Money Advice for New Nurses

As healthcare professionals, we tend to focus on physical and mental well-being, forgetting another essential type of health– financial health! As a new nurse, one of the greatest things I learned is how to set myself up for the future by making smart money decisions. Now, as you begin your journey into the field of nursing, I’m here to pass on a few of the most important pieces of advice so future you will look back and thank twenty-something you.

Start Investing For Retirement

I know you’re just getting started and retirement is a literal lifetime away, but what you do now will have an incredible impact on your life in 30 or 40 years. The simplest way to start investing is in your employer’s retirement plan, whether it be a 401(k), 403(b), Roth IRA, etc. These retirement plans automatically deduct and invest your contribution with each paycheck into various funds. Over time, your investments may gain and lose money, but historically the stock market has always recovered from slumps to reach new highs (see below).

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Its never too early to start contributing to your retirement because the earlier you start out, the more your money will work for you. That’s right, your money will work for you! Albert Einstein once said “compound interest is the eighth wonder of the world. He who understands it, earns it… he who doesn’t… pays it.” Compound interest allows you to not just make money on your initial investment, but also the interest it gains. It enables your wealth to snowball over time and makes it easier for you to reach your financial goals. Keeping all of your money in a savings account to gain 0.25% or less is just not enough to survive on in retirement.

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This chart shows how much money you can accumulate over time if you invest $250 a month starting at age 25, 35, and 45 (assuming an 8% return). Notice the difference time can make!

So how much should you be saving? Investopedia interviewed a number of financial advisors across the country and found that the recommended contribution rate is at least 10% to 15%. The most important thing is to at least contribute enough to take full advantage of your employer’s contribution match. The employer match may vary across institutions, but let’s say your employer will match a 4% contribution. You only need to contribute 4% of your pay for them to add an additional 4% for free.

Avoid the Post-Grad Spending Spree

It’s inevitable. You and your friends will graduate, begin earning a real income, and you will see many of them buy big-ticket items like a new 4-door Jeep Wrangler or an entry-level luxury car. Just wait for the posts on social media… This is known as rapid lifestyle inflation. In other words, as our income improves, we spend more on things we may not necessarily need– a brand new car or a pricey apartment, for example. There are many expenses you will incur as a new-grad nurse without making it more difficult for yourself. You may have to pay for new scrubs, a stethoscope, and other supplies while also covering rent, utilities, commuting expenses, etc.

Instead of blowing your first few paychecks immediately, resist splurging and spread out your purchases so you can build up emergency savings. Most financial advisers will say your emergency fund should cover at least three to six months worth of expenses, but financial expert Suze Orman insists an emergency fund should cover close to a year of living costs. Yes, this is a lot of money and will take you time to accomplish, but that’s the point! You need to be serious about monitoring your habits and keep track of your income and expenses to achieve financial security.

In his book “How to be Richer, Smarter and Better Looking than Your Parents,” Zac Bissonnette details common mistakes and misconceptions when buying a car:

  • Buying a used car these days not mean driving a vehicle with 100,000 miles and severe maintenance issues
  • Used cars are not only cheap but safe to drive too
  • Buying a used car for just a couple thousand dollars in cash will save you from the depreciation of a new car the moment you drive it off the lot
  • You likely won’t need theft or collision insurance because thieves are less likely to steal older cars

So, avoid the brand new car and do some research to find a reliable, used car you can pay for in cash. It may be tempting to finance a vehicle and stretch out the loan to keep your monthly payments low, but you will end up paying much more than the value of your car by the time it is paid off! Bottom line: if you do not need a new car, save yourself the money and get as much as you can out of what you have or take public transportation.

Now that I covered the basics, here are a few more tips I’ve learned over the past few years that can help you accomplish your financial goals:

  • Paying off your student loans should be your number one priority! Make the minimum payment on loans with the lowest interest rate and pay extra on loans with higher interest rates.
  • Don’t rely on credit cards to get by. Use credit cards to help build a good credit score by paying off the card before interest is applied each month. If you’re close to or are maxing out your credit card, you’re living outside your means and need to review your budget.
  • Invest in yourself. Whether it be graduate school, advanced certifications, or conferences, make a continued effort to improve your worth. Pursuing further education will increase your earning power and open up opportunities for advancement. If your employer offers continuing education and tuition assistance, take advantage of that valuable benefit!
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The First Job Checklist for New-Grad Nurses

Your first job as a new grad nurse can be many things… eye-opening, exciting, humbling, or just terrifying! We all come from different backgrounds and with different experiences that contribute to how our first nursing job will go. One thing I learned through my nurse residency is that whether you start out on a med-surg unit, in the ED, or an ICU, we all have the same feelings as we navigate through our first year as new nurses So here are five tips that I put together from my experience as a new grad nurse to help make your transition as smooth as possible!

1. Talk with your preceptor

Your preceptor should take it upon themselves to reach out to you, but not all will do this. If you haven’t talked with your preceptor yet, get their contact info from your unit’s nurse manager or educator. Send them an e-mail or text letting them know who you are and that you’re looking forward to working with them. Make sure you have each other’s phone numbers in case you need to communicate more quickly than what e-mail allows. This is a great way to start off your professional relationship and shows initiative. They’re going to be the one leading you through the madness as you learn the ropes, so the earlier you get to know each other the better!

2. Hit the books

Hopefully, you didn’t sell all your textbooks because it might be time to break them out again! Before I began my first job as a cardiac surgery nurse, I spent some time each day on anatomy and physiology and meds. Your work should eventually provide you with educational materials for whatever specialty area you choose, but getting a head start is smart. Just remember, you will not know everything before you start your first job nor are you expected to! You might want to search for any textbooks specific to your area so you can keep it as a resource even after you start. For any other cardiac nurses out there, I recommend the Manual for Perioperative Care in Adult Cardiac Surgery by Robert M. Bojar (this is my bible).

3. Don’t get lost

If you work in a big hospital, it can get confusing at times. After one year at my job, I still wasn’t sure how to get everywhere in the building. To be fair, the EP lab is about half a mile away… You’ll visit your unit before starting, but just make sure you remember the route, so you aren’t lost on your first day of work. This is also where contacting your preceptor ahead of time can come in handy! Meet up with them before starting your first shift or just send them a quick message if you get lost.

4. Get your routine down 

You’ll need to have your routine down in the morning (evening, for you night-shifters) so you can get in on time. Think about how long it takes you to get up and out the door, the route you’ll take, the traffic you’ll hit, where you’ll park, and the walk from your car to the unit. Having your uniform, supplies, and lunch ready to go the night before can help save a lot of time in the morning. Also, be aware of any busy events near your work. I hit traffic coming into Baltimore when the Orioles or Ravens have home games, so I always keep an eye on their schedule. If you’re in a similar situation, print out the schedule so you’ll remember to leave early.

5. Understand that you will make mistakes

I’m sure you’ve heard this plenty, but guess what… no one’s perfect! You’re going to mess up, maybe look plain stupid, but don’t get down on yourself because it’s all a part of becoming a good nurse. Don’t let fear or anxiety of making a mistake hold you back or shake your confidence! Reading up on what not to do can’t hurt either… 9 Mistakes To Avoid as a New Nurse

If you’re starting soon as a new nurse, good luck and know that it will continue to get easier. You are a badass nurse in the making and don’t ever forget it!

How to Stay up to Date With Research

Ever since I began nursing school, the importance of understanding and utilizing research was made clear. Now, as I continue my education in pursuit of my Doctor of Nursing Practice degree, the emphasis on research is even more profound! We all know it is important to keep up to date and apply evidence to our practice, but who has time for that?!

Regardless of where you are in your career, nursing student or experienced nurse, you probably find yourself short on free time- I know I do. I remember the eye rolls when a professor would suggest a book or article just published to read in our “spare time”. Yes, between writing 20 page care plans, cramming for exams, and sleeping 4 hours a night, I will read it eventually (but, probably not).

So, why all the fuss about research? Well, evidence-based practice is an essential part of improving quality of care, patient outcomes, and decreasing healthcare costs. In 2001, the Institute of Medicine published guidelines stating that decision making in healthcare should be based on evidence. The goal was that by 2020, 90% of clinical decisions would be supported by evidence.

Not surprising, although no less disappointing, we are still far behind. Also not surprising, one of the greatest barriers to health care professionals reading research articles is time. It has been reported that a healthcare provider would have to read at least 19 articles every single day in order to stay current on the latest advancements¹.

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That’s ridiculous if you ask me (or anyone else)… So, how is it that you can stay up to date while not quitting your day job to read 19 articles a day? There are several systems available providing updates on the latest research, so you don’t have to go snooping for it. The following three resources are all ones that I use and have had great experiences with.

  1. EvidenceAlerts is a free, email, evidence update service offered through a collaboration with DynaMed Plus and McMaster University in Hamilton, ON. You can determine which areas you want to receive updates in to weed out subjects you either aren’t interested in or don’t apply to your field. You can also select how frequently you want to receive updates. The updates are not full articles, but a quick synopsis of the studies and results. Each synopsis offers several comments from clinical raters, which can be pretty blunt and are actually my favorite part of the updates!
  2. AHRQ Evidence-Based Practice Email Updates is another great way to stay up to date on the latest advancements in healthcare. The Agency for Healthcare Research and Quality (AHRQ) developed this free system to assist health care providers and organizations in their efforts to improve quality or care. Similar to EvidenceAlerts, there is a wide spectrum of topics to choose from, so it’s best to narrow it to what areas you want updates on. You can also choose between weekly or daily updates. To be honest, this is pretty similar to EvidenceAlerts, so you’ll have to look around and see what you like best! I receive updates from both and have never received the same articles, so I’d recommend both if you’re really interested in a topic.
  3. The last system I want to mention is the one I’ve been using the longest- MedScape e-newsletters. This is different from the other two because in addition to weekly medical news and featured stories, you also receive news about medical conferences and continuing education (CE) opportunities through quizzes and case they send you. Again, you can filter out what areas you don’t want updates on. Some of the recent updates I received from their MedPulse service were related to Alex Wubbels’ arrest for refusing to draw blood from her unconscious patient and the controversy surrounding President Trump rescinding DACA. This is a good way to receive updates on research and hot topics in the medical community.

Hopefully one or all of these services will benefit your practice and make reviewing research a less time consuming part of your schedule! I really do recommend subscribing to all three services, but whatever you choose, good luck and don’t lose your spirit of inquiry!

¹Straus, S. E., Glasizou, P., Richardson, W. S., & Haynes, R. B. (2011). Evidence-based medicine: How to practice and teach it (4th ed.). Edinburgh, London: Churchill Livingstone Elsevier.

 

 

Introvert or Extrovert? You Might Be Surprised…

You may believe that an introvert is just a shy person who fears large gatherings and an extrovert is the opposite- outgoing and hates to be alone. This assumption would be wrong! Susan Cain, who authored “Quiet: The Power of Introverts,” showed that introverts can be warm, interested in others, and powerful in their own ways. If you don’t believe me, here’s a list of a few mildly successful introverts:

  1. Albert Einstein
  2. Bill Gates
  3. JK Rowling
  4. Michael Jordan
  5. Meryl Streep
  6. Barrack Obama
  7. Warren Buffet

I guess that’s decent company, no? So, then what does it actually mean to be introverted or extroverted? Well, introverts tend to recharge by spending time alone and lose energy from being around people for long periods of time or large crowds. Extroverts recharge by being around other people and they feed off the energy of a group.

You can probably think of someone you work with or a friend and guess which category they belong to, but remember it isn’t that black and white. There are shy extroverts and outgoing introverts– it’s often hard to tell.

In a room full of about 30 nurses, we took a survey that I’ll share with you in a second. After completing the survey, we were asked to stand on opposite corners of the room based on our results and, to my surprise, only eight nurses went to the extroverted side! Now, you’d think that a nurse must have to be extroverted. Nurses spend 12 hours a day talking to patients and their families, other nurses, and healthcare professionals. How would an introvert survive?

The more that I think about it, the more it made sense though. We do spend all our time around others and when I get to my car, I thoroughly enjoy the quiet drive home talking to my girlfriend or listening to music and then laying in bed without the sound of telemetry alarms, call bells, or my work phone constantly going off.

Now, it’s time to find out which one you are! Here’s the survey we took that was also a part of Susan Cain’s work, “Quiet: The Power of Introverts”– give it a try!

Answer each question true or false. Choose the answer that applies to you most often:

  • I prefer one-on-one conversations to group activities.
  • I often prefer to express myself in writing.
  • I enjoy solitude.
  • I seem to care about wealth, fame, and status less than my peers.
  • I dislike small talk but enjoy talking in-depth about topics that matter to me.
  • People tell me that I am a good listener.
  • I am not a big risk-taker.
  • I enjoy work that allows me to “dive in” with few interruptions.
  • I like to celebrate birthdays on a small scale, with only one or two close friends or family members.
  • People describe me as “soft-spoken” or “mellow.”

Introverts answer “true” to five or more of the above. I answered “true” to eight of the items, which confirmed what I already knew– I am definitely an introvert.

Let me know what your results said in the comments below!

7 GIFs to Perfectly Explain How Nurses Feel When…

You’re brand new and a code goes down…

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Working back-to-back night shifts has you feeling the darkness…

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Your patient’s insulin coverage starts at 120 and their finger stick is 121…

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Working 4 straight shifts…

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Your patient threatens to leave AMA…

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You hit that vein no one else could…

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You work with the nurse that always has your back…

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Sorry (not sorry) for doubling down on Will Ferrell and Steve Carell.

 

Early CPR for the Best Results in Out-of-Hospital Cardiac Arrest

A systematic review showed lay first responders had the highest impact on out-of-hospital cardiac arrest survival, but called for new strategies to engage more volunteers to increase survivors.

via Bystander CPR Best Hope for Out-of-Hospital Cardiac Arrest? — Medscape Medical News Headlines

According to a recent Medscape article, early defibrillation by bystanders may double the survival rate after an out-of-hospital cardiac arrest when compared to waiting for EMS arrival. The time to delivery of treatment is so important that the median survival to hospital discharge decreases from 53% when bystanders deliver defibrillation to 28.6% when defibrillation is delayed until the arrival of first responders.

There are two main barriers standing in the way of increasing bystander intervention during a cardiac arrest:

  1. Training the public on how to provide CPR and use an AED. If you work in healthcare, I’m assuming you’re likely CPR/AED certified, but you should encourage your friends and family get trained as well. If you aren’t certified, you can search for an American Heart Association CPR/AED class near you by clicking here. Public availability of AEDs has improved significantly, but without trained bystanders to use them, it makes no difference!
  2. Awareness of a nearby cardiac arrest. Some U.S. cities and European countries have initiated text alert systems to notify volunteers of a suspected cardiac arrest. There are also apps like Pulse Point and Good Samaritan which notify you of a nearby suspected cardiac arrest. These alert systems have been shown to decrease response times, increase CPR and defibrillation rates in cardiac arrest events, and improve survival rates.

Hopefully, improved public awareness and training will increase upon the less than 5% of all out-of-hospital cardiac arrest patients receiving defibrillation before EMS arrives. Let me say that again: Only 5% of cardiac arrest patients receive defibrillation before EMS arrives on the scene!

To read the full article, click the link at the top of this post. Also, check out my post on Stop The Bleed, another public health initiative placing importance on bystander training.

9 Mistakes To Avoid as a New Nurse

Approximately 10% of all deaths in the U.S. are due to medical errors making it the THIRD highest cause of death in America. The numbers are shocking, but actually under-reported and still add up to over 250,000 death per year. As a new nurse, you will make mistakes, but you can limit these by learning from and avoiding the same mistakes other nurses have made. The list I’ve compiled below includes ten common mistakes I’ve found, heard of, or maybe even made myself.

1. Not scanning/rate verifying a patient’s drips at shift hand-off or after a transfer. This should be done any time you take over care of a patient. Just looking at the IV pump isn’t enough. Actually, scan the patient and medication, check the rate and concentration, and document. This may require a dual sign-off for some meds, so do it with the off-going nurse or pull someone into the room. You’ll cover yourself from someone else’s mistakes and ensure your patient is safely receiving their medication. You’d be surprised how often your patient may be getting the wrong dose or no medication at all and it is better to catch this early than 2 hours into your shift.

2. Charting intake or output incorrectly. Monitoring fluid balance is vital for many patients. Be careful when documenting intake and output to use the correct column/row. Multiple drains, tube feeds, urine output, etc. can make this more complicated so don’t rush your charting.

3. Sending a patient home with an IV in. Check your patient over before discharging them to make sure they don’t have any peripheral IVs, central lines, or pacer wires they shouldn’t have. You don’t want to find out that you sent a patient home with something still inside of them and they had to come back in to get it removed.

4. Not having the chair and bed alarms on for a high fall risk patient. I work on a unit where all patients are considered fall risks, so every patient should have chair or bed alarms on. You may not be on a unit like this, but if your patient is a high fall risk or has a history of falls, put the alarms on! Almost all falls are preventable, so we must do our best to prevent them.

5. Making promises to patients you may or may not be able to keep. Just don’t make promises. Period. You will be asked so many questions from your patients and their families, but so much is out of your control that it is best to not commit or make promises. “We’ll see” or “I’ll keep you updated” might become your catchphrase

6. Leaving IV tubing clamped after hanging a medication. After setting up an infusion, check the IV lines before walking away. You don’t want to walk back in 30 minutes later and realize the tubing was clamped the whole time. Or it goes unnoticed and your patient just completely missed a dose. To piggyback (see what I did there) off of this point, make sure you reconstitute a bag of IV medication if it requires it.

7. Pushing a medication too quickly. If you don’t already know, ask someone on your unit to show you where to locate IV push rates. You’ll eventually remember most of the common ones, but until then you should know where to look them up. I frequently use Micromedex to look up medications if I’m not sure about something, especially IV push rates.

8. Being afraid to delegate. If nurses could do it all, we wouldn’t have CNAs, PCTs, or unit secretaries. You might feel that you have to prove yourself as a new nurse by not asking for help, but this is a huge mistake. Get to know your techs, secretaries, and other nurses well because when things get hectic they’ll be there to help you out.

9. Not asking questions. I highly doubt by the end of your orientation or even first year you’ll know everything there possibly is to know about nursing. If you’re unsure of yourself or how to do something, first do some research and if you still have questions, just ask! Find your charge nurse or a more experienced nurse and let them teach you. When you’re a new grad, you should be learning something new every day and if you aren’t seeking new things to learn, you’re losing out!

Hopefully, you’ll be able to avoid some of these same mistakes in your practice as you begin your nursing career. One piece of advice I would want to give every new grad nurse is to not go around in fear that you’ll mess something up. You have to be confident and calm! Slow is smooth and smooth is fast, so take your time and don’t let your busy shift sway your focus.