Janet Fikany
Janet Fikany is a “Placement Diva” for HealthCare Staffing Network. For travel nursing advice, please visit HSN online at http://www.hcstaffingnetwork.com, or call Janet toll free at 1-800-388-2610.

There has been a significant blurring of the lines between candidates who have achieved an assistant of science in nursing and a bachelor’s degree in nursing. The ability to operate at a higher technical level is what some institutions need. The breakout requirement in the performance capacity is what a health care facility depends on when wards fill up with heavy need patients. These caliber professional performance levels are what hiring managers look for when screening applicants.

Nurses should not put patients into panic mode. they should do everything the can to secure the patient from any feelings of pressure, worry, or discomfort. By charting interactions and vitals, they begin the case for the patient’s outlook as noted in the charts. Follow up nurses then can refer back to these notes. Progressively senior nurses should be able to handle multiple patients per shift managing these dynamics.

But all too often the wards are filled with anxious and confused patients who have been left to sit or lie down for hours or even days without clarification or proper addressing of certain problems. Patients who feel ignored by their nurses will file complaints and tell visitors their nurses are slacking off. Senior nurse staff should make sure these patients do not feel “lost in the mix”. Inexperienced nurses might be able to miss certain details but peer nurses and managers will notice and hear about patients who have been left by the wayside.

Sometimes this can be too late. Nurses need to keep a weather eye on patients who may hide their symptoms. Patients who fear their treatment due to pain or physical discomfort will take their bead from nurses. If the nurse comes off as too busy or distracted they may pass or suppress medications or palm them. This is fraud. Hyper-adrenalyzed patients can collect the medications and trade or sell them on the street.

Sufficiently trained nurses will watch their patients consume all ordered narcotics and medications and  closely observe their effects, For example, a patient consuming multiple painkillers should display drowsiness and lethargy. Trained nurses should take away patient’s own medication. Patients undergoing narcotic and other pathologies of medical care will lose track of what personal medications they may take, confusing displayed symptoms.

On the job training and experience will progressively groom a nurse to deal with such patients.Patients may hide problems and nurses can only tell by examination and assessment what is going wrong. progressively trained nurses should be able to observe changes in hygiene, outlook, and mental condition. Perfectly normal patients sitting in a room all day can turn manic after induction of medications and excitement.

Nurses who are properly trained can skip over important details in haste. So when re-checking patient conditions and vital statistics over time nurses can catch a problem with a patient or even a machine. Nurses can pick upon failure in machines or other technical problems only with usage experience on patients and issuing of improper results. If a nurse is trained to assess both the patient condition and the readings, they may simply report inadequate readings.

The patient then has inappropriate and inaccurate readings reported to the physician and to their chart. This can really impact negatively the care plan for that patient. Nurses assigned to different patients in the same room cannot pick up the slack. They sometimes may switch working machines for technically unproductive machines without the nurse’ knowledge. The timing of dealing with these machines may be more than the nurses can handle.

Therefore  a properly trained nurse is required for patient care because they can determine the difference between a technically accurate  vitals reading from an erroneous one. But only highly trained nurses capable of independent thought processes and independent decision making can achieve these top notes of nurse duty performance. Otherwise patients suffer in silence.And supervisors wonder why their feedback card ratings are declining.

Here are the top nursing study tips available. Follow these and other study tips at Nursingstudytips.com to win the best performance from your study efforts. The investment in your nursing future will then be secure.

1. Take an approach to study the final nursing exam test material that is comprehensive of your strengths and weaknesses.
Review known study material and learn new nursing concepts little by little, fleshing out the detail more each time. As the known body of nursing knowledge increases, so does intrinsic strength of retention. All the study material will stay fresh and anxiety to “know everything” will be alleviated.
2. Don’t rely on nursing practice tests, past exams, or other materials. Sneak copies of the final exam will cheat you of the chance to test your real nursing training and medical knowledge. Buzz or word-of-mouth regarding the final exam can blow up in your face. If the test is all new, you need to be prepared for it in any case. Use the nursing instructor’s final exam review to gather what suggested material to use for a final study reference.
3. Do not become dependent on flash cards. Exercising the wrists does not guarantee retention. Use flash cards only to briefly refresh memory. Learning complex nursing concepts from flash cards does not work. Use suggested textbook materials and reference diagrams, charts, and tables.
4. Use verbal cues and video and presentations and media to fuel your knowledge. YouTube and/or Googled search terms can supplement textbook and lecture materials. Many nursing students are making them to study online with.
5. If memorization of language is key, then learn synonyms for difficult nursing words and rephrase hard to understand medical textbook passages. Rewrite the symptoms, conditions, procedures, and nursing treatment facts in your own words. This will yield better study results and retention.
6. Rewrite labs, ranges, phases and classes of diseases, symptoms and drugs to actively engage the mind. Studies prove this works. Simply staring at a diagram does not work. By integrating the note taking avenue to a treatment process or series of chemical equations, nursing study progress can be made.

7. Get plenty of rest and avoid caffeine, cigarettes.

8. Find a study coach or study partner to help aggressively review material. Share clinical notes with other nursing students and verify readings or ranges for mechanized treatment.
9. Use all available time, and delay scheduled tasks until later after the exam or communicate the need to postpone.10. Ask for Help. Don’t wait until the day before the final exam to realize you need some study help. Get some nursing class review partners, borrow better notes, or find support network individuals to help prep you and keep you motivated.  Nursing study takes focus and concentration. Isolation, cocoon behavior, escapism via video games or television and/or substance abuse become very seductive under stress. Nurses know better.

The tap-in should be clean and free from swelling, tension, stiffness,’and/or causing discomfort for the patient. Blood, water, liquid of any type collecting under the dressing should be examined at once. Once affixed, tapes should be annotated with the date of line-in for future reference. Finding peripheral lines in veins must accord with circulatory norms. Nurses cannot begin to rely on easy veins and many long-term patients will need the best pick line insertion techniques when their pick line sites will begin to dry up.

The PICC line is not an easy skill to master. Connecting with the Superior Vena Cava is essential, and thus not just “any” vein can be used. In long term patients the proper veins ”hide” or “become smarter”, evading nurse’s or a technician’s search. This the need for mechanized equipment to find the proper vein is often required. A sonogram machine can be used to generate a visualization of the vein location for technical insertion point.

Nurses categorically check the line on every patient they have in their care roster, whether they are on IV drugs or not. Infection can start if a pick line is left in for too long. This is due to the procedural adaptation in every patient’s medical status whereby IV drug therapy becomes necessary. Grooming a patient’s line and monitoring its condition must be done at all times. Re-insertion of the line must be performed at once if problems arise.

Yet time and again the need for a re-insertion of a patient’s line can shed light on just how few nurses on the ward, if any, can find a vein and insert the pick line in a manner which will be sustained over a number of days. Patients may pull the line out, loosen it, or even worse, injure themselves. Nurse should explain to patients why they need to be conscientious about their line and work towards not straining it or causing tears at the skin’s opening.

This is a serious problem and could cause further delays and inefficiencies in nursing care down the line. Hunting through various staff wards for a nurse who can insert a pick line without the assistance of a sonogram is a seriocomic statement of what training nurses are expected to have versus what the actually bring to the job each day. Nurses should note in their charts the condition if each pick line and notify patient services if additional assistance is required.

A Certified Nurse Anesthetist monitors patients undergoing surgery for local and overall body anesthesia. They administer anesthesia to patients prescribed by procedure in conjunction with a physician’s treatment plan. CRNA’s collaborate with surgeons, anesthesiologists, dentists and podiatrists to safely administer anesthesia medications.

Anesthetists must enable critical care during surgery and post-surgical treatment procedures while the physician is operating other tools and monitoring heart rate and blood pressure. It is utterly critical for the registered Nurse Anesthetist to have a good record and solid commitment to best medical practices.

Nurse Researcher – $100,000

Grants and funding for hospitals and clinics are funded by private pharmaceutical research more than ever. these studies depend on reliable field results. Nurse researchers work as record gathering personnel, lab staff, and onsite analysts for private companies or health and public policy bureaus, as well as nonprofit institutions.

Nurse researchers and lab staff help publish research studies and approve clinical trials drugs based on data collected on specific pharmaceutical/medical/nursing products and practices. Long term health benefits stem from drug treatments whose trials require committed nurses who will last the study and keep the research practices consistent and whole.

Psychiatric Nurse Practitioner – $90,000

Psychiatric Nurse Practitioners are advanced level practical nurses who provide care and consultation to patients suffering from psychiatric and mental health disorders. Psychiatric nurse staff can form relationships with patients that aid their long term progress and satisfy needs for a constructive yet protective environment. Long term care of psychiatric patients can improve compensation inside certain healthcare organizations. Correctional facility nursing has a similar vein of staffing needs.

Certified Nurse Midwife – $84,000

Nurse midwives provide primary care to pregnant and current due date women. The conduct or assist in procedures including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. CNMs work in hospitals, clinics, health departments, homes and private practices. Midwives will often have to work unpredictable hours (due to the unpredictable nature of childbirth). TMidwives should have good communications skills and should be willing to commit to a holistic approach to patient care

Pediatric Endocrinology Nurse – $80,000

Pediatric Endocrinology Nurses provide care to young children who are suffering from diseases and disorders of the endocrine system. Juvenile patients can require extra patience and communications skills. This often involves educating both parents and children on the the physical and sexual development issues that arise from these disorders.

Orthopedic Nurse – $80,000

Orthopedic Nurses provide care for patients suffering for musculoskeletal ailments, such as arthritis, joint replacement, and diabetes. Orthopedic nurses generally work form referrals or from HMO referrals for secondary consults. They are responsible for educating patients on these disorders, urging adherence to the care plan, and assisting with available care and support systems.

Nurse Practitioner – $80,000

Nurse practitioners provide basic preventive health care to patients, and increasingly serve as primary and specialty care providers in mainly medically underserved areas. The most common areas of specialty for nurse practitioners are family practice, adult practice, women’s health, pediatrics, acute care, and gerontology; however, there are many other specialties. In most States, advanced practice nurses can prescribe medications

Clinical Nurse Specialist – $75,000

Clinical Nurse Specialists develop uniform standards for quality care and work with staff nurses to ensure that those standards are being met. Policies on enabling and enacting these policies will vary from place to place. Nurses who are clinical care specialists required to have strong managerial skills and an ability to anticipate potential staff/patient conflicts. In congested hospital and healthcare environments with full schedules these skills can be critical for staff motivational tenor and quality of care. Clinical care coursework and excellent references from within a facility can lead to this career.

Eldercare/Gerontological Nurse Practitioner – $75,000

GNPs deal with senior citizens and may hold advanced nursing degrees specializing in geriatrics. Gerontological Nurse Practitioners are able to diagnose and manage their patients’ ailments. GNPs can be faced with long-term conditions like senility and degenerative disorders. GNPs provide regular assessments to HMOs, personal physicians, and patients’ family members. Like all geriatrics nurses, Gerontological Nurse Practitioners know holistic medical techniques. Bedside nursing manner and understanding of eldercare is required.

Neonatal Nurse – $72,000

Neonatal Nurses care for sick and/or premature newborn babies. This can vary from infant care to intensive care to postnatal surgery and more. Experience in this nursing specialty can be critical at the proper time.They also provide consultation to the newborn’s family during what can be an emotionally draining period. Hospitals specializing in newborns will compensate Neonatal Nurses according to their ratings and years on the wards.

There are also nursing scholarships for moms who are interested in a career change.

Check the course catalog for instruction or contact the webmaster of the school’s website. The campus ombudsman or academic counselor should have the contact information to college or educational institution resources for this purpose. Keep records of communications with the instructor and other nursing students concerning tests and nursing exam results. A journal of nursing study and the concordance to the resulting grades is helpful.

Sometimes nurses make mistakes. It’s the same for nursing school instructors. Its wise to understand what options for academic discipline and instructor intervention are available before enrolling. The Dean’s office can refer you to the proper contact if necessary. If you get the teacher from hell or get sick, miss a class due to heavy traffic or have serious concerns about a teacher’s mental fitness, it’s best to know your options beforehand.

But the impact from nurses does not end on the hospitals steps or past the elevator line. Nurse are winning crucial gains in nursing right and patient care victories across the nation. The agenda for professional nursing organizations to improve patent care and hospital care has been under reported n the news, perhaps due to the overwhelming lack of press attention to nurse community support versus hospital clinic and HMO facility support.

But nurses can benefit from a wider scope of attention to their independent community support not only f nursing contracts and patient wellness rights, but institutional changes toward patient care for the impact of all nurses, healthcare technical staff, physicians, and patients. Nurses at the local Manhattan VA hospital recently acted against workplace violence, returning their facility yo t abetter atmospheric environment for patients and nurses.

Do patients know how much nurses fight for them even when they aren’t in the hospital? Do patients know how much nurses are their advocate even before they get to the hospital? Nurses are in a position to assess the need for facilities for public healthcare and how they match patient and family access to services. Nurses who know the insurance firewall many patients have to face to afford services support the means by which patient can access care in multiple community and facility scenarios.

Nurses who stand up for their rights provide an arena where they can support patients with adequate return and compensation. The collective bargaining and contract negotiations they pursue with their respective employment groups can affect the standard of nursing care any patent receives in future. The good news is that nursing right s and wages have been strongly supported recently in wage and professional demonstrations and labor agreements.

A San Leandro California acute care facility was kept open by widespread support in person by masses of healthcare staff to demonstrate the need for its operations to continue. The facility was facing closure. In May, the national Nursing United association supported senators Sanders and Rep. Jim McDermott introducing the American Health Security Act of 2011, which would bring to patients everywhere a single-payer bill for healthcare services.

Children’s Hospital nurses struck recently in Oakland, California to defend the healthcare rights of children in that facility for expanded hours and technical staffing. The University of California body of nurses administration won a new contract for 26 months. That’s 12,000 nurses who will be committed to quality healthcare in an extended scenario of skilled patient care planning and execution of bedside and operation and procedural skilled nursing.

University nurses nationwide met at a convention held in Chicago in March to share policies, advise wisdom and experiences. This level of concentrated nursing power, together with the monetary and community gains in healthcare access due to nurses, show that nurses have more than just a commitment to a paycheck. Whether the workplace is skilled nursing, home care, clinical assistance or surgical nursing, nurses today at all levels are showing they have a commitment to the well being and healing of all their patients.

Every nurse now in circulation learned medical skills and caregiving techniques from other nurses, and every nurse in any level of administration was once a novice nurse. The pressure to move appointments along and complete a full course of inquiry to a care plan may create a conflicts with the novice nurse’s training.

Novice nurses can start a shift experienced and knowledgeable and be downturn by the end of the shift, confronted with a vast array of situations they didn’t see coming. The press of visitors, the beeping of machines, the traffic back and forth to the patient rooms and the trek between departments, pharmacy, and floors can wear down the novice nurse.

Novice nurse leave behind the impressions they received about the nursing profession from school and begin to form a knowledge base from their own experience. The academic setting where the knowledge was borne in fades before the immediacy of the nursing experience in the real. How nurses relate their academic learning to their on-the-job challenges creates an occupational expertise they can draw on for a lifetime.

The nurturing and caregiving professions demand a lot of their best personnel. Novice burnout can occur when peer counseling and supervisor encouragement is not available. This is a particularly challenging time to enter the nursing field as so many hospital clinics and healthcare facilities face community growth in patient demand with diminishing resources and funding for patient care. Novices may not also understand how staff hours and patient ratios affect the operating budget of the hospital going forward.

Patients may often be less than pleased by what the hospital and staff can do for them under their existing coverage or as a result of care plan staging. This may be a drain on psychological energy for novice nurses who expect grateful and happy patients. Learning to rely on fellow nurses for emotional assistance, encouragement and tips and support is key to the survival of a novice nurse. Methods for communicating feedback and channeling energy from initial shifts in nursing can be the start of a beautiful working relationship with the nursing occupation for any novice nurse.

Novi nurse must bear down under stress to meet their performance requirements, both from patient assessments, note taking, reporting to other nurses and physicians, and executing new and changing orders from other healthcare personnel as well as communicating and acceding to patient demands where possible. Nurses stretched to the breaking point and crowded wards may be all they can handle, and new customer service problems and peer correction issues may be more than novice nurses can handle.

Novice nurses looking for a variegated assortment of patients across disease and condition boundaries may be surprised to find the bulk of their outpatient population in recovery from gastric bypass, or the multitude of inpatient care plans based around obesity and diabetes. Despite what the nursing textbooks say, these conditions are vastly saturated into the healthcare patient population and create a draw on nursing resources, surgical staff, and beds. And the real world practice of selecting patients according to their ability to pay is often not what nursing brochures on ethics policy stated when novice nurses were in school.

Economic downturn, a glut of midlevel and superior nurses in top tiers of employment, and aging population centering medical care around certain disciplines are taking novice nurses by surprise these days. Nurses prone t a certain specialty may find their career orientation shifting more to where the bulk of the patient population is geared, which today is toward seniors and aging in place communities as well as homecare nursing situations and disorders of the general medicine front.

Novice nursing can be the freshman year of a nurse’s career, or the turnaround phase that make an individual shift their occupational expertise in nursing to a more paraprofessional career like counseling, nutrition, technical equipment operator, or EMT. Lateral changes in the career of a novice nurse, or the decision to further their nursing education in occupational research, counseling, or advanced nursing education is often the fruit of the bulk of reflections made after a novice nurse completes their season caring for patients hospital wide.

Patient interaction with the medical system is one of many dynamics studied by occupational nurses and nursing science researchers. One of the most important dynamics of these is the concordance to physician orders and medical advice by the patience. But the system goes through countless documentation, clinical sessions, direct medication advice, treatment care plan repetition, and verbal reminding of exactly the same pharmaceutical cautions and instructions given by the doctor. This should result in a faithful concordance to doctor’s orders.

But the pharmaceutical sciences are rife with abuse. Patients try to alter or extend prescriptions. Even when they don’t need additional medication they may want it. They may try to obtain additional medication or stronger dosages to achieve an average for resale to others online or on the street. On the lighter side, some patients merely forget the intended dosages or make a change once and unwittingly change their medication habits against doctor’s orders by accident.

Why do patients act or react against their own self interest when their health is at stake? What makes a patient who knows they haven’t gone to medical school decide they know best concerning a given pharmaceutical substance or medication? Nurses strive in vain to understand the willful ignorance or slight attention paid to circumstances serious enough to warrant pharmaceutical intervention with the body, but not attention to the law. It is against the law to take medication not intended for you or to give medication to others it was not prescribed for.

Nurses, doctors and physicians must observe and report irregularities about patient use of medications at once. There are standard and practices that underscore this need for medication vigilance. The doctors and medical staff must responsibly monitor medications among all their other duties, but the public may often misunderstand why nurses, doctor’s patients and medical staff are evaluating the patient on an ongoing basis. The incarnation of the watchful, evil nurse who sees all evil is a comic but altogether inexact one.

The laws concerning patient practice and pharmaceutical medications for nurses to give to patients have been through several decades of streamlining and change. The process by which papers and documentation goes through to the patient from a hospital, clinic, dispensary and/or nursing facility is conducted after thorough overviews and training. Entire wards and surgery staffs must be on the same page regarding the flow of information, medication, approval and dispensation of medications to patients. These are safeguards for the public good.

The patient population as a whole can be counted on for a good faith follow up to doctors advice and medical consultation results. But medications, prescription alteration, medication abuse, and suspected suppression of treatment via pharmaceutical interaction must be monitored on a daily basis, sometimes hourly in some cases. patients may hear contrary advice from friend relatives, and other patients and change their use of the treatment accordingly, without the doctor’s knowledge.

Physicians may check up on patients to make sure they are not mixing up their current treatment plan and care with a previous systems or pharmaceutical therapy schedule. Since similar medication and painkiller,s topical antibiotics and medications in differing combinations would be use to treat any given ailment it is not surprising that long term care patients of any ailment may elect to become a “higher authority” on what the medications can do for them. But absent from these “independent” decisions by the patient regarding their medications.

Pharmaceutical therapy is only part of a balanced diet and exercise, rest and mobility that physicians have in mind when they admit or discharge a patient. Surgical intervention and other processes or procedures applied to the body set up the scenario for pharmaceutical follow-up. Drug taking can affect the way a patient sees the medical process and they can feel they are taking stand for themselves asserting an independence over the control of medical substances ingested.

Patients may become so familiar with their medications and with the running of a long term course of treatment they may unwittingly alter their completion of a physician’s instructions.
The dosage of the medication of a patient must be of concern to their nurses at all times. Do sufficient dosages exist of each medication and are they readily available at the proper time? Querying patients can determine their level of awareness of what drugs they are taking and when.

Typically patients may receive the initial notification of a pill medication from their physician but they may not realize that they want to change it or make changes later when the bulk of the problem may be over, in their own estimation. Their state of mind and medical condition may change such that they are no longer able to recall the exact information. They my reach in the dark, fuzzy and sleepy, or excited and in pain, for the wrong medication in the wrong amount.

One patient may independently decide the benefit of a medication has run its course, without the benefit of a doctor’ input a nurse advise or consultation. The patient may need money and want to change their dosage to make up for another one they will sell or trade for goods, cash or other drugs. relatives may steal their drugs or they may accidentally pour them down the sink or spill them. And a very small rate of patients will report low or null absorption due to extremely rare factors such as mineral presences, menstrual activity, or neural chemicals interfering with drug adhesion.

As a solution, physicians will order specimen testing to ensure patient concordance to prescription advice. Verbal counseling and reminder follow ups, and well as constant checking of available medications and the condition of these medications and their quantities, can be very impactful, especially for outpatients. Blood tests and urine tests will reflect this and should be collected and reported to the patient’s file as accurately as possible.

The reasons why a patient may change their use of a medication are varied. But a nurse or physician, attending nurse or technician must report and consult with a physician for any patient suspected of altering or changing their intake of prescription medication for any reason. Regardless of the rational employed by the patient for such a change, patient fidelity to pharmaceutical therapy plans must be safeguarded as much as possible.

Patients don’t like to feel like prisoners. Feel free to remind them they can refuse any care, feeding, test or snack before discussing it with the physician. Nurses should make sure patients understand they have treatment options even if they don’t know to ask for them. Patients have options that busy nurses may not feel obliged to advise them of. Nurses should exercise the utmost care in administering and counseling patients regarding pain management and pain therapies.

Nurses should know the data that pain specialists need to know to assess and consult with the patients when pain management becomes the primary topic of concern in a care plan or actively applied treatment. No treatment should require a split-second decision by the patient. If the Internet is not available in an urgent care setting, hospital room, or clinic visit, patients are completely dependent on the communications the nurse makes.