Start preparing early.
Your NCLEX test date can creep up on you. It seems so far away and then….PANIC…it’s right around the corner. The earlier you begin studying, the less overwhelmed you’ll feel. Start small by buying a review book and trying out a few questions each day. Familiarizing yourself with the style and content of questions will help you figure out where you need to spend the bulk of your time when you really get into study mode.

Be consistent.
It takes a few weeks for something to become habit. Make NCLEX studying part of your daily schedule. Spend the same time each day and if possible, in a specific study spot. Having a regimen will give you a greater chance that you’ll stick with it.

Take that review class.
Review classes are worth it. Where else are you going to find someone who will condense an enormous amount of material into a need-to-know review book? When else would you sit in a room for eight hours doing nothing but NCLEX review? Nowhere! Review classes are worth the money.

Questions, questions, questions.
There’s no doubt the NCLEX has a distinct question format. In many cases, it’s more important that you catch on to how they want you to think things through than that you know all of the content. Sometimes you can go the other extreme, though—thinking into things too much can actually confuse you. The only way to find the balance is to do as many questions in advance as you can find. Your scores really will improve with time.

Practice deep breathing.
No matter what you do to prepare, sitting at that test station on the day of your NCLEX exam is completely anxiety provoking! “How many questions will I have? When will it shut off? I have no idea what the right answer is!” One of the best things you can do is stop every few questions to take a few deep breaths. You can’t do your best thinking in that worked up state. Make deep breathing part of your NCLEX review practice so that it’s second nature by the time you’re up at bat.

Going back to school when you’ve been in the real world for a while can seem completely foreign. Some subjects have been given a bad reputation over the years, but not to worry! Don’t let your fear of these 5 courses hold you back from pursuing your nursing degree.

Statistics
Statistics just sounds frightening. But with a solid foundation of algebra knowledge, a good portable study guide, and a low threshold for getting some one-on-one help, it doesn’t need to be. Be proactive, have a plan, and you’ll fly through basic statistics.

Research
Most nursing research classes serve to give you a basic overview of how research is conducted and interpreted so that you can effectively use research in your practice. Everyone worries about the papers they’ll need to write. The NSNA has a helpful guide to help you through a literature review. And Cincinnati Childrens has an online Power Point presentation with tips for forming sound research questions.

Anatomy
The key to mastering anatomy is memorization, memorization, and more memorization. Cramming for exams isn’t going to work. Setting up a calendar with the materials you need to study will. Buy a set of anatomy flash cards, like these from Elsevier Health and keep a stack with you to look over during your lunch break or while in a grocery store line.

Physiology
Physiology can be challenging. It requires the memorization that anatomy does, but it also requires that you understand how cells, organs, and muscles function. It’s a wide range of complex information, so make sure you have a comprehensive study guide to help you focus on what you really need to know. Finding a few classmates for a study group can be a sure way to get through the material, answer questions, and cheer each other on.

Chemistry
Chemistry isn’t as scary as it seems! Once you get over the new terminology and that darned table of elements, chemistry principles are actually fun. For a quick free overview of a basic chemistry lesson, take a look at Pink Monkey and get familiar with all things atoms and electrons.

It’s probably because I’ve based my understanding of how sexual assault victims are examined on what happens in episodes of Law and Order SVU or NCIS that I have been under the impression that police detectives and physicians are the only ones who examine the victims they encounter in the emergency room.  I am embarrassed to admit that, until very recently, I had little understanding about the critical real-life role forensic nurses play in caring for victims of sexual violence.  

Forensic nursing is a relatively new subspecialty of nursing, and the men and women who work in this career field do so in different settings and in various roles.  In the United States, the most common patient population for forensic nurses to work with is those who have been sexually assaulted.  I didn’t know that forensic nurses are often the ones who interview and examine victims of sexual crimes, collect evidence, collaborate with law enforcement officials and provide expert testimony. 

In a 2006 forward to the book, Forensic Nursing: a Handbook for Practice, Vice President Joseph Biden wrote, “Forensic nurses play an integral role in bridging the gap between law and medicine.  They should be in each and every emergency room.”  There is incredible value to having them there.  Victims of sexual assault suffer physically and psychologically at the hands of their attackers.  Without quality, sensitive health care, they may be forced to wait for long periods of time before they can be seen by already overworked staff.  They can be further traumatized during the invasive medical examinations, interviews, and evidence collection.    

This week, November 7-11 in Forensic Nurses week.  IAFN has created a documentary about forensic nurses.  If you, like me, could use more information about what these amazing professionals do, I encourage you to view it here: http://www.youtube.com/forensicnurses.

Last week I attended an on-line webinar titled, “Nursing Guidelines for Using Social Media,” hosted by representatives from the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN).  Both organizations recently published guidelines for nurses on the responsible use of social media, and the speakers discussed the recommendations in the context of real-world nursing scenarios.  

Social media offers tremendous opportunity for professional growth because if provides a platform for nurses to communicate, collaborate, and inform.  It has transformed how we interact with our colleagues and patients.  I can use Facebook to share important health-related articles and to keep up with happenings at the School of Nursing at my alma mater.  I can learn about events at my local health care services provider on Twitter, and stay on top of issues that impact nurses by frequenting and commenting on discussion forums for nurses. 

In their book From Silence to Voice, Bernice Buresh and Suzanne Gordon wrote that talking about nursing is our moral imperative.  Blogs, like Theresa Brown’s (http://well.blogs.nytimes.com/author/theresa-brown-rn/), have afforded us an accessible means of sharing stories about our practice so that the public better understands what we do and why it’s so important. 

And yet, there is also tremendous potential for misuse.  In fact, according to a 2010 survey of boards of nursing, 33 of the 46 responders reported receiving complaints about nurses who violated patient privacy through the use of social networking sites.  Our use of social media has the potential to blur the lines between the nurse-patient relationship and to reflect poorly on our profession or our place of work.  Nurses at a hospital in Wisconsin were fired for taking a cell phone picture of a patient’s x-ray and posting it on the internet.  Nurses at a hospital in California were disciplined for discussing a patient’s case on Facebook. There are many other examples.

Despite the potential pitfalls, we shouldn’t avoid the use of social media; we should simply use it responsibly.  Reflect on boundaries that may be crossed when thinking about accepting a patient’s friend request on Facebook.  Consider the difference between venting about a challenging day in an on-line forum and in a chat with friends over a drink after work.  Be vigilant about safeguarding your patient’s privacy.  Know your institution’s policy on the use of social media.  If one doesn’t exist, advocate for and participate in the development of one.  Be familiar with the guidance ANA and NSBCA provided on the use of social media. 

But don’t stop talking about nursing.

During a recent (and thankfully rare) visit to a physician’s office, I wanted to ask a nurse a question. In the sea of brightly colored and dissimilarly patterned scrub-wearing people, I could not readily discern who was a nurse, receptionist, or nursing assistant. Only the physicians and nurse practitioners, in their street clothes and lab coats, were easily identifiable.

Whether or not to standardize nursing uniforms is an issue that has been hotly debated. Some argue, particularly in acute care settings, that what amounts to camouflaging nurses is a way to hide their dwindling numbers in staffing plans. Others applaud that the traditional all-in-white, cap-wearing RN has gone by the wayside.

In my case, finding a nurse was no big deal. I just asked to speak with a nurse and was quickly pointed in the right direction. (They do wear name tags in this practice, but titles are not always visible from a distance.) But under different circumstances–say, if I were hospitalized with a serious medical condition and being examined, questioned, and visited by multiple people with varying roles and responsibilities–I can see how this would be problematic. (Did my registered nurse just tell me it was okay to eat post-operatively, or was that the housekeeper?)

Some hospitals are implementing uniforms color-coded by role. Nurses at one New Mexico hospital will soon be wearing black uniforms to make them easily identifiable. Some are reverting to the all-white tradition, though in the form of scrubs and without caps. Nurses at some health care facilities are staunchly defending their desire to choose what they wear, so long as it adheres to existing dress code policies; while others are wearing white pants with any choice of top.

The way we present ourselves can and does impact the way we are perceived, not only by our patients, but also our co-workers. I’ve always been bewildered by those who work outside of pediatric settings but choose to wear cartoon character prints from head-to-toe. Or those who wear scrubs, not because they are so comfortable they feel like pajamas, but as though they actually were pajamas—wrinkled and ill-fitting.

Regardless of whether are not uniforms are standardized, one way professionalism is expressed in by what we wear. I’m all for making nurses more visible and identifiable—both for the profession and for our patients—but I’m not sure what the answer to the uniform debate is. I do know we should take pride in whatever uniform we are wearing. For me, that means wearing pressed, blue scrubs with my large-print “RN” nametag.

Following is a list of what I consider to be the top ten advantages of being a nurse, in no particular order:

1.     Job Security

Despite being laid off from an inpatient staff nursing position once in the late 1990’s, I have always had options for employment.  Even during the recession, the Bureau of Labor Statistics reported an increase in health care jobs.  By 2018, more than 580,000 nursing positions will be created.  Nurses are in high demand, and will continue to be for the foreseeable future.

2.    Flexibility

The nature of nursing care is that it is needed all the time, and everywhere.  As a result, you can opt to work full time, part time or per diem on day, evening or night shifts.  You can work in rural or urban settings, inpatient, outpatient, in a home setting, in a school, in a law office, in a research setting—the prospects are endless.

3.     Options

As an RN, I have worked as an inpatient nurse, an outpatient nurse, in a law office, for a medical device company, and have even been self employed.  Very few professions offer the plethora of career choices that nursing offers.  In addition to the various specialties you can choose from, nurses fulfill a variety of roles within each specialty.  Experienced nurses are in high demand in many non-traditional settings as well.  In nursing, it’s possible to explore other options without jeopardizing your career progression. 

4.     Opportunity to Make a Meaningful Contribution

It may sound trite, but it’s true:  nurses routinely make meaningful contributions to the lives of patients and their families.  The work you do on a daily basis, though frequently stressful and repeatedly frustrating, has a real and tangible impact.  I still have the first card a patient’s wife wrote to me thanking me for caring for her dying husband.  It reminds me that the work we do is important. 

5.     Lifelong Learning

The science of nursing is always advancing, and a successful nursing career requires a commitment to learning and openness to change. Attending conferences, joining specialty organizations, reading journals, attending graduate school keeps me interested in and inspired by nursing. 

6.     Variability

In the years I worked in oncology nursing, I never encountered the same patient or the identical situation twice. You can count on the unexpected and the unpredictable, which I think tends to keep things interesting.

7.    Competitive salary

Nursing offers a competitive salary and, in many cases, potential for overtime.  According to the Bureau of Labor Statistics, the mean national nursing salary is $67,720, but the range is highly variable depending on location, educational level and role.  For example, the American Academy of Nurse Practitioners reports the average salary of a nurse practitioner is $89,450. 

8.    Portability

Nursing is a career that you can take with you wherever you go.  Once you have a registered nurse license in one state, you can apply for reciprocity in another state.  (Each State Board of Nursing has different requirements, so check with them for specifics.)  

9.    Challenge

Over the years, nursing has challenged me intellectually, spiritually, emotionally, and at times even physically—and although the challenges aren’t always without frustration, they do have way of keeping me engaged and motivated. 

10.  Trusted

Since 1999, nurses have been ranked as the most trusted profession in the United States every year except 2001.  (That year, fire fighters were ranked first.)  To me, that speaks to the relationships we have and the value we bring to our patients.

“Your time is limited, so don’t waste it living someone else’s life. Don’t be trapped by dogma – which is living with the results of other people’s thinking. Don’t let the noise of other’s opinions drown out your own inner voice. And most important, have the courage to follow your heart and intuition. They somehow already know what you truly want to become. Everything else is secondary.”  Steve Jobs

Although impressed by a number of his accomplishments, what inspires me most is his belief in our ability to shape our lives, to dream our future into reality, and to trust our intuition.  Each of us will not necessarily impact the world in the dramatic fashion that Steve Jobs did, but if we do everything we can to live our best life, to be who we want to be, and to do what we want to do, we increase our likelihood of being successful, fulfilled, and of making lasting difference. 

There is inspiration all around us:

A friend of mine worked for years at brokerage firms knowing she wanted to be a nurse.  September 11, 2001 finally prompted her to apply to nursing school and start doing what she knew she was intended to do.  I admire her decision and the sacrifice it required. 

Another friend is finally starting nursing school after years of working toward completing her prerequisites while simultaneously caring for triplets and moving around the world every few years as her husband’s military career demanded.  I am in awe of her persistence and patience. 

A former graduate school classmate has returned to school to obtain her Doctor of Philosophy (PhD) in Nursing.  She juggles a demanding academic program with two small children and a part-time job.  I respect her determination and ability to balance her personal and professional life. 

Are you thinking about going back to school? Are you thinking about becoming a nurse?  How hard are you willing to work for it?  What is holding you back? 

Your time is limited.

During one particularly busy shift, I suspected one of my patients developed an acute upper gastrointestinal bleed.   After completing my assessment, I called the physician to report my findings and suspicions.  

People with upper GI bleeds may have black, tarry stools; bloody emesis; alterations in their vital signs; and cool, clammy, pale skin.  They typically require intravenous fluid and insertion of a tube through the nose and into the stomach.  In this case, the patient required lavage, or irrigattion of the contents of the stomach; the administration of blood products; preparation for an upper GI endoscopy; and transfer to the Medical Intensive Care Unit for closer observation.

Working calmly, but hurriedly, I inserted the nasogastric tube and began lavage while another nurse prepared to start a second intravenous line on the patient.   I explained to the patient what we were doing and attempted to reassure him as best I could.  Together with the physician, we were ultimately able to stabilize the patient and transfer him to the ICU. 

Once the crisis had passed, I quickly rounded on my other patients and sat down to catch up on my charting.  Standing at the other side of the nurses’ station, the physician said, “You know, you really should have gone to medical school.”  

Initially, I took this as a compliment.  I respected this physician, and reasoned that he must think I’m smart if he thinks I should have gone to medical school, right?  It was only later, as I became more confident in my role as a nurse, and developed a more sophisticated understanding about the difference between nursing and medicine, that I wished I had questioned him on his choice of words. 

Today, I would not be complimented by the implication that being smart and competent are not essential attributes for nursing practice.  If I could replay that scene, I would take the opportunity to explain to the physician that my actions during the management of our patient were not extraordinary, but typical of ordinary, qualified nurses. I would politely point out that without skilled and knowledgeable nurses at the bedside, our patient’s outcome could have been dramatically different.  

I would make clear that, despite shared characteristics, nursing is a unique and distinct discipline from medicine—one that respects and works in concert with other health care professionals—but that offers a unique perspective to patient care.  I would explain that I was interested in focusing on the human response to illness, on spending time with patients and advocating for them, and helping them achieve the best possible state of health or a peaceful death. I didn’t want to be acknowledged for my potential as a medical student; I wanted to be acknowledged for my capabilities and value as a nurse.

Your scheduling preferences also may be dynamic, changing based on changing life circumstances.  To avoid the need for outside childcare, a nurse I once worked with opted to work twelve hour weekend shifts once she had children, another worked 11pm-7am night shifts, whereas I opted to work part time and–later–per diem. 

A recent article in Nursing Economics* suggests that one of the predictors to a registered nurse remaining in nursing is scheduling. In their survey, researchers asked over 8000 nurses to quantify the weekly number of hours they were hired to work, the number of hours they actually work, the number of hours they would ideally like to work, and the number of hours they work providing direct care to patients.  They compared this data to the nurses’ plans to continue working as nurses.   Not surprisingly, the researchers found that when the schedules and hours were in harmony with the nurses’ expectations, retention of the nurses was more likely. 

This didn’t strike me as unusual—scheduling logically influences job satisfaction and quality of life.  What I had not considered was the tangible ways in which we, as nurses or future nurses, can do to enhance our job satisfaction so that we remain in nursing.   The researchers identified specific strategies nurse managers, individual nurses, and nurse educators can employ to improve job satisfaction relative to scheduling:

Management should find ways to meet nurses’ requests for schedule changes whenever possible. 

Many hospitals now offer flexible or alternative scheduling for their nurses, including offering shifts that range from four to twelve hours, having the option to stagger shift start times, allowing nurses to self-schedule, and having access to additional staffing through hospital float pools or outside staffing agencies. 

Nurses should clearly understand the expectations the employer has regarding scheduling.

Prior to accepting a position, we have a responsibility to ask questions to ensure we understand what our obligations are.  We need to have ongoing conversations with our managers to ensure that our expectations are reasonable and to facilitate a process for requesting changes.  

When I was hired to work the aforementioned evening shifts, it was explicitly stated and written into the job offer that I would be switched to twelve hour rotating shifts as soon as such a position became available.  Although there was no guarantee as to how long this might take, my manager kept me informed as to the anticipated timeline, and my request was granted within a few months. 

Nurse educators can be instrumental in developing student nurses who have a realistic expectation about scheduling. 

Nursing education must include exposure to the rigors of the shift work involved in staff nursing, not only by discussing the issues, but when possible by facilitating clinical rotations on off-shifts and weekends.   The more realistic the students’ expectations are, the more likely their transition to nursing will be. 

*Kirschling, J.M., Colgan, C., & Andrews, B.  (2011).  Predictors of registered nurses’ willingness to remain in nursing.  Nursing Economics, 29:3, 111-117.