourself from the stress trigger (the prof), and controlling what you can by relying on your skills. Here are some tricks that improved my performance anxiety.
Know your supplies and master the dexterity.
Just like there’s an art to cooking or crafting, there is absolutely an art of nursing. Practice with those trach suctioning kits and foley cath kits a million freaking times. Just like I say you should be able to fly through the script without any papers and completely from memory, you should be able to fly through the actual hands-on part of the checkout, particularly the suctioning and cathing without a flaw.
You want to know exactly how you will set it up on the bedside tray and know exactly where the little boat is going to be placed and how you’re going to move your hand to grab the sterile water without crossing over your sterile gloves. Fumbling adds to the anxiety. Be the quarterback and make your game plan beforehand.
Remember that none of this is a surprise. You know exactly what is coming, so start early and be absolutely prepared. Go to the lab if they offer open time if it makes you feel better. Give your stuffed animal a water bottle tracheostomy or urethra. Pretend practice with your friends so they can point out your mess-ups. And just become so familiar with the process so that when the big day comes, you can focus on deep breathing, remaining sterile, and thinking happy nursing thoughts!
*below is my very simplified version I used to help fly through the procedure! Feel free to use to help create your own with everything that is expected of you and the updated procedure for your institution!
Listen to your future self
Let’s time-travel quick. Take a moment and step into the future with me. Not very far in the future, but let’s say 8 months from now. You’re cruising along through your 4th semester of nursing school and learning complicated, exciting things. You’ve had all these clinicals, you’ve seen some crazy stuff the last couple months. You’ve taken dozens of tests, you’ve crammed for a few of them, but you’re making it. Your first semester of nursing school seems ages ago and you can’t believe you were stressing over the things you were. You know how to study now and you can handle a crapload of stress. You sit back and think “man if only I knew then what I know now.”
Now tell me, what would your confident, almost-done-with-nursing-school-self tell you right now?
Give yourself the advice that you need. Your future self is very intelligent. Your future self is looking back and seeing everything twenty/twenty because that’s how it looks in hindsight, right?
I invite you to step into your future self and write your current you a note of advice. Maybe you tell yourself how to study, how to handle the stress, how to keep a positive mindset, what you should be doing in your free time, how you need to be organized. Whatever your future self wants to say.
- Write it down.
- Walk away.
- Come back later with fresh eyes and an open mind.
- Go take your own best advice.
I do this simple exercise everywhere in my life. I’m constantly jumping into my older, very wise experienced nursey self and reminding my newbie ass that I’m doing okay and what actions to take to be my best version. I have a quote in my room that says, “Live the story you want to tell.” It reminds me to always be stepping into the future and seeing what I need to change to be happy and proud of my future stories. Slow down and start to develop an awareness that you do not yet know.
Relax and take a deep breath and remember that you are doing awesome and have already made it so far! Take that second to be proud of everything you have already overcome in just the past few months. Yes, the journey may still seem long and overwhelming, and yes you should keep your goals big and your standards high. But stop right here with me and celebrate you and your growth. Celebrate every little change you have made up to this point. Remember it is always just as important to celebrate the little wins in life as well. Keep pushing, my friend!
Xoxo, Lindsey ♡