Two scholarships were recently brought to my attention and I remember all too well the stress of paying for my nursing education – I must share the details with you!

BestNursingDegree.com is currently offering three scholarships in the amount of $2,500 each to aspiring and current nurses who are pursuing:
       *A second degree BSN or direct entry MSN degree 
       *An RN to BSN 
       *An MSN, DNP or PhD in nursing
Applications are available on their home page at www.bestnursingdegree.com. Deadline is April 15, 2012.

Loyola University Online is offering a set of five $4,500 scholarships for their online Master of Science in Nursing degree program. Applicants are asked to submit a 200-300 word essay answering the question: “What does nursing mean to you, and how will an MSN with a specialization in Health Care System Management benefit you or help further your career?” For more information and to apply, visit http://scholarship.loyolaneworleansonline.com/msn/. The deadline for entry is fast approaching - March 23rd.

Do you know of any other scholarships currently available? Please share! 

MAP, or mean arterial pressure, is defined as the average pressure in a patient’s arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure (SBP). True MAP can only be determined by invasive monitoring and complex calculations; however it can also be calculated using a formula of the SBP and the diastolic blood pressure (DBP). 

To calculate a mean arterial pressure, double the diastolic blood pressure and add the sum to the systolic blood pressure. Then divide by 3. For example, if a patient’s blood pressure is 83 mm Hg/50 mm Hg, his MAP would be 61 mm Hg. Here are the steps for this calculation:

MAP = SBP + 2 (DBP)
                3

MAP = 83 +2 (50)
                3

MAP = 83 +100
             3

MAP = 183
           3

MAP = 61 mm HG

Another way to calculate the MAP is to first calculate the pulse pressure (subtract the DBP from the SBP) and divide that by 3, then add the DBP:

MAP = 1/3 (SBP – DBP) + DBP

MAP = 1/3 (83-50) + 50

MAP = 1/3 (33) + 50

MAP = 11 + 50

MAP = 61 mm Hg

There are several clinical situations in which it is especially important to monitor mean arterial pressure. In patients with sepsis, vasopressors are often titrated based on the MAP. In the guidelines of the Surviving Sepsis Campaign, it is recommended that mean arterial pressure (MAP) be maintained ≥ 65 mm Hg. Also, in patients with head injury or stroke, treatment may be dependent on the patient’s MAP. 

In what other clinical situations do you monitor MAP?  

References
Surviving Sepsis Campaign. Accessed December 8, 2011. 
Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2010). Brunner & Suddarth's Textbook of Medical-Surgical Nursing, Twelfth Edition. Philadelpha: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

I just finished reading Professional Growth: Taking a novice nurse under your wing from the September issue of Nursing2011. In this article, the author, Pamela Woodfine MSN, RN, emphasizes the importance of mentoring and making a new nurse’s first experiences in the “real world” of nursing positive ones. She also stresses the importance of recruitment and retention to the future of our profession. Below, the phases of the mentoring process are listed as presented in this article. Regardless of where you are in your nursing career, whether the new nurse or a new or experienced preceptor, I think you’ll find them interesting and helpful in planning and implementing a successful transition into nursing. 

• Phase 1: introductions, discuss one another’s personal and professional goals 
• Phase 2: set goals and objectives together, establish a time frame
• Phase 3: determine guidelines for implementing plan of action and working relationship (for example, open communication, availability, and constructive criticism) 
• Phase 4: reflection and feedback  (most important phase; fosters critical thinking and increases clinical skills)

I hope you enjoy this article. You can read it free online while it is on our Recommended Reading list.  Also, you can read about A memorable mentor in my career and my thoughts on The makings of a good mentor.

I was on orientation in the Medical Intensive Care Unit and I had the most amazing preceptor. She really did know everything. I still have yet to meet a smarter nurse, or person, for that matter. Her knowledge of physiology, pathophysiology, medications, technology, and random entertaining facts to keep us going during night shift astounded me! Not only that, she was (and is) an amazing nurse --- caring, compassionate, a good listener, excellent at time management, and all things nursing!

And her teaching skills? Amazing.

I was a new graduate fortunate to work with and learn from this nurse every day. I had worked in this MICU as a nursing assistant for over a year, so I knew some of the basics (where to find supplies and knowing which room is which is huge when you are just starting out, right?) I’ll never forget this one time…

Amy (not her real name, of course) would often stand back in the corner of a patient’s room while I did my assessment at the start of a shift. Sometimes I’d forget she was there until she’d start with “the questions.” During this particular shift she said, “Lisa, what if all of a sudden the ventilator alarms for a high peak airway pressure?” I started to go through my list of troubleshooting ventilator alarms: look at the patient - is he in distress, what is his oxygen saturation, how is his color, listen to his breath sounds, is his endotracheal tube in place - and then moved on to the ventilator - any water in the tubing, is everything connected as it should be, etc.

Amy then said “Okay, you don’t find any concerns, but the high pressure alarm is still sounding. Now what?”  I replied, “I would disconnect the patient from the ventilator and bag him.” Amy said “Yes, and what else could you do to search for a reason for the alarm?” I could tell by Amy’s face that I was missing something.

She pretended to take a picture. Huh? I must have looked confused, because she did it again. I thought for a minute and then it hit me --- a chest x-ray!

Hi again! Here’s part 2 of my mnemonics list. These tips need a little more explanation, but they worked for me, so perhaps you’ll find some value in them as well.

To remember the types of white blood cells and their descending proportion in a blood sample…
“Never Let Monkeys Eat Bananas” = Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils

To remember where lymphocytes mature…
B cells mature in the Bone marrow; T cells mature in the Thymus

To remember the cranial nerves…
“On Old Olympus Towering Tops, A Finn And German Viewed Some Hops” = Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glassopharyngeal, Vagus, Spinal Accessory, Hypoglossal

And to remember the functions of the cranial nerves (sensory [S], motor [M], or both sensory and motor [B])…"Some Say Marry Money But My Brother Says Bad Business Marry Money."

To remember the location of the adrenal glands…
Think ADD RENAL; they're "added" to the renal organs, the kidneys.

That’s all for now! Here’s R-E-M-E-M-B-E-R (Part 1) in case you missed it!

As you can imagine, I do a lot of reading about nursing. Journals, books, newsletters, blogs - you name it and pretty much I’m reading it! I think I’ve mentioned before how some titles really hook me. I love lists, so when I come across anything that starts with “Top 10” or “Tips for” or “List of” chances are that I will open to that page or click that link. Another one of my favorite things are mnemonics, or easy tricks for remembering complex things, which in nursing school and in practice, are very helpful!

Here are some of my favorites:

To help organize your day…
IMAGE: Introduce yourself, Medications, Assessment, Goal, Explain & Educate

To evaluate a symptom…
PQRST: Provocative/Palliative (what makes it better/worse), Quality/Quantity, Region/Radiation, Severity, Timing

To assess skin lesions…
ABCDE: Asymmetry, Border, Color/Configuration, Diameter/Drainage, Evolving

To assess pupils…
PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation

To include in your documentation…
PIE:  Problem, Intervention, Evaluation

More to come soon...do you recall the one for remembering all the cranial nerves?

Have you made any adjustments in your career goals or education plans based on the RWJF and IOM Report , The Future of Nursing: Leading Change, Advancing Health, released last October?

I have been away from clinical nursing since 2001. I can’t believe that it has been 10 years. I’ve always believed that someday I would go “back to the bedside” and I really do miss taking care of patients. It’s been a little more noticeable to me lately just how much I miss the clinical side of nursing. I’m not sure if it’s because the fact that it’s been 10 years overwhelms me or because I am excited about the direction in which our profession is headed. Perhaps it’s a little of both.

The question that really gets to me is where do I want to be? Critical care was my home for most of my clinical career.  I loved the thrill of caring for acutely ill patients and their families. Titrating vasoactive drugs, assisting with invasive procedures, using the latest technologies - all so cool! Admissions from the ER, “road trips” to diagnostic tests, end-of-life discussions, and the list goes on…

However, my “other list” is quite impressive to me also. As a women’s health NP, it was so fulfilling to be in the community and make a difference educating women about preventive care. Also, contraceptive counseling, prenatal care and teaching, helping someone find some relief from her symptoms of menopause, and so on…. Primary care practitioners have so much to offer and the need is so great.

The very first key message from the IOM report states “Nurses should practice to the full extent of their education and training.” Does this mean that it is my duty to practice as an NP because I have the degree and license? Would I be disregarding this message by returning to staff nursing in the ICU? I sure hope not. Then again, I could always pursue another degree…critical care NP might be the answer. Now there’s something for me to think about!

Perhaps as we prepare for the future of our profession, we should all take this time to look at our individual goals as well. What is your future in nursing?

By now, most of us have read about, heard about, discussed, seen the picture, etc., of the nursing student who posted a picture on Facebook of herself with a placenta.  While we may have differing opinions about the ethics involved, whether HIPAA was violated, or whether the punishment of expulsion was too severe, the lessons to be learned are the same - think before sending anything out there into the realm of the world wide web, proceed cautiously before clicking that “submit” or “post” button, and consider the effects and possible repercussions of your actions.

Today, this nursing student, who was scheduled to graduate this May, will be taking action against her school and the involved faculty. I’ll be following the case, how about you?

Change is not usually easy. Nurses who have made nursing their second (or third or fourth…) career deserve much recognition and respect. Imagine being an expert accountant, someone who people seek out to answer their financial questions and meet their needs, and then starting over from scratch in a new environment, with new people, learning new skills and knowledge.  Imagine returning to the novice role after already having travelled that path of novice to expert. Remember those days of care plans and clinicals, searching for a job, and then starting work in an unfamiliar unit or facility. Now imagine doing it all over again. A bit overwhelming, isn’t it?

In the January/February issue of Nursing Made Incredible Easy, Sally Jo Borrello, MSN, RN, CTTS, takes a closer look at the second-career nurse.  She reminds us that while individuals pursuing nursing as a second career are usually adult learners who are more serious and confident than their younger counterparts, they still face the same long hours of studying and class preparation. Many are also sacrificing personal and family time to obtain their degree.

The author goes on to share tips for experienced nurses to mentor second-career nurses. Building a mutually respectful and trusting relationship is key. Remember that this mentee is bringing his or her background and knowledge to the relationship also, so be open to learning quite a bit yourself. Use positive feedback to support and guide this student or new nurse.

Are you a second-career RN or currently pursuing nursing as a second career? Please chime in with your thoughts and experiences!

When I was in graduate school, my schedule was a little busy. I’m sure many of you can relate - juggling work, school, friends, family, and other responsibilities can be daunting. My weeks went like this: clinical Tuesdays and Thursdays, classes all day Wednesday, and work Friday, Saturday, and Sunday (three 12-hour night shifts).

It was exhausting, but fortunately the hospital where I worked paid 100% of my tuition and allowed me the flexibility of working 36 hours each week, while getting paid for 40 hours and receiving full-time benefits. This schedule didn’t leave much time for anything else, but I was pursuing a goal and luckily had a supportive (and understanding) network of colleagues, friends, and family.

My best day during that year and a half was Monday. I felt so free driving out of the city on Monday morning. While traffic on the other side of the highway was stop-and-go, I breezed home without any problem. Driving with the windows down (even in winter - had to stay awake!) and the radio on with some “snappy tunes” had such a calming effect after 3 shifts in the MICU. Having the entire day ahead to myself was such a gift. Of course, there was studying to do, and showers, meals, and sleep to squeeze in, but it didn’t matter. Monday was my best day.

What's your best day? Remember, nurses, no matter how busy you get or how overwhelmed you feel, take a little time to take care of yourself. Have a great Monday!