So I have good news and bad news. The good news is that I’ve finished my Bachelor’s of Science in Nursing!! Now I’m just up to my eyeballs in NCLEX prep as I impatiently await the arrival of my ATT (authorization to test for those who aren’t fluent in nursingstudentese). The bad news is…I will no longer be blogging at TDAMCP.

Somewhere along the way the blog and my identity became intermingled which was never really my intention and I’d really like to regain my anonymity. Not that I plan on violating HIPAA or slandering my organization or my colleagues or anything, I’d just like the real me and the work me to be separate. I also haven’t decided which direction I want to go with my blogging now that I’m no longer a student nurse, whether to continue personal experience blogging or switch to a more professional type of blog. In any event, TDAMCP will remain up for those who may want to reference topics in some of my posts or the resources found herein (I’ll also still be reachable via the Contact Me page as well). And of course I’ll update you all once I pass boards and have officially “crossed over” to the other (dark?) side…

But somewhere, out there, a new grad RN blog has already been born, with yours truly at the helm (I hope they’re ready…). Maybe I’ll see you there…

This is a guest post by Caleb Christenson RN. He is a med-surg nurse living and working in southern California, read more tips from Caleb at RookieNurse.org. A site dedicated to the success of you, the student and new grad nurse. Sign up for his newsletter to get exclusive material and resources.

It has been said that “war is hell.” Well, so is hunting for a job, especially your first nursing job.

Times are tough for new grad RN’s. Older nurses aren’t retiring and schools are pumping out new grads at an ever increasing rate. Google “nursing schools” and see how many career colleges and online programs are preparing nurses, in addition to traditional ADN and BSN programs.

Lets look some of a warriors traits and habits and apply the principles to landing a job.

As a warrior enters battle they must be mentally centered. In the face of gunfire and artillery they must control their mind, emotions and inbred preservation of self to achieve the goal of absolute victory over the enemy. They are mentally prepared to die for their cause.

As a new grad you have to be willing to do whatever it takes to land your first job. You cannot casually apply online and expect results. Accept the fact that you might have to make some sacrifices for your first job.

2. Make battle plans.

No warrior just wanders around the battle field waiting to be shot at. They have detailed plans of how they are going to attack the enemy.

So too you must systematize your job search. I created an excel spreadsheet with columns for hospital/department, point of contact, date of first contact, outcome of contact (face to face, msg, phone call etc.), thank you letter sent, follow up notes.

From there I did a search of all hospitals within a 100 mile radius. I would call the HR dept. and ask who was the nurse recruiter. This info was plugged into my spreadsheet.

If that hospital had a specific new grad program as many do, I would plug deadlines and details into that hospitals column.

I now had my battle plan on where and who I was going to attack in a systematic manner.

3. Attack

Go Ape S***

My dad was formerly an insurance salesman. He said that for every one hundred calls, he would make three appointments and one sale. Landing your first job is no different, it will take multiple contacts to see results. You have to go ape S***, be persistent, bold and relentless. You must present yourself as the only reasonable option for hire for their opening.

Before you go nuts, get your paperwork in order (resume, cover letter etc.) Click here to see my resumes for formatting examples.

-print your resume on textured document paper.

-Use a copy machine and shrink it to a quarter page, double-sided. Carry this around as a “business card”, or place into your follow-up thank you notes.

The hospitals that were within driving distance I would put on a suit and go hospital to hospital, floor to floor and speak with nurse managers and call the nurse recruiters. One time a manager fed me chocolate cake

Hospitals that were to far away to just drive I made phone outreach to nurse recruiters.

Phone script:

Hi my name is Caleb Christenson, I am a new graduate RN in your area. I would like 5 minutes of your time to discuss and learn about employment opportunities at your facility.

Face to face script:

(As I shake the managers hand, give them my resume and make eye contact)

Hi my name is Caleb Christenson, I am a new graduate RN in your area. I would like 5 minutes of your time to discuss and learn about employment opportunities at your facility.

After a phone call or a face to face I ALWAYS mailed a thank you letter on custom stationery with a picture of me and my family (I also enclosed a mini-printed resume in the note). I thanked the recruiter/manager for their time and asked them to keep me in mind for this or future openings.

Forget applying online. If your job application strategy boils down to this then you are just a name and credentials against 300+ others. I spoke with one RN recruiter in Southern California who says that for every posted opening she receives over 300+ applicants.

This same recruiter hired me on the spot in her office for a full-time med-surg position. Why, I made a face to face appt and she liked me. Its alot harder to say no to a human face than to an email application.

Make a personal contact first, then go through the online application or whatever specific instruction they give you. This way you’ll waste less time on forms and spend more time building relationships with the ones who will actually hire you.

4.If you can’t find Bin-Laden, kill Sadaam.

Not to get too political, but after Sept. 11th America was pissed leading to the war in Afghanistan as we hunted for “terrorist evildoers”. After a couple of years America wasn’t seeing the results they wanted and then we started poking around in Iraq, we killed Saddam and America was re-energized to keep hunting for Bin-Laden.

There is a good chance that your job hunting will lead you to many dead ends. If you efforts fail to land you your dream job, or in the town you live then is when you must make some sacrifices. Remember when I said that you must be willing to make some sacrifices? Do not be discouraged. There are 50 states and thousands of hospitals. Heres my nursing employment timeline.

Graduation-First job as LVN in long-term care (4 months of solid work with the system above). I was working below my pay grade, but I was still nursing.

LVN job to first acute care job (7 months of solid work with the system above). I was getting no traction in Northern California where I lived. I had some friends in Illinois, so I applied for an RN license there and began applying with methods above for 3 months. I got hired.

Illinois back to California (1 year worked, last two months in the application process). Because I made the necessary sacrifices to get some experience I was no longer considered a “new grad”. This put me in a different resume stack. I called recruiters in San Diego and told them I was going to be in town for a three-day window. I asked for a 10 minute appt. to learn about their hospital. I got four appts, two formal interviews and was hired on the spot once.

Don’t be afraid to move, or take a less than desirable position. Use one experience to parlay your win into a greater one.

Now go crazy and get hired.

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The price: Nursing students (well, any students in this economy) are interested in the numbers. How much am I gonna have to rob Peter (or the parentals) to pay Paul? Well NCSBN’s courses will cost you any where from $50 – $160 depending on how many weeks of access you are interested in; whereas Kaplan is gonna run you about $418 – $499 (this figure is based on my zip code, so double-check your own zip code for the most accurate price in your area). But holy moly cannoli!

The timeframe: NCSBN offers 3, 5, 8, or 15 weeks of access to their course. Kaplan provides 21-hours of class time, plus 3 months of access to their online resources (more on those coming up).

The format: NCSBN is a totally online “campus,” offerring 24-hour access and the ability to work at your own pace. Kaplan has three basic format options—Classroom, Classroom Anywhere, and On Demand. Classroom is basically an in-class, brick and mortar type of deal (like we nursing students want to go to anymore classes—but, to each his own)—set dates, set times, set locations. Classroom Anywhere courses still have set dates and times, but allow you to log in from wherever. And On Demand pretty much speaks for itself—you hold the reins, and can log on and do your thing pretty much whenever (within your 3 months of access of course).

The meat and potatoes: NCSBN boasts access to 1,100+ “NCLEX-style” questions, 2,000+ pages of content review, in addition to other resources such as medical dictionaries and other online references. And if the idea of no professor standing in the front of the room freaks you out have no fear—they do offer the ability to ask questions via their “Ask the Instructor” feature. With Kaplan’s program, after your 21-hours of class instruction (if you selected one of the “Classroom” options), you’ll have 3 months access to 3 online resources—Qbank (question bank), Question trainer (practice tests), and a Diagnostic and Readiness test. Kaplan also offers a pass-or-your-money-back guarantee (certain restrictions do apply).

So that’s an *ahem* brief overview of the NCSBN and Kaplan NCLEX-RN review courses. On the one hand my id is screaming “What are you waiting for? 50 bucks?!? Can’t beat that with a stick!” But on the other hand my ego is saying, “Well wait a minute now, they must be mighty confident to offer a 100% money-back guarantee…”

So what’s a girl to do?

..is finally here.

Can-you-believe-it? I wouldn’t if I didn’t have the battle scars (and the gray hairs) to prove it…

So—before classes started I trekked to campus and happily marched into the security office to purchase a parking permit. The parking guy asked me if I wanted a full year permit to which I answered no, it’d be my last semester. I am sure I sported a Cheshire grin.

Do you know this guy had the nerve to tell me not to be so cocky about finishing on time—not that he didn’t wish me well he added as an afterthought (um too late, don’t try to clean it up now). Just crush my hopes and dreams why don’t you?…

Of course—sh!t happens—and I plan on just about everything but that happening. So I internally bristled and thought to myself that if he wanted to spend the rest of his days in that 5 x 8 parking office then he was free to do so, but I was getting the heck out of there. Hmph. The nerve.

But I’m ready (or as ready as I can get anyway). All of my books (required and recommended) have arrived, binders are set up, chapter bookmarks are made, powerpoints are printed and hole-punched, and assignments/exams are loaded into iStudiez Pro. Let’s get it crackin’!

I even have the first week—though truncated thanks to Hurricane Irene—under my belt already.

And clinicals start this weekend!

Here we go again!…

I admit that my posts can be a bit snarky. They drizzle with sarcasm at times. But Sarah Good of social media I am not. The things I blog about such as coming to work sick, bedside manner, test taking, CPR, health statistics, professionalism, med math—just to name a few—are very relevant topics.

I don’t violate HIPAA, I don’t demean or disrespect patients, and let’s face it—I only say what most of you are already thinking (or have thought) anyway. Oftentimes I poke fun at the system—which we all know is far from a perfect one. But in order for things to change we need to shine light on the issues—not ignore them or sweep them under the rug. The light I shine just happens to be a sardonic, slightly mordant one…

So will I continue to blog? Yes. Will I cut down on my snarkiness? Probably not.

A closed mouth doesn’t get fed. And we have a lot of work to do—so open wide.

There are let’s just say…unwritten policies (and punishments)…when it comes to calling out sick—especially in the hospital environment.

First, now you’re on your managers’/charge nurses’ radar (and not in a good way) because it’s an inconveniece—depending on how much notice you’ve given them they now have to scramble to find someone to fill your slot. Then there’s the fear of being given a write-up for an unexcused or unscheduled absence—which could come back to bite you in the arse during your performance reviews. And now that you’re on management’s proverbial sh*t list you now run of the risk being snubbed, given “harder” assignments or a heavier load than others (and being left to flounder), or other forms of horizontal hostility—even possibly being passed over for promotions and perks.  

So now staff just come to work sick. If you’re sick enough according to managements’ standards (which may mean damn near dying) then they’ll have to send you home. And if management sends you home, you’ll avoid a write-up, be seen as a devoted staff member willing to “take one for the team” coming to work come hell or highwater—plus you’ll still get paid for the day/night. So staff now cover their @sses by putting the ball in managements’ court.

But at what cost? Not only are you not at your best (which can be a recipe for disaster in patient care), but it creates the potential for others to get whatever the hell cootie it is that YOU have! And oftentimes, for whatever reason (*hint, hint* staffing), management may not send you home! They may decide (with the plethora of licensed bodies in a hospital qualified to assess you) that you do in fact ”look okay” to stay and work. Big. Fat. Fail. Now what?

This call-out taboo is even brainwashed into nursing students. To call out from clinical is to shoot yourself financially in the foot—students are sometimes threatened with having to personally pay the clinical instructor ($50/hr I have heard quoted) to come in on a non-scheduled clinical day to oversee your make up. As if. Or sometimes they’ll give you an ungodly amount of ridiculous busy work to do to make up the hours. And so students just come to clinical sick hoping they can just make it through the eight- (sometimes twelve-) hour shift. We are breeding the next generation of nurses with cover-your-ass-itis.

I was sick a few months ago. And I don’t get sick often, but I really felt like death warmed over. I went to my primary, who gave me a note stating that I needed to stay home (his exact words were “you shouldn’t be in anyone’s ICU like this”). I called the big cheese to let him know (and way before the two hours notice we’re required to give when we call out—I wanted to give him as much notice as possible to find someone else to come in).  I was told that even though I had a doctor’s note it would still be “an incident.” I stayed home anyway.

Would you???

For more insight on the subject, check out Terri Polick’s post, Presenteeism: Why Nurses Don’t Call Out Sick and @TorontoEmerg‘s How Hospitals Punish Nurses for Being Sick.

So here’s my summer semester roundup!

This summer I took Public Health Nursing (also known as ”Public HELLth” if you follow me on twitter) and the Art of Listening—I know, WTF right? But I needed one last elective that had to be an art (already had credit), language (only offered the same night as Public Health), literature (too much reading/writing), history (same), or music. So Art of Listening it was. And it was offered online which saved me another night of trekking to campus.

I actually thought I might enjoy a slight break from nursing topics. How bad could it be with no meds, no care plans, and no NCLEX practice questions? Bad enough apparently. Besides the fact that the class was all over the place the topic just didn’t hold my interest—I developed some serious ADHD trying to get all my reading and forum posts done by all of the crazy deadlines.

And then there was Public HELLth. O. M. G. To her credit I will say the professor tried to keep it interesting: breaking up the lectures with videos, tossing frisbees with communicable diseases taped on them around the classroom, and other theatrical stunts—it just didn’t work. She did give out candy at the beginning of class which was nice—especially if there were pink Starbursts (my fave). But eventually, I just stopped going if there wasn’t an exam/quiz or if we didn’t have something due that day. I found her lectures distracting and understood things a lot better when I just read and studied on my own. I’m not trying to corrupt anyone else, that’s just what happened to work for me, for this particular semester. On the other hand, the instructor I have this upcoming fall I’ve had before and I wouldn’t dare miss one of her classes—her lectures are like GOLD.

I also managed to squeeze in a second peds clinical rotation this semester (we usually only have one) and worked as an Asthma Educator in a peds clinic. And man was there some educating to do! From parents giving their kids their maintenance inhaler when they should have been using their rescue inhaler (and wondering why it wasn’t working) to the parents who just didn’t see the point of giving the maintenance inhaler every day when their kid wasn’t currently having any difficulty breathing—and so they didn’t (le sigh). No wonder there are so many uncontrolled pediatric asthmatics and asthma is the #1 admitting diagnosis in our local children’s hospital. Sheesh.

But that’s all over. Now I get a month off to rest my fragile mind (and get some sand between my toes) before heading back into the flames for the grand finale. That’s right—final semester coming up! I can hardly contain my excitement. Until then…

Peace, love, and coffee…

~IsntSheLovlei

So what else I have I been up to? Let’s see… I was inducted into Sigma Theta Tau International, Honor Society of Nursing. I am now also a member of Chi Eta Phi Sorority, Incorporated (shout out to the Spring 2011 line of Theta Gamma Beta).

Then on the home-front there’s always a plethora of things that need to be attended to: IEP and treatment plan meetings, report card conferences, doctors’ appointments, ED visits—my son fractured his wrist when a kid two years younger but about 40 lbs heavier than him fell on it, acupuncture to try and keep my chi in line, birthdays (30′s the new 20), autism awareness events…

But I’m happy to be able to put another semester behind me, and that I’m one step closer to December 2011!

My clinical instructor assigned us two patients as usual (the nurses on that floor only have three themselves). I’d been working with the same nurse for the past couple weeks so I came in and let her know which two of her three patients I’d been assigned to. She automatically said, “Oh no, I don’t want you to have 47.” I assumed the patient was a “difficult” one (which usually meant interpersonally challenged) so I didn’t resist or even blink—it was the last day and besides that guy had about three pages of meds anyway. The nurse said he was just really mean and she didn’t want me to have to deal with that all day. Trust and believe, I’ve already been called my share of four- and five-letter words by patients so it really didn’t make any difference to me. But they ended up giving me her other patient—who ALSO had three pages of meds (cringe)! But hey, such is life…

So I’m going about my merry day, and “47″ needed a bladder scan so the nurse ask me if I had ever done one (no) and if I wanted to watch (sure). We go in and she starts doing the scan—the guy’s condom cath was bone dry but he had about 650 mL being held hostage in the confines of his bladder. She told/reminded him that he’d had two accidents yesterday and that she needed him to ring the call bell when he needed to go. He rolled his eyes and told her he had been ringing the call bell, but “they” take too long to come (which sadly, I could believe). She kinda laughs and replies “Well, we’re busy.” Love her to death, but I didn’t think that was the most therapeutic response she could have given him but I kept a straight face. “47″ asked her for some ginger ale and ice. While she finished up with his urine and left, I went to the pantry. I came back with a cup of ice and a diet ginger ale—he told me it was too much ice. So I said okay and went and dumped some in the sink—”how about now?” He said it was fine. I needed to raise his head of bed but knew that would cause him discomfort so I told him I would go slow and for him to tell me when to stop. “Is that too much?” I asked. I had to keep asking him to repeat himself because he didn’t talk very loud and I didn’t understand what he was saying. Meanwhile, the housekeeping guy was in there cleaning the room and I could feel him watching me—I guess he was waiting for me to lose my patience as I went back and forth with the patient nitpicking over this and that. I cracked open the can and poured the ginger ale over the ice and handed “47″ the cup. He sipped. “What’s your origin?” he asked. Again, I wasn’t sure what he’d said and asked him to repeat it for me. “Where are you from?” I assumed he was asking about my nationality so told him I was from “here”—that I was born in Florida. “You speak so soft. But these nurses, they yell at me.” ”I do ring the bell,” he continued, ”but they don’t come for 15, 20 minutes sometimes. It’s too long.” I nodded, and apologized for his experience. He continued to talk, telling me how he had 2000 people working under him and how he had never been spoken to the way he has been spoken to in the hospital. He told me about how his brother was taking over the family business now that he was sick. I stayed and listened to his story. His nurse came in and asked if I was okay—I’m sure she was wondering why I was still in there. I said that I was. Clearly he wanted someone to listen, and I had the time. Usually I have all of my assessments and morning meds done by 9:30am anyway.

But I didn’t see the “mean” patient everyone else saw (and therefore wanted nothing to do with). The man was sick. And he was in pain. And he had been retaining almost 700 mLs of urine before being straight-cathed—you’d be a little irritable yourself. But all it took was for someone to listen, to give him a few extra minutes of attention, for him to mellow out. I realize that nursing staffing levels (and the insane amount of documentation) oftentimes makes it difficult for nurses to spend more time at the bedside, but this is something we need to work on—it can really make a difference in the quality of patient care. For a little food for thought, head on over to NurseTogether and check out Sue Heacocks’ article, Bedside Manners 101.

My bad.

It’s just part of my own personal test-taking philosophy I’ve acquired over the years. It consists of three things:

1) I don’t overstudy. I read what I’m supposed to read; I listen to my recorded lectures; and I review my powerpoints and notes. But I gave up some of my more neurotic studying habits. I no longer strategically position my notes on the steering wheel on the way to class so that I can take a glimpse or two at every red light or stop sign. And though I do review the morning/afternoon of the exam I don’t try to cram in the last few minutes while the scantrons are going out. What for? Whatever I don’t know at that point I’m not going to learn in the five minutes before the exam starts. At that point I’ve turned on my “it is what it is” switch. Woo-sah. And to be honest my grades have been better since I stopped driving myself into the ground. I’m more relaxed and I no longer stress-eat on test days. When you overstudy, if you don’t go in there and suffer a total brain fart (which sucks after all that extra effort), you’re overthinking the questions and second guessing yourself—all because you psyched yourself out. And so I don’t (anymore). There’s a lot of information to learn in nursing school and you do need to study. But you don’t need to overdo it.

2) I don’t sit and stare at test questions if I don’t know the answer. What for? The answer is not going to jump off the page waving its arms at you. Pick one and keep it moving. Narrow them down (with multiple choice there’s usually two you can toss out right off the top anyway) and eeny, meeny, miny, moe the rest if you have to. Though on a rare occasion if I’m really torn between two answers I will skip a question and come back to it—you just have to be very careful that you also skip it on the scantron sheet or that can lead to a whole other mess…

3) I never erase. Go with your gut. Usually when you change an answer, you had it right the first time.

I guess it also helps that I happen to be a good test taker. The Kaplan review course for instance that many people like to take before they take their boards (it’s actually required for my program) is actually less about content review and more about how to be a better test taker. It’s all about strategies for breaking down the questions and recognizing traps. I’ve already got that down. To be perfectly honest, I don’t even read the whole question most of the time (which is why it only takes me about 30 seconds per question when we’re allotted a minute and a half for each). Usually, half of the question is superfluous information you don’t need and was thrown in there to confuse you. I choose not be be distracted by the distractors. This is not to say I’m just guessing answers and getting lucky. You do need to have a solid knowledge base to be able to recognize trigger words/phrases and weed out the riff-raff. But hey, this is just what works for me. Different strokes for different folks…