Reality Shock For New Nurses

Written by kimmel52 on November 12, 2008 – 12:07 am

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

So now you are close to graduating from nursing school or you have graduated recently. Whichever the case, you will be in for a reality shock when you begin your career as a Registered Nurse. What do we mean by the term, “reality shock”? Well, like the term says, it is the reality that shocks us. For second-career nurses, the transition from nursing school to working with real patients can range from somewhat uncomfortable to highly shocking. These rookies often have given up secure, well-established careers, only to discover on-the-job demands never mentioned in the textbooks.

However, the right attitude can help you weather your first few months on the nursing unit. For those who overcome the challenges of transitioning to nursing, the rewards outweigh the costs of starting over. Education of nurses is thought to lack reality orientation, which is reflected in the difficulty graduate nurses experience in their transition from an educational to a work situation. The phenomenon of “reality shock” is defined by Kramer (1974) as this lack of reality orientation. On graduation, “neophyte” nurses are confronted with conflicting roles of professional (from education) and bureaucratic (from work environment). Adopting a particular role is part of the socialisation process graduates undergo. Methods of adjusting and improving the experience of “reality shock” have been suggested by Kramer (1974) and developed using a theoretical model, by Neuman (1982). The quality of care provided by graduate nurses needs to be examined as this is the ultimate role of the nurse. (1)The question you may ask is, “so there is a difference in the reality of being a student or graduate nurse”? The answer is an emphatic, YES! First of all, as a student nurse you were given assignments that were not beyond the scope of your practice or ability. In addition to that, you were working under your instructor’s license and whether or not you were aware, they kept a very close watch on you. Therefore, there was a safety net that always hovered beneath you in case you were to fall.

This is not the case as you take on the title, Registered Nurse. There is no safety net. You are out there by yourself, free to make decisions and make mistakes. With those decisions and mistakes you are also, FULLY ACCOUNTABLE. Now imagine yourself with eight or more patients. You may be asking yourself, “What do you mean eight or MORE patients?” Most student nurses never have more than six or seven patients and that is only at the very end of the program. Even then, the student nurses can delegate tasks to assistive personnel thereby lessening their work load. However, there will be time that you will be on a floor, without any assistive personnel, with more than eight patients and no one to rely on except yourself. To compound this scenario, there may be patients that have very critical care pathways that you must follow, incoming calls from patient’s families, doctor’s, operating room staff, and other collaborative care departments requesting information. Now, let’s stop this scenario in its tracks. You probably feel the stress building by just reading the previous passage. If so, don’t worry, it is a perfectly normal reaction. So, relax, and know that there are ways to ease this inevitable right of passage. Let’s take a look at some of the ways to help ease and deal with reality shock.

1. First of all, it is important to understand that, “reality shock” does indeed exist and you will come face to face with it. Knowing what you will face is most of the battle. The task at hand then becomes, knowing what steps to take and resources to use, and how to use them.

2. Learn as much as you can during your in-service training program, which usually lasts up to eight weeks or more. This means familiarizing yourself with every inch of your floor. Know where everything is located, from safety pins to I.V. tubing. You may never know when you may need it, NOW, and the worst thing that can happen is that you spend precious time looking for something as small as a safety pin.

3. Know, who the assisted personnel are, and know them by name and face. Find out who will be the ones that you will be working with during your shift. What usually happens during in-service training is that graduate nurses train on the main shift, which is most frequently days, before transferring to the shift that they have been hired to work. Therefore it is very important to know who you will be working with during your shift. Try also to develop a working relationship with the assistive personnel. Remember, it is not a popularity game, you are not out to make best friends. Your goal is quality patient care, and the patient comes first. Let your intentions be known that your number one goal is to give the best patient care that you have respect for the care team assistive personnel and are a willing and helpful body to them as well. In doing this, you will have disabled the invisible wall that exists between nurses and assistive personnel. That wall is the one entitled, I am a NURSE and you are ONLY an aide. One thing that you must strive for is to use an even tone of voice, and fairness when delegating. You must also remember the rights of delegation, which are as follows, a. the right task, b. the right person, c. the right communication, (must be clear and concise), d. the right feedback, (the person who is delegated the task must comprehend what it is that is asked of them and let the nurse know that they comprehend). By doing this you are ensuring that patient care will not suffer do to a personality glitch, which could have been avoided.

4. Know, know and KNOW where the Policy and Procedure manual is located on the floor. Part of your hospital in-service will include the introduction of the Policy and Procedure Manual. This is the manual that you will have to refer to many times for protocol from everything from changing out a Foley Catheter to transporting a patient to another floor. The final analysis will be in any investigation, “did the nurse use and follow the Policy and Procedure Manual?” You want to always be sure that you follow the rules and protocols contained in your institutions manual. Therefore, you should know where it is located and be familiar with how to look up various procedures and policies, particularly

5. The policy regarding medication errors. Most everyone makes them and it is crucial that you know what paperwork is required to be filled out. It will come in handy. You cannot just, “wing it”, when making a decision, you have to follow protocol.

6. Use assertive communication when interacting with doctors’. Assertive communication indicates that you are aware of yourself and your limitations as well as your liability to the patients that you care for. Using this form of communication with over assertive medical personnel will help you function to your maximum capability and earn respect as an independent care professional. {For more information on the uses and strategies concerning assertive communication, please refer to the text entitled, Nursing Today, Transition and Trends, by JoAnn Zerwekh, Jo Carol Claborn, 5th edition, Co. 2006, Saunders, Philadelphia.}

7. Ask questions. You will have time during your in-service training to ask questions and get answers. It is your right to do so. Remember, not knowing is not an excuse, and you do not want to be in a situation where there will be no-one to ask. This is not to say that you will know everything, but a least you are giving yourself a head start and a good solid foundation by knowing what you can. So don’t be afraid to ask. Also, know who your resources are, for questions that you may have on the shift that you will be working.

8. Find a mentor with whom you can relate. Try to find someone not only on the shift during training, but also on the shift that you will be working. It is nice to find someone who has the experience and understanding as well as someone that you can get along. There might be a time that you will want to call them in the middle of the night and vent your concerns, or just to have them give you positive input in your performance. Mentors are essential to the growth of a new nurse.

9. Lastly, Know, Know and Know, what your State Nurse Practice Act states. This Act, is your guideline for most all that you do as a Registered Nurse. Know it well.

Hopefully these tips will help to ease the reality shock that you will face during your transition from student nurse to full time graduate nurse. Remember, you can’t do it all. You are a welcome asset to your employer, but first and foremost an embodiment of all that Florence Nightingale stood for. Best wishes on your journey.
Mirella Pancia

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Information on Your Nursing State Boards

Written by kimmel52 on November 12, 2008 – 12:03 am

Nursing Education – Summary of Information from Pass Rate Reports

In reports submitted by nursing education programs with NCLEX pass rates ten percentage points or more below the national average, the following commonalities were noted: Read more »

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Critical Thinking as a Nurse

Written by kimmel52 on November 11, 2008 – 11:53 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

In the nursing profession, more now than ever, the ability to think critically is essential. The responsibilities of a Registered Nurse have increased over the years. In correlation with this increase in responsibility comes the additional increase in educational prerequisites and core requisites required to achieve a degree in Nursing. The ANA (American Nursing Association) Standards has set forth the framework necessary for critical thinking in the application of the “nursing process”.

Critical thinking is taught at the beginning of nursing school.  Many students feel that the nursing school tests are too difficult mainly because of their lack of training in the use of critical thinking and analysis.

The nursing process is the tool by which all nurses can equally become proficient at critical thinking. The nursing process contains the following criteria:

1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation

It is in the application of each of these processes that the nurse may become proficient at critical thinking. It is important to look at the components that describe critical thinking in nursing, The table below lists components that define the critical thinking process. There is much more that goes into critical thinking than what is listed in the table. The table is a rough draft of the process.


Entails purposeful, informed, outcome focused thinking, that requires careful identification of specific problems and other physiological and psychological factors that affect the clients position on the health and wellness continuum. The process is driven by the client, the client’s family and other health team members who are also collaborating in ensuring essential client care.

Specific educational knowledge base and level of experience in applying that knowledge in client care. (Nursing School to graduate nurse to experienced nurse) As the level of experience of the nurse increases so will the scientific knowledge base that the nurse applies.

Proficiency in the application of the institutions standards, policies and procedures.

Application of the humanistic standards of caring in conjunction with the nursing process, to holistically treat the clients response to an actual or perceived illness.

Constant evaluation and re-evaluation of the nursing process to determine the clients level of wellness.

Nurses learn critical thinking via application with experience. Experience is the best teacher. But it is equally important to know that the process is being applied correctly. Many institutions will ensure that this pathway is followed by enlisting new nurses in a eight to ten week orientation program. During this time the new nurse will learn about the polices and procedures of that institution and what type of documentation is used for charting purposes. Also, the new nurse will have an experienced mentor who they will follow and who will evaluate their performance as well.

Documentation is an essential part of the critical thinking process for the nurse. Every institution places emphasis on documentation. It is said, “that if it is not documented, then it was not done”. Since the nursing process is a scientific process. In scientific research, all things are documented. In this documentation, researches can look back to see if the results were due to interventions and whether or not the interventions were successful or have to be altered.

The documentation process helps the nurse accomplish the same goals. Many times procedures are used that have unproven efficacy. In it is this framework of critical thinking and documentation that such procedures can be either continued or eliminated, depending on the efficacy of the research. In other words, does the procedure actually improve, help or otherwise jeopardize the client’s health. An example of the critical thinking process and scientific reasoning is in the efficacy of taking a rectal temperature of new born infants. Currently, this procedure is still widely accepted. However the scientific approach is to ask the following, is the procedure safe, is it necessary, and can an axillary temp be used in place of the rectal temp? In answering these questions, the nurse can better evaluate whether the efficacy of taking a rectal temp on a infant should be continued. This is just one example of how the critical thinking process is used within the nursing profession.

The scientific approach using critical thinking helps the nurse develop evidence based practice. It is through “evidence based practice” that the Joint Commission on Accreditation of Health Care Organizations (JCAHO) rates the performance of hospitals. Further research is still continuing in delineating the intricacies of the nursing process and the integration of critical thinking. All health care professionals are encouraged to pursue this type of research in their practice to ensure the quality of client care and enhance the validity of their profession.


Zerwekh, J.,Claborn, J.(2006).Nursing Today Transition and Trends. (5th ed). St. Louis: Saunders
Alfaro-LeFevre, R. (2006). Applying Nursing Process, A Tool For Critical Thinking. (6th ed). Philadelphia: Lippincott Williams & Wilkins

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Learning Patient Assessment Skills

Written by kimmel52 on November 11, 2008 – 11:50 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Nurses are trained to learn and apply patient assessment skills. These skills are the cornerstone of being a proficient nurse. The knowledge and procedures for developing these skills are learned in the first two years of nursing school and honed in clinical as the student nurse takes on a greater patient load. The “Standards of Care” that are the basis of nursing include the following:

Standard 1. Assessment

In an assessment the nurse must use all of his or her senses. These include hearing, touching, visual, and therapeutic communication. The cephalocaudal approach is most always used. In other words, assessing a patient from head to toe. The nurse must self aware to be able to conduct a thorough assessment. Data collection forms the basis for the next step in standards of care which is diagnosis. A nurse must have all the necessary equipment, such as a scale, tape measure, thermometer, sphygmomanometer, a stethoscope and pen light. The setting is also very important in doing an assessment. If a client is nervous or anxious they may not be as willing to answer questions that the nurse asks or to be examined. Obtaining a quiet environment is not always possible, especially in an emergency situation. Therefore, the nurse must be very observant, and try to get as much pertinent data as possible to formulate an nursing diagnosis For example, when doing an assessment on a client that is complaining of severe stomach pain, asking them what foods they last ate would give the nurse more pertinent information than asking them how many brothers or sisters they have.

Standard II. Diagnosis

A nursing diagnosis is not a medical diagnosis. A medical diagnosis would be the medical condition of “Diabetes”. Whereas, a nursing diagnosis would be, “Altered Tissue Perfusion”, related to decreased oxygenation of tissues as evidenced by a pulse oximetry of 92% , secondary to the medical condition of “Emphysema”. A nursing diagnosis is a formal statement that relates to how a client reacts to a real or perceived illness. In making a diagnosis the nurse attempts to formulate steps to assist the client in alleviating and or mediating how they respond to real or perceived illness.

Standard III. Outcome Identification

In this process the nurses uses the assessment and diagnosis to set goals for the patient to achieve to attain a greater level of wellness. Such goals may simply be that the patient now comprehends the regime of testing their blood sugar, or perhaps a new mother gleans a sense of security now that she has been instructed in the correct method of breast feeding. The nurse must plan the goals that the client is to achieve around the clients ability. For instance, the goal that a client will walk normally after two days of having knee surgery is unrealistic, in the sense that the client’s knee will not be completely healed. However, the goal that the client will be able to demonstrate the correct use of crutches, would be more realistic. This goal is also measurable, since the patient will be in the hospital and the nurse can teach and observe a return demonstration. Therefore, the goals or outcomes for the client must also be measurable.

Standard IV. Planning

The planning standard is designed around the clients activities while in the hospital environment. Therefore the nurse must plan to teach and demonstrate tasks when the patient is free to learn. This would involve administering pain medication prior to learning to walk with crutches or waiting until after a patient has finished a meal before teaching on how to use a syringe. The atmosphere should be conducive for the client to learn.

Standard V. Implementation

This standard requires that the nurse put to the test the methods and steps designed to help the client achieve their goals. In implementation, the nurse performs the actions necessary for the client’s plan. If teaching is one of the goals then the nurse would document the time, place, method and information taught.

Standard VI. Evaluation

Evaluation is the final standard. In this step the nurse makes the determination whether or not the goals originally set for the client have been met. If the nurse concludes that the goal or goals have not been met, then the plan has to be revised and documented as such. Goals therefore should be timely and measurable. If the client’s goal was to use crutches successfully, and the client was able to perform a repeat demonstration for the nurse, then the goal was met.

The above standards are the cornerstone of the nursing profession. These standards take time and experience to learn and to implement. Experience is the best teacher, and a nurse should continuously strive for excellence in their care of patients, and recognizing how to help patients achieve a higher level of physical and emotional wellness.

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Should Nurses Be Unionized?

Written by kimmel52 on November 11, 2008 – 11:46 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Since the days of Florence Nightingale, the profession of nursing has been viewed as a career consisting of self sacrificing individuals who, with caring and compassion have devoted their lives to easing the pain and suffering of those in need. Such noble and honorable individuals would surely never strike for what ever reason, right? Wrong! So, what has happened over the centuries to the profession of nursing?

To begin to understand what has taken place in the arena of nursing, one needs to understand what the nurses of today are faced with in the hospital settings. First, many nurses are required to care for more patients than they can handle safely. This is to say that a patient care load of seven on a medical surgical unit can go up to eleven during the afternoon and midnight shift. Depending on the acuity (level of care needed) of the clients, the nurse may not be able to safely attend to all of the clients needs, and need to forego certain aspects of care just to be able to get the majority of their responsibilities completed by the next shift.

This situation of patient overload can result in very serious health consequences for the patient and ultimately, death. The direct consequence of patient neglect for the nurse involved would usually entail a law suite being filed by the family naming the nurse and the hospital as well. Patient overload is just one of the many reasons that nurses have sought to form a coalition and be represented by their own organizations.

Another reason for nurses to organize is due to the policy of pulling nurses to other floors where the patient acuity care process requires specific knowledge to be able to practice safely as a nurse. An example would be a maternity floor nurse being pulled to a medical surgical floor and being assigned a patient load consisting of newly admitted pre-operative patients and others that require suctioning and vent care. The maternity floor nurse would not only be unsafe to work on the medical surgical floor, but could also put patient’s lives in jeopardy due to her inexperience. So, what is that nurse supposed to do if they decide to decline being pulled to another floor? Many nurses feel that they may be reprimanded by the shift supervisor and perhaps written up for insubordination. But are they not in fact, declining for a valid reason? Also, shouldn’t quality patient care be the utmost priority as well as patient safety? The answer to both of these questions is of course a resounding, YES! However, many nurses are faced with these dilemmas day in and day out. They leave at the end of the day feeling as if they haven’t been able to give proper nursing care. They would be correct. It is an unsafe practice to float nurses that are unfamiliar with a particular floor to work there. The fact is, that it is done on a regular basis. Would this be a sufficient reason to strike? Many nurses think so. The list could go on and on. How safe would you feel with a nurse caring for a loved one who was on the sixteenth hour of a double shift? Not very, right? Approximately 60% of nurse in practice are providing care in hospitals (Work-Place issues, 2005)

In 1946, the American Nurses Association’s House of Delegates unanimously approved a resolution that opened the doors to nurses to engage in collective bargaining. Then about thirty years later the legal precedent that determined that state nursing associations are qualified under labor law to be labor organizations is the 1979 Sierra Vista decision. The important consequence that affected nurse was that they were free to organize themselves and not be organized by existing unions. Currently, it is the American Nurses Association that is in the forefront of establishing coalitions and bargaining for nurses nation.

The Patient Safety Act:

What the Bill Does

It protects patients safety

– The Act calls for the Massachusetts Department of Public Health (DPH) to develop and implement limits on the number of hospital patients assigned to Registered Nurses in Massachusetts. The limits would be based on scientific research and testimony from public hearings. Once established, the staffing levels would be adjusted in accordance with patient needs and requirements using a standardized, DPH-approved acuity system. An acuity system provides a means of measuring the illness level of the patients on a particular unit and their needs for care.
– These scenarios represent just an overview of why the nursing profession has sought to organize themselves into a union status.

“It is time for a new generation of leadership to cope with new problems and new opportunities. For there is a new world to be won.” – John F. Kennedy

Zerwekh, J.,Claborn, J.(2006).Nursing Today Transition and Trends.
(5th ed). St. Louis: Saunders
The Coalition to protect Massachusetts Patients, P.O. Box 309 Canton Massachusetts 02021 617.731.2813

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How To Choose The Right Nursing School for You!

Written by kimmel52 on November 11, 2008 – 11:42 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

In considering going into the nursing profession, there are a few priorities that are crucial to determining future success.

When individuals look at all of the criteria it becomes clear which schools would be a better choice. The first criteria that many people face when going back to school is financial. Some of the factors that need to be considered about the school are for instance, how much will it cost per credit hour? Cost per credit hour depends on the school, whether or not it is accredited, a community college, a private college or a four year university.

The other criteria for determining which nursing school to attend, is of course whether or not one can obtain financial aid. Financial aid is available for many that are in the working class.

There are also Federal loans that can be obtained with very low interest rates. It would be considered a wise step to visit the financial aid office of a college or university near ones home to find out about the availability of government funding.

The next criterion, which may or may not be important for some, is the vicinity of the nursing school. For many whom work and plan to attend school, the closer the school’s location the easier the commute. In this society of multitasking, the closer that work, home and school are to one another the better.

Also, gas is now a real concern. Driving fifty miles may not have been a deterrent to some a few years ago, but certainly with the cost of fuel now days; it has become a real deterrent to many.

Along with the schools vicinity, one needs to look at whether or not the nursing school is accredited. If someone is considering obtaining an Associates Degree in Nursing from a non accredited nursing school, then if they decide to go on to their Bachelors of Nursing, they will find that they cannot continue. The reason for this is due to the following; an accredited Bachelor of Science in Nursing Program, requires and accredited degreed Nursing Program from the two year Associate Degreed Nurse.

What this imples is that the two years Associate Degreed Nurse who graduated from a non accredited nursing school will not be able to transfer in their nursing courses to the four year university. This may be a real stumbling block to those nurses who wish to go on for a Bachelor of Science in Nursing.

It is also important to know how the nursing school graduates perform on the NCLEX®, the National Licensure Examination for Registered Nurses. When there is only a forty or fifty percent passing rate on schools National Boards, this should raise a red flag for the prospective nursing student. There is no greater disappointment then failing the boards on the first time around. Many hospitals will hire graduate nurses prior to their sitting for the national boards, on the premise that if they fail their national boards, one of two things will take place;

1. their job as graduate nurse with the hospital will be terminated,
2. they will be demoted to a lesser position with less money,
3. they will be demoted to a lesser position with less money and be offered a second chance with a specified time frame to sit for the national boards once more.

None of the previous scenarios is an attractive option to any graduate nurse. Therefore the percentage of students that pass the boards at a particular school should also be included in the criteria for choosing a particular nursing school. However, do not judge the school too harshly on their rate of students who do or do not pass the national boards. The reason for this is due to the fact that some schools require a high grade point average, such as a four point zero just to get into the nursing program. This requirement will of course skew the results of passing scores in favor of those with higher grade point averages. These criteria will of course preclude many from even entering the nursing program, since many students are not four point zero in academics. Generally speaking, an average of seventy percent and above passing rate on the national nursing boards is a good predictor of the nursing school. But, it is up to the individual as to how much time and effort is put into the program as to how much they get out of the program. The nursing programs in general are very physically demanding, time consuming and mentally challenging. It is a very serious profession and there are those who find out that the field of nursing is not for them very early in the program. The best advice to those deciding on which nursing school to attend, is to use the above mentioned criteria only as a guide, because it will be up to the individual how well they do in the final analysis.

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Thinking About Your Goals as a Nurse

Written by kimmel52 on November 11, 2008 – 11:40 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

As the student nurse approaches graduation, thoughts of beginning a career in nursing come to mind. A new nurse should think very seriously about their career goals. These include long term as well as short term goals. As with any path of life that an individual takes, it is not random. Each person that seeks an education does so with a set of plans and directionality for their immediate goals and long term. The idea of graduating from a nursing program once again dictates to the graduate that plans once again must be laid for the road ahead. Nothing worthwhile doing is done haphazardly. All things require preparation. Even as one contemplated going into the nursing field, certain pre-requisites had to be completed before hand. Graduating from a nursing program is another transition phase that must be approached with the same dedication and planning as was first applied. The short synopsis below is a sample of a career goal paper. Everyone will have their own unique career goal paper. Now is a good time to start thinking about career goals.


The field of nursing attracted me for several reasons. The first reason being, that a nurse is the front line person in caring for others and saving lives. The nurse will in many cases such as in the hospital or homecare environment discover the patient who needs emergency attention before the physician. It will be up to the nurse to respond accordingly within the scope of their practice and hospital procedures. Why does this facet of nursing attract me? Well, it is because that this type of responsibility is not too far off from the type of responsibility that a physician has, which is what I had hoped to become many years ago. Nurses did not have that crucial level of responsibility initially. Because of this, many patients died. For instance, a nurse from the past may not have known the therapeutic values of electrolytes and blood gases thereby putting the patient’s health in jeopardy. Now, in present times, the nurse must know all of the pertinent lab values and act upon any change immediately, either by calling the physician or implementing standing orders.

The other aspect of nursing that is also attractive to me in becoming a nurse, is that the nurse uses therapeutic communication and treats the patient’s response to real or perceived illness. This is the corner stone of which nursing is based on. The holistic approach is so successful in helping patients to heal. I am a firm believer that for an individual to be able to heal from without, they must first heal from within. Therefore the nurse can help clients to adapt and grow in a positive way rather than negative. Since all of nursing is now based on evidenced practice, it is exciting to be able to put the scientific method to use. There are now logical and provable reasons that a nurse should take a particular course of action.

These are just some of the reasons which have attracted me to the profession of nursing.


My short-term career goals consist of successfully passing Nursing 255, then passing the national board exam. Once this is accomplished, I hope to be work on a medical-surgical floor and hone my skills as a graduate nurse. I have chosen medical-surgical nursing as a starting point because this particular field will help me to develop my clinical skills.


I hope to be an active member in the profession of nursing, joining the American Nurses Association, attending seminars and lobbying for the advancement of nurses to prescribe medication independently. Hopefully within the next five years or so I will have a degree as an advanced practice nurse in the field of family healthcare and be working in an emergency room.


My personal goals are humble. Money has never been a goal, rather doing that which enriches the soul. I am thankful to my Lord that I have been given the opportunity to have made it thus far. I take care of my mother and help my family as best I can. I am happiest when I am helping others, and owe a large debt of gratitude to my instructors, who have given of themselves their wealth of knowledge and experience to help produce competent nurses. I hope to make them proud.

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Continuing Nursing Competency

Written by kimmel52 on November 11, 2008 – 11:38 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

For those student nurses who are about to graduate, their main priority is to pass the NCLEX-RN examination. The practice of nursing is regulated according to licensing authorities in each state jurisdiction.

Each jurisdiction must ensure that each nurse has the minimum competency to practice nursing in their state. In order to ensure such requirements, the National Council of State Boards of Nurses, Inc.

(NCSBN) has developed a comprehensive examination entitled, National Council Licensure Examination for Registered Nurses (NCLEX-RN). The NCLEX test plan occurs in several steps. The first step is to conduct a practice analysis. This is used to collect data on the practice of entry level nurses. By collecting this data the board can design NCLEX test questions that will be applicable to the majority of graduate nurses.

For instance, it has been found that the majority of new graduate nurses find work on medical/surgical units. The majority of the new graduates surveyed also indicated their primary responsibility was in the delivery of direct patient care. (1) Therefore, questions regarding the care of patients on medical/surgical units is pertinent and important for graduate nurses to know. Although some graduate nurses will tell you that they had more questions on psychiatric nursing or maternity nursing on the NCLEX, this is not the norm. Six thousand or more newly licensed registered nurses are asked about the frequency and priority of performing more than one hundred and fifty care activities. These activities are analyzed in relation to the impact on patient care, safety and client settings where they are performed. It is in this framework that NCLEX test questions are designed to be applicable in real world settings, thus requiring graduate nurses to be knowledgeable of such practices.

The second step in the NCLEX test plan is to develop a method to test behaviors regarding the content formed in step one. The NCLEX-RN, Test Plan, provides a focused summary of the concepts to be tested. It serves not only to delineate what content to cover and the method of presenting the test questions but also serves to assist in developing a study guide in preparing those who will take the test. The NCLEX assesses the graduate nurse’s knowledge of required skills to practice nursing safely and competently.

Beliefs about people and nursing underlie the NCLEX-RN test plan. People are finite beings with varying capacities to function in society. (2) Each person is a unique and special individual existing in a system that they exert some control over, such as their beliefs, social systems, family systems, health customs. It is in this underlying theory of each individuals beliefs that the nursing process guides in the intervention to promote psychological and physical wellness. Nursing is an art as much as it is a science, founded on a scientific body of knowledge that has been tested and proven effective in meeting the goals of each individual. The cognitive learning domain is a integral part of the NCLEX test plan. The use of Bloom’s taxonomy is the basis for writing and coding items (Bloom,e tal.,1956: Anderson & Krathwohl, 2001) Since the practice of nursing requires application or higher levels of cognitive ability, it becomes imperative to test graduate nurses complex and abstract reasoning.

The framework of Client Needs was selected for the NCLEX due to its all encompassing body of nursing knowledge that must be applied to successfully meet these needs. There are four distinct categories of Client Needs that are integrated into the exam, with two of the four categories subdivided to more adequately cover all subject matter. The categories are as follows:

A. Safe and Effective Care Environment
1. Management of Care
2. Safety and infection control

B. Promotion and Maintenance

C. Psychosocial Integrity

D. Physiological Integrity
1. Basic Care and Comfort
2. Pharmacological and Parenteral Therapies
3. Reduction of Risk Potential
4. Physiological Adaptation

Integrated concepts and processes are fundamental to the nursing practice and are applied to the various and categories of client needs.

These integrated concepts are as follows:
A. The nursing process- a scientific problem solving approach to client care that includes, assessment, analysis, planning, implementation and evaluation.

B. Caring- interaction between the nurse and client that provides for a nurturing, positive, and helpful environment whereby the client feels special and important knowing that the relationship that develops between themselves and the nurse will provide the needed assistance in their achieving a higher level of psychological and physical wellness.

C. Communication and Documentation- verbal and or nonverbal interactions between the nurse and client, significant others and multidisciplinary health teams. Validation either through written and or electronic entry which reflects that what has been done is documented and is within the scope of the nurses educational and licensure level as well as meeting the policies of the hospital or other client care environment.

D. Teaching-Learning- facilitating the acquirement of further knowledge which will lead to a more informed and skilled nurse with the application of the newly learned material.

The distribution of content and the percentage of test questions assigned to each Client Needs subcategory in the NCLEX test plan is based on the results of the Report of Finding from the 2005 RN Practice Analysis:
1. Zerwekh, JoAnn, Claborn, Jo Carol, (page95) 5th Edition, Co. 2003, Nursing Today Transition and Trends , Saunders, Philadelphia 2. Henry Ford Community College, Division of Nursing, NSG255 U-1 M-1.6, Co.2006 page 3-5, Dearborn, MI

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Nursing Scholarships and Your Ethnic Roots

Written by kimmel52 on November 11, 2008 – 11:35 pm

By Nancy Lydia Kimmel R.N., Ph.D., C.H.M.M.

Have you ever considered finding out if you are eligible for a scholarship? If not, my advice to you is to try. Why? Well, for one, you would be surprised at how much money is actually out there for you. It is certainly worth the effort, instead of having to pay back school loans at a given interest rate for years to come. Remember, the most important thing about nursing school scholarships or scholarships in general is that they do not have to be paid back. They are given free to those who qualify. Do you think that you won’t qualify? Again, do give up. Chances are that you do qualify for a scholarship to nursing school. Some good resources to find out if there is a scholarship for you would be to visit the nursing school of your choice. There are counselors on staff that you can make an appointment to see, to find out about other nursing school scholarships that best fit your needs.

Nursing school scholarships abound, and are not only offered from diverse places and entities in America but are offered from other countries for those students going to school in America that have some type of affiliation with that particular country. One would be wise to get in touch with their ethnic roots. Whether you are a fifth generation American or a third generation Irish, there is a scholarship for you. It is also important to consult your local college or university of choice to find out if there may be others that fit your situation. Yes, you can have more than one scholarship for nursing school. Actually there is no limit to how many scholarships that you can get, as long as you qualify for the particular scholarship.

It is very important in considering a career in the nursing field to research scholarships that are available for nursing school. You will find many on the internet, but be careful of those that seem too good to be true. This article is written to help direct prospective nursing school students to the many resources that are available to them. There may seem to be a lot of reading, but it is well worth your time and effort. But before we begin with a list of important sites to help you, here is a wonderful true story of a woman who has been blind since birth. Her name is Melissa Resnick and she has always dreamed of becoming a nurse. Read this excerpt by Kathy Quan, you will find it awe inspiring. You know why? Because she has actually begun her studies as of 2005. The moral of the story is, if she can do it so can you.

Here is a list of some websites that may prove helpful in your search for information on nursing school scholarships:

  • www.afrotc.com/scholarships/hsschol/schools.php
  • www.nasa.org
  • www.ana.org
  • www.fafsa.gov
  • nursing.sdsu.edu/scholarships.php
  • aid.military.com/scholarship/search-for-scholarships.do
  • www.globalscholarship.net
  • www.uic.edu/nursing/programs/gep-admissions.shtml
  • www.butlercc.edu/fin_aid/index.cfm
  • Graham School of Nursing Scholarships and Awards

Want to read more…. just go to my nursing education store and get the book entitled ‘Nursing Scholarships

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Culturally Competent Nursing Care

Written by kimmel52 on November 11, 2008 – 11:33 pm

By Nancy Lydia Kimmel, R.N. Ph.D. C.H.M.M.

Immigration to the United States has never ceased. It is a continual process that brings a variety of rich cultures and knowledge this great country. Health care workers experience the vastness of cultural diversity more so than any other profession. Therefore, more than any other profession, health care workers, nurses and physicians in particular must be culturally sensitive to the patients needs.

As the population of the United States continues to increase, hospitals are more likely to see more patients that have cultural needs. Meeting the cultural needs of a patient is essential in treating the whole person. Enhancing a client’s mental and physical wellness is the responsibility of the nurse. The nurse must attempt to use all of the resources at their disposal to see that the client receives the care that they need.

Nurses are faced with a great challenge when treating clients of various ethnicities. Hospital rules are not always congruent with the requests of patient’s families. Hospitals with set visiting hours may pose a problem for the nurse who recognizes that the patient needs family members around them at all hours. Hospitals do not always cater to the patient’s diet. Hospitals in Dearborn Michigan now carry Halal food for the patients who are of the Islamic faith. The city of Dearborn has one of the highest populations of Arabic speaking peoples in the nation. Hospitals had to recognize that to give quality care, they had to be sensitive to the client’s needs.

Nurses may not be able to change hospital protocol, but they can make a significant difference in how the patient views his or her health care. Therefore the nurse must make every effort to ensure that the patient’s needs are met. It may be to allow family to visit on off hours, or to have a plate of food brought in from home. Many cultures have a theory about sickness. In this theory, there are cold foods and hot foods. Each of these foods is used to treat a particular sickness.

Preventing families from taking a integral role in their loved ones care could possibly impede the healing process, by adding additional stress. Stress has been known to cause numerous illnesses. The nurse must attempt to balance the care that the family gives while in the hospital with the rules and regulations of hospital protocol. This can be a fine line. However, the patient comes first. To facilitate an atmosphere where the client feels most comfortable is the goal of the nurse as well as the other medical staff. Of course one would not encourage food from home if the client had leukopenia, or their immune system was compromised.

A nurse must possess the skill and compassion to facilitate the healing process from the first meeting. When the client cannot speak English the nurse should do their best to enlist an interpreter. Using a family member is not a wise choice, due to the fact that the family member may not know how to translate medical terms or may be selective in translating so as not to worry their loved one. Interpreters are usually employed by hospitals to assist medical personnel. Some hospitals have what is known as the “Blue Phone”. The Blue Phone is a direct line to an interpreter of choice for a specific language. The nurse merely has to hand the phone to the patient after explaining to the interpreter what the patient needs to know.

Being a culturally sensitive nurse can bring about positive change and improve the healing process. The client will want to return to that hospital if they find it necessary, and will recommend other family members as well.

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