I’m drawn to articles that offer tips, top ten lists, mnemonics, and quick-reads to make our days and lives as nurses run smoother. That’s why I’m happy to share that we’ve just added a new article to our Recommended Reading list with not one, but two handy mnemonic devices! Plus, the topic is ECG interpretation and you may recall that one of my most memorable days as a nurse began with analysis of a Six-Second Strip. 

Please allow me to share one of these clever mnemonics with you here (you can click through to the article to learn the other – enjoy free online access while it’s on our recommended reading list). 

So, what are the H’s and T’s referred to in the title of this post? They are the reversible causes of cardiac arrest, which include:

* Hypovolemia

* Hypoxia

* Hydrogen ion (acidosis)

* Hypo- or hyperkalemia

* Hypothermia

* Tension pneumothorax

* Tamponade, cardiac

* Toxins

* Thrombosis, pulmonary

* Thrombosis, coronary

Do you have any similar mnemonic devices to share? Let’s help one another to remember all that is nursing and healthcare!

Reference:

Craig, K., (2013). Heart Beats: Rhythm self-quiz: Fast and deadly. Nursing2013 Critical Care, 8(1).

“Learning is one of life’s most essential activities.” — Annie Murphy Paul

Enrollment in all types of professional nursing programs increased from 2011 to 2012, according to new survey data from the American Association of Colleges of Nursing. These findings are based on data reported from 664 of the 856 nursing schools in the U.S. with baccalaureate and/or graduate programs.

The survey also saw a 3.5% increase in entry level Bachelor of Science in Nursing programs. The number of students enrolled in RN-to-BSN programs increased by 22.2% from 2011 to 2012, which, according to the AACN, signals a growing interest for baccalaureate-prepared nurses from both nurses and employers.

"AACN is pleased to see across-the-board increases in nursing school enrollments this year, given our commitment to encouraging all nurses to advance their education as a catalyst for improving patient care," said AACN President Jane Kirschling in a press release. "As the national voice for professional nursing education, AACN is committed to working with the education and health care community to create a highly qualified nursing workforce able to meet the expectations and challenges of contemporary nursing practice."

A few other interesting survey findings:

• Enrollment in master’s and doctoral degree programs increased “significantly.”
• Survey data indicated an 8.2% jump in enrollments for nursing schools with master’s programs (432 institutions reported data).
• Doctor of Nursing Practice programs saw a 19.6% enrollment increase (166 schools reported data).
• Baccalaureate nursing graduates are more than twice as likely to have jobs at the time of graduation than those entering the workforce in other fields.
• Graduates from master’s degree programs (MSNs) were most likely to have secured jobs at graduation (73%).

"Momentum is clearly building for advancing nursing education at all levels,” Kirschling said in a press release. “Given the calls for more baccalaureate- and graduate-prepared nurses, federal and private funding for nursing education should be targeted directly to the schools and programs that prepare students at these levels."

"Further, achieving the Institute of Medicine’s recommendations related to education will require strong academic-practice partnerships and a solid commitment among our practice colleagues to encourage and reward registered nurses committed to moving ahead with their education."

This post was written by Erica Moss, who is the community manager for the online masters in nursing programs at Georgetown University.

Last week I had the privilege of speaking with Carole Eldridge, RN, DNP, CNE, NEA-BC, Director of Graduate Programs at Chamberlain College of Nursing. This fall, Chamberlain is launching a new Masters of Science in Nursing Healthcare Policy Track and I was particularly interested in learning more about Dr. Eldridge, as I’ve been following her on twitter for years (@Nerdnurse), and about this new MSN track.

I was more than impressed when I asked Dr. Eldridge to share her nursing background with me. In a nutshell, after about 15 years in acute care (including critical care, post-surgical care, hemodialysis, and transplant), Dr. Eldridge and her husband moved to Africa for about a year to run a health clinic. When she returned to the U.S., she started a Home Health and Hospice Agency which grew into about 50 agencies in 4 states! After selling this business, Dr. Eldridge became interested in education and saw a need for training nurse aides. She started her own publishing company which developed training packets. After selling this company, Dr. Eldridge returned to school herself for her MSN in Leadership and Healthcare Business, and later her DNP. She taught for about 3 years, and since then has held various titles including Director of a Master’s program, Dean, and Campus President. Wow!

In her current role, Dr. Eldridge oversees all of the graduate programs at Chamberlain College of Nursing. As previously stated, this fall, a new Healthcare Policy track is available for MSN students. The development of this track is timely in the wake of the report from the Institute of Medicine – The Future of Nursing: Leading Change, Advancing Health – and as we approach a Presidential election here in the United States. An MSN in Healthcare Policy will prepare nurses to be active in bill and policy writing, foundations, education and training, academia and research, disease investigations, health services, and other positions where one can “Impart the voice of nursing to direct the path of healthcare policies that benefit patients, the community, our nation and the world.”

This particular program involves 6 core courses (foundational concepts, theory, informatics, leadership, research, and basic healthcare policy) and 6 specialty courses (healthcare systems, economics, global health, nurse leadership and healthcare policy, healthcare policy practicum, and a capstone project).  When asked for more details about the capstone project, Dr. Eldridge gave me several examples that students from similar programs have done, such as global health projects, legislative proposals, and oral testimony collaboration. The coursework is flexible, can be completed in 2 years, and is completely online.

My favorite part of our conversation had to be discussing the upcoming election. Dr. Eldridge reminds us that as nurses, we have a responsibility to be politically engaged in order to best advocate for our patients. In particular, we need to be alert to the following:

• Economics – how will healthcare be funded? 
• Affordable Care Act
• The aging population, including funding their care & medical devices
• “Equitable access”
• Epidemiology
• Vaccines
• Global Healthcare 

Remember, Florence Nightingale was our first political activist. As nurses, let’s remain educated about the issues and share our voice. We are more than 3 million strong – it’s important that we are heard!

Resources:

The Future of Nursing: Leading Change, Advancing Health 

Keeping Health Care Reform Healthy, Patients Informed (American Nurses Association) 

ANA’s Policy and Advocacy page 

ANA's Nurses Strategic Action Team (N-STAT)

It was my sophomore year of college and we were heading into the hospital for the first time. We had been learning about communication and practicing with one another and now it was time to meet a REAL LIVE patient and use our skills. I was so nervous!

I realize now what this first encounter meant to me. I wanted my first official interaction with a patient to be a positive experience. I had already had some doubts about nursing as a career choice (you can read a little about that in Is Nursing Really For Me?) and thought that this experience would give me some insight if this path was indeed the right one for me.

Another thing that I realize now, was that I wouldn’t be just talking as a friend, daughter, sister, or student – roles that I was familiar with. This was new territory and this patient would look to me for answers and support. My role as a nurse was beginning and this patient would trust me to say and do the right thing. 

Despite my nerves, I remember wondering (and being a little impatient about) why we weren’t doing real nursing things when we went to the hospital. I know now that communicating with patients is real nursing. Making that human connection is a big part of what makes us different from other disciplines in health care. Think about how you communicate with patients, their family members and caregivers, and other healthcare providers. Think about how others communicate with you? Any differences?

I like to think that since becoming a nurse, I’ve become a better communicator. I try to consistently think before speaking. I work hard to really listen to others rather than thinking about what I’ll say next when someone else is talking to me. When a difficult conversation is taking place, I think back to the communication strategies that I learned during those first years of nursing school. I also try to pay attention to my own nonverbal cues and those of others.

Have your communication skills and strategies changes since becoming a nurse? How so?

Dear New Nursing Graduate,

Welcome! What an exciting time for you! I realize that it probably is somewhat of an emotional and stressful time as well. My sons just “graduated” from elementary school and through all the events and ceremonies, I was reminded just how special these milestones and traditions can be. Probably the biggest one for me was finishing up nursing school and entering the “real world.”  

So, first let’s get out all of the stress that you are probably feeling right now. These were my top 3 sources of anxiety, if I remember correctly…

1. Leaving the security of school with instructors who guided me and classmates who supported me. I did find other mentors and formed another support network rather quickly and you will too! Get to know other new nurses during orientation. Be receptive to learning from more experienced nurses and other staff.

2. Facing the NCLEX exam. How could I possibly know all that I was expected to know? I did, and you do too (but don't stop studying!)

3. Encountering a discouraging job search. I had to be persistent and open to options that weren't my first choice.  Remember that any job can serve as a stepping stone to your dream job.

I recall hearing over and over again how the “real world” of nursing would be so different from nursing school. How can you make the transition a little easier? Here’s some advice:

• Never stop learning! Learn from other nurses, other disciplines, support staff, anyone around you! Some of my most critical skills and communication techniques I learned from my very first preceptor – a nursing assistant who had been working on the unit for more than 20 years! Take advantage of the knowledge and experience of those around you. Really listen to advice and observe how others do and say things. You may not want to emulate all of what you see, but you can learn from it.
• Keep up your education! I know you just finished school, but there is so much more to learn and things in healthcare are always changing. Attend inservices and maintain your continuing education requirements. Also, when the time is right, consider getting certified in your specialty and think about going back to school.
• Ask questions! This goes hand-in-hand with learning and education. Chances are, if you have a question, someone else is wondering the same thing. Don’t assume – get the answer or find out how to get the answer. Then share it with others.
• Join a nursing organization! This is a great way to stay informed and network with nurses who have similar interests.
• Take breaks! Remember to take breaks during your shifts. Also, be sure to enjoy “non-nursing” time with family and friends. One of my favorite nursing tips is "Nursing is a 24/7 operation that requires teamwork - do your best to prioritize and work safely & pass on the rest."

A last word of advice is to not forget this feeling of uncertainty and stress, as uncomfortable as it may be. This will help you when students or new nurses are on your floor. Welcome them and treat them with respect. Share your knowledge with them, even become a preceptor. They’ll thank you for it.

Best of luck to you as you make this transition!

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!