All Things Nursing
I have received so many questions about nursing, nursing school, and NICU nursing, so I decided to write a blog post to try to answer them all! If I leave anything out, always feel free to message me on Instagram. I had SO many questions during nursing school so always am here to answer yours if I am able!
I can honestly say that taking a chance by switching my major and following my heart to this career has been the best decision I have made. Although I am often tired and stressed, I genuinely look forward to going to work. I know I am still young and this can change, but many of my young friends already dread their jobs.
My mom always told me to "find a job you love and you'll never work a day in your life" and that's exactly what nursing is for me. I am so incredibly anti "living for the weekends" because that means you are just "getting through" 70% of your life! As tough as nursing can be, it is so incredibly rewarding and you truly are making a difference. Not too many jobs out there can say that!
NURSING SCHOOL
The WHAT
There are many different types of nursing degrees:
Nursing Assistant: you can become a nurse's aide with a course earned in a few weeks time. You can work in hospital's or privately and can do things like take vital signs and blood glucoses and care for patients. If you are in nursing school, you may be able to get a job as a nursing assistant without taking a course. This is what I did and it helped so much with time management and patient care skills!
Licensed Practical Nurse: This degree focuses a lot on the skills and practical matters of nursing and often work under the supervision of an RN. Programs can be completed in about a year but I don't believe they can or often work in hospitals. Think more outpatient facilities like nursing homes.
Registered Nurse: This is what I am! You can currently become a registered nurse with a two year associates degree or with a bachelor's degree, but most hospitals are requiring the bachelor's degree. This degree focuses on the science of nursing and evidenced based practice. You have to learn the WHY behind everything you are doing- you may not be writing the orders but you need to anticipate, request, and understand them all.
Nurse Practitioner: Once you have experience as a nurse with a bachelor's degree, you can earn your masters or doctorate degree and become an NP. In most states, you can write prescriptions for medications and treat patients independently.
COUNTLESS other areas to go into!
There are also many specialties: I have friends in emergency, neonatal, pediatric, cardiac, neuro, ortho, psych, geriatric, intensive care, burns, palliative care, and more! You will NEVER be bored as a nurse.
The WHY
I got my Bachelor's of Science of Nursing at Villanova University. I started out as a biology major, then was a math major, and finally transferred into the nursing school after my sophomore year. I wanted a job that combined my love for science with my love for people. After shadowing many healthcare professionals (HIGHLY recommend) I knew that nursing was the right fit.
However, nursing is still very misunderstood especially amongst older generations. I have had countless people ask me why I did not want to go to med school, tell me I was "too smart to be a nurse," or encourage me to marry a doctor and quit my job (?!). Nurses are so much more than what people realize- while we do not have to order the medications, we still better know the proper dose, the pharmacology, the possible adverse reactions, why we are giving it... AND we must be able to confidently educate the families on this as well. Nursing is extremely science based, and not just the "doctor's helper" as some people still believe. While I do not love these assumptions, there is so much about nursing that I do love!
What I love about nursing:
Relationships: You spend the most time with the patient and get to know them the best. You are with your patient all day, while other health care workers are in and out in under an hour. You are there for the good and the bad and really get to know them and their family and make a difference.
Holistic Care. We do not only focus on the disease and what is "wrong" with the patient, but we care for the patient as a whole and see the big picture. For example, if a patient has a heart attack we are also looking at their diet, lifestyle, family risk factors for other illnesses, psychological state, emotional support, and availability of resources. We are an emotional support for them and their family and work to educate them on their new medications and lifestyle.
You make a difference. You MATTER. Every day you go to work and make the difference in a patients life. Your positive attitude and loving care can make all the difference in the world
Teamwork. You are a part of a TEAM. Every day, I work with other nurses, NPs/PAs/Doctors, respiratory therapists, social work, nutritionists, OT/PT, child life, and more. Each of us have our own niche and contribute to the common goal of healing the patient
Flexibility. You can work 3 ,12 hour shifts a week as a bedside nurse or move into another roll as an educator, manager, or charge nurse. You can go back to school for health care management or to become a nurse practitioner or nurse researcher. You can work in a hospital or in a clinic or in the community. You can try dozens of specialties. For indecisive people like myself, there are countless options. Nutrition is also a huge aspect of nursing because the food we eat directly correlates to our health. Food choices and wellness are huge pieces of education we give every patient, but if you want to specialize further there are options to do so! For example, you can become a nutrition nurse and specialize diets for different medical diagnoses.
The HOW
To earn your BSN, you will need to take tons of core curriculum classes like biology, chemistry/organic chemistry, pathophysiology, pharmacology, genetics, some english classes, and more depending on your school.
Then, you take nursing specific courses like medical surgical nursing, OB nursing, etc. and each of these have a clinical component where you are in the hospital caring for patients and learning on the job. We also had many lab days at my school where we practiced skills and simulations in lab. And YES, we had to take the ATI exams for each of these classes! They stunk but did give us some great test taking practice.
I also was a psychology minor because I love the human mind and thought it would be helpful while dealing with patients! I took child development psychology, positive psychology, forensic psychology, psychology of personality, and social psychology.
WELLNESS AND NURSING
Here is a photo of me before an exam, hyped up on coffee. Not the healthiest form of wellness but sometimes ya gotta just chug through!
Nursing is HARD. I won't sugar coat it. I arrive at work by 6:30am and often don't leave until close to 8pm. My day consists of standing and walking 90% of the time, and I am lucky my patients are only a few pounds so my back is spared rolling them in bed. I am often stressed and busy and do not have much time for breaks. Nursing is sad- patients die, family members are distraught, there are tears and yelling and blaming. You will be screamed at by frustrated family members or doctors taking it out on you, you will feel unappreciated, and you will feel stupid because nursing is hard and a TON to learn.
Nursing school is hard. There is so much to learn in such a short time on top of waking up at 4am a few times a week to drive to clinical and try to take care of patients with ailments you have only read about in text books. You will wonder why you didn't choose any other major that allows you to have a social life and spend time doing anything but studying the pharmacology of seven different diuretics at the same time as memorizing the long and convoluted assessment of a healthy newborn while writing your twelve page care plan on your cardiac patient while stressing in the back of your mind that you will have to insert a foley catheter sterilely the next day and mess up all while trying to get to bed at a decent hour before waking up at four in the morning for your twelve hour clinical the next day. And thennnn your friends don't understand why you can't go to happy hour on a Tuesday night. Yeah, I've been there but you will make it!
Nursing is hard but SO worth it- what other job lets you make such an impact, perfect some pretty great techinical skills, utilize knowledge in both science and human emotions on a daily basis, and have so much flexibility?
Here are my tips on surviving nursing school and nursing career:
Find a hobby. It may seem impossible to juggle a hobby on top of all the business and stress, but even if you divert your attention for 20 minutes a day it will allow you to destress and recenter. I loved reading and cooking and made these a priority, but for you maybe it's a sport or musical instrument.
2. Self-care: prioritize 8 hours of sleep, prioritize meals that make you feel good, and prioritize movement. It can be easy to say we don't have time, but if we make a decent study plan and spend some quality time studying and stop aimlessly scrolling and watching Netflix, it can be done.
Sleep: I am not the type of person who can run on 4 hours of sleep. To excel in clinical and ace exams, I neeeeeded my
Food: for both nursing school and my nursing job, I made sure I am properly fueled. It is easy to put off meal prepping and run on random processed snacks we can find while studying or in the break room at work, but these leave me feeling sluggish and run down. I ALWAYS prep nutrient dense meals and have fueling snacks on hand. Doesn't mean I will say no to the cookie while studying or donut in the break room, but I feel so much better with some great nourishing fuel in me as well.
Movement: I feel so much more energized when I can move my body. I will NOT work out on days I have a 12 hour shift, but I walk a ton during the day. In nursing school, I loved to incline walk or ride the bike while listening to nursing videos or studying flash cards. On days I have more time, set aside even just 30 minutes for yourself to get a quick workout in and energize yourself!
3. Support. You need people to talk to about the stress of nursing school or nursing. My floor has support groups for nurses, and finding nursing friends who 'get it' is important. Don't be afraid to start seeing a therapist that you can process everything with either.
4. Remember why you are doing it all. You are going to help so many and have an amazing career so just keep your eyes on that.
5. Journal! I love writing down the good and bad times, my worries and fears and accomplishments. It helps me so much to get everything out of my head and onto paper.
Some Quick Study Tips: I will admit that I have never been the type of person to "have to" study before. I was usually able to float through without putting in much effort and ace the exam anyway. Nursing school is different- you will have to study, even if you are naturally a good test taker. Maybe not as long as some other people, but do not think you can just float by like in high school and other undergraduate courses!
Study smart. Do not just read and re-read your notes or the text book- that will get you nowhere. SO much of nursing is concept based, so I made concept maps outlining disease processes or pharmacology of drugs to map it all out. Let google be your friend, they have some great concept map examples and resources! Start early. I tried to review the chapter or powerpoint before class so I could sit and listen and absorb without frantically writing all new information. Then I would go home and re-write my notes. This way I was staying on top of the information and was not as overwhelmed come test time.
Use index cards sparingly. Like I said, nursing is highly conceptual. Index cards work well for memorizing quick statistics or definitions but that is about it!
Use resources. The internet is amazing- sites like RegisteredNurseRN, ATI, Kahn Academy, etcetera offer valuable resources. I also used UWORLD to study for the NCLEX and highly recommend it- I would suggest buying it in nursing school and using those practice questions to study for the exams as they come!
NICU NURSING
These photos are ALL from google and not my patients! I just wanted you guys to get an idea of what kind of patients I see. They are from google and I included the links. The first few are more intense patients, and the last one is a "feeder-grower" that is over the intense stage and just remains in the NICU to get bigger and master how to eat before going home!
As mentioned earlier, there are so many different kinds of nursing. I work in the NICU, or Neonatal Intensive Care Unit. I knew going into nursing school that the NICU was where I belonged- I honestly felt a calling. I have always had a passion for babies and their innocence and working with them full time felt like a dream.
I love the intensity of the NICU and all of the high-tech and complex treatments my babies are on. I love only having one or two patients to focus my attention on and get to know. I love educating and supporting the families. I love that my patients stay for months and I can really form a relationship with their families. I love that a lot of my babies will heal and improve and just need a little extra help before being carried out the doors to live a big beautiful life. And when my patients' stories do not have such a happy ending, I love that I can be the one to care for them and make them comfortable during their short stay on Earth.
I am so lucky that I work in a huge, 100 bed level IV NICU. Level II nurseries take care of later gestation babies or babies with simple needs, level III NICUS take care or more complex kiddos, and level IV can handle any baby including the most technical and complicated cases. My NICU cares for babies born either in the hospital or transferred from surrounding cities and states. Many of my babies are premature and need extra help breathing, eating, and regulating their temperature. They usually stay until at least their due date, so usually many months.
Many of my babies also have other reasons to stay, including heart defects, birth trauma, blood sugar issues, genetic conditions, and more.
Many babies have ventilators, feeding tubes, IVs, central lines, and wires all over their bodies to monitor different important values. This can all look scary at first but is just to help them and you get used to it quickly.
I typically have one to three patients- one if they are very complex and three if they are simple. I usually will have two! Care is usually clustered, which means you try to do everything for the baby at once to give them more time to sleep between care. These babies are highly sensitive because they are not supposed to be outside of the body yet, so even a simple touch or diaper change can be very stressful and adversely affect their vital signs.
Every day looks different, which I love. Here is a 'typical' day. I made up these patients entirely and they are not real babies I have cared for, just some very common diagnoses and treatments I see!
5:30am: my alarm goes off. I write in my journal for about 15 minutes, check my texts, and get up. I quickly get ready and grab the lunch I have packed the night before.
6am: I leave for the hospital.
6:30am: arrive at my unit and head to the breakroom. I usually eat a smoothie made with frozen veggies, berries, almond butter and protein powder.
6:38am: clock in, get my assignment list and listen to a general report with the dozens of other nurses working today from the charge nurse in the break room about how the night went and how many babies we have
6:45 am: meet the night shift nurse that I am getting report from and write down a full report on each of my babies. Today it is a 26 weeker needing some extra support breathing with a ventilator and a two month old baby with a heart condition. Report goes over each baby in detail body system by body system as well as any family information I may need to know. I listen to report and ask any questions I may have. I here in report that the 26 weeker has been "spelling" more frequently, which means he becomes apenic and bradycardic which leads to declines in heart rate and oxygen saturations that require us nurses to intervene by suctioning, giving more oxygen, stimulating the babies, or bagging the babies or calling a code if it gets really bad. This beeping and alarming can be scary especially when your baby turns blue but it is part of the job!
7:30am: report is over and I take a look at the online charts of both my babies. I plan my day around their care times (usually every three hours) and medications, lab draws, and treatments they may need. I write out my schedule for the day so I do not miss anything! Each baby has a care time every three hours, so one is an 8-11-2-5 schedule and one is a 9-12-3-6 schedule.
8 am: I grab the milk and medications for my 26 weeker's care and enter the room. I heat up the milk while I perform a full assessment, head to toe. I palpate his fontanels and palette, listen to heart and lung sounds, measure his belly, feel pulses, examine capillary refill times, and more. I will then start his care, which includes suctioning his mouth and ET tube, changing his diaper, taking vital signs, and cleaning him up. He has a feeding tube, so I check it's placement and hook up his feeding. His alarms start going off because his oxygen saturation is 76%, so I suction him again and turn up the oxygen percent going to him from his ventilator. I work on setting up some IV medications and leave the room to check on baby number 2.
8:45 am: My cardiac babies care is not due until 9am but I always start early if I can because nothing ever goes as planned in the NICU! Her care looks similar to baby number 1, but she has some extra equipment for her heart like special probes that measure the oxygen going to her kidney and brain, a pre and post ductal oxygen meter, and an arterial line measuring blood pressure continuously inside the body. I perform an assessment and spend extra time examining the body systems affected by the heart. I will make sure I examine these systems every time I enter the room because much can change quickly! This includes pulses all over the body, temperature, capillary refill, urine output, neurological status, and more. I do the care and medications for this baby and hook up her feed.
9:30am: I exit the room to sit down at my computer. Both of my mommas have called for updates on their little ones, so I call them back and introduce myself and give them an update on how the night went and how the mornings care was. Then it is time to CHART. I have to document my full assessments, as well as vital signs, care, intake of all of the continuously running IV medications, and more. Charting is a huge part of my day and can get tedious, but is so important.
10:15am: the team (NPs, residents, PAs and doctors) is rounding on my babies and I am a huge part of it. I voice any and all concerns and my opinion is valued. Every day, the team re-evaluates the baby and it's plan of care. It is my job to advocate for the baby and suggest any medication or feeding change I see fit. The team often goes up on feeds or switches out drugs to better help the baby.
10:30am: I usually try to grab a snack but often do not have time. My favorite quick snacks is a cup of greek yogurt, an apple, or a protein bar!
10:50am: Baby number one's second care is due at 11am. He is sleeping peacefully so I try to make it quick. I change his diaper, take a temperature, provide some oral care and other hygiene, hook up his feed and push some IV meds.
11:20am: on to baby number two. Care is due at noon, but I start early. I repeat the cardiac assessment and perform her care. A lab draw is due that I can take off of her arterial line. Mom and dad arrived so I welcome them and answer their questions. Mom is tearful so I provide emotional support. I tell them they can hold baby after her 3pm care and they are so excited!
11:47am: I hear the alarms beeping on baby number one. Oxygen saturations are falling, so I leave my cardiac baby to take care of baby one. His tube needs to be suctioned and his oxygen needs to be turned up. I noticed he has had an increased oxygen requirement, which can be signs of infection or worsening condition. I page the team to let them know.
12pm: I sit down to CHART.
12:30pm: I help a fellow nurse with a sterile line change. This is a long process that has to be completed every four days on central lines and involves wearing sterile gloves and gowns to change out the tubing and klaves on the line to reduce risk of infection. It takes about 15 minutes and I am behind on charting, but nursing is all about team work.
12:45pm: I realize I have not peed all day and run to the bathroom. I usually upload a photo I have saved in my drafts to instagram during this pee break ;) before charting some more.
1pm: The team got my page about baby number number one requiring more oxygen, so they order a chest x-ray. I call to have x-ray come and am in the room to assist.
1:15 pm: I take my lunch break when I can. It is supposed to be thirty minutes, but I am running behind so I take 15. I eat my spaghetti squash casserole and banana bread and chug some water before running back to my babies.
1:30: I am back in baby number one's room. The chest x-ray showed some fluid in the lungs so the team ordered a diuretic drip and bolus to increase urine output and get rid of some of that excess fluid. I set those up and perform the two o'clock care.
2:30pm: Baby one's mom calls for an update and is nervous about the status change. I assure her this is not uncommon for preemies and explain how the drugs work. She thanks me for taking such good care of her baby.
2:45: I perform my 3 o'clock care on baby two. Mom and dad are still here, so I involve them by having them perform the diaper change and temperature check. After care, I get the baby out of bed with all of her lines and equipment so mom and dad can hold. It is quite a challenge with all of the tubes but so worth it!
3:30pm: Time for more charting!
3:45pm: I hear that one of the babies I had for a while a few months ago is being discharged today, so I run over to their room to say goodbye and good luck to the parents. They hug me and thank me and are beaming with excitement and gratitude!
4pm: I get my cardiac baby back in bed. Babies in the NICU often cannot tolerate being held for more than an hour because it can be stressful.
4:15 pm: I draw a lab on baby one, but he does not have a line so I have to prick his heal to collect blood. I use a heal warmer first to make the blood pump faster so I can collect the small sample before it clots off! Since I am in the room, I perform his 5pm care a bit early.
4:45pm: It is almost Christmas, so I decide to get crafty. I place ink on baby one's feet and take his footprints on a small piece of paper that I make into a "my first christmas" card to display on his glass door of his room.
5 pm: charting time!
5:30pm: It's time for my cardiac babies last care. I perform it and hook up her feedings. Her hemoglobin level on her latest lab was low, so she needs to be given blood. I have to insert an IV and run the blood, but must stay with her for the first 30 minutes to make sure she does not have any reaction.
6:30pm: The blood put me behind for my end of shift duties, so I quickly chart up. I calculate my urine output for the shift and tidy up my report sheets so I can give report to the night shift nurse.
6:45: The night shift nurse arrives and I update her on my day and the babies.
7:30pm: I clock out and head home! It was a long day, my feet hurt, and I feel like I can eat a cow. I eat another apple as I walk to the car and smile thinking about my day.
8pm: I made it home! Dinner is a salad with tomatoes, cucumber, and feta along with a leftover piece of some sort of baked good I made. Always have to have dessert!
8:30pm: Shower, read, and relax before I am in bed at 9pm. I have to wake up bright and early for another day with the babies!
Andddd that's it! Sorry for the super long post but nursing is a lot and their is so much more I could have included! If you have any more questions, feel free to message me. I will leave you with this quote that wraps up why I love my job:
