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Friday, August 21, 2015

Please, Let Sleeping Patients Lie

A recent Kaiser Health News article highlights one of my personal pet peeves about hospital care: Unnecessarily interrupted sleep during hospitalization. It is bad for the patient and certainly impacts their satisfaction with your care.

You know how you feel when you haven't slept well, right? Add illness to that and for some, aging changes and you end up with a cranky patient and often family to boot.  Sleep is important for all when ill, no matter what age the patient.

Sleep helps you heal.  It allows your body to work on fixing the problem while the mind switches to different activity levels that allow for physiologic healing to occur.

Sick kids need it so they have the energy to cope with their illness during the day and all those grown ups doing stuff to them.

The elderly need sleep because it will take them longer to recover.  Lack of sleep also puts them at higher risk for delirium, confusion, and wandering. (Oh, does that explain a few things?!)

So if you are working night shift, ask yourself a few important questions:

Can I give my patient all the meds they need before they go to sleep or get them scheduled that way?

Do I REALLY need to get that set of vital signs on the medically stable patient in the middle of the night?

Can I reposition the BP cuff on the sleeping child who keeps rolling over on to it and showing a BP drop that sets off alarms so both parent and child can sleep better?

Start critically thinking about how you can promote sleep with your patients.  You just might find it might make for a better night shift for you.

Tuesday, August 18, 2015

How to Choose the Right PhD Program for You - Part III: Finances

Money issues stop a lot of nurses from going back to do their PhD, sometimes for good reason. Let's dispel some common concerns first.

When Enrolled Full Time in a PhD Program, Your Student Loans Go Into Payment Deferral

That's right. When you're studying full time you don't have to pay your loans. You're allowed to defer payments until you finish. You can pay the interest so the amount doesn't accumulate too much.  It is a good idea to pay the interest while in school.

Many Full Time PhD Programs Offer Full Tuition Funding and a Living Stipend

Funded PhD study is a great thing. It allows you to focus on your studies and develop your ideas. You can take the time you need to think, because you'll never have it again.

So how much is a living stipend? It varies by school and program but reports from the field suggest that it ranges from $1,500 to $2,300 per month. It is usually enough to cover rent, food, and your internet/phone connection. It is not meant to be enough to pay your credit cards, go on trips, or cover nights out at good restaurants. That's on you.

Notably, depending on your state, you usually do not have taxes deducted or in lesser amounts because policymakers consider this an investment in your future. Odds are you're going to become more economically productive after graduating, so you'll have a higher salary and pay more in taxes over the lifetime of your career.

I Cannot Possibly Live on that Kind of Stipend

Sure you can and people do it all the time. It's not forever either. A good program will want you to graduate in 4 years and once you're done with your first two years, you can work a little more --but not too much.

One recommendation I often make to students, even fully funded ones, is to borrow money to cover the rent. That way you never have to worry about a place to live. Now don't rent a luxury apartment and borrow money to cover that kind of rent. Find someplace comfortable to live, with or without roommates, so you have that peace of mind.

Don't borrow money to pay for a full cable package, make sure you can go out to eat at nice restaurants multiple times a week, or a new wardrobe. That's a poor use of resources and will stress you out more when the bills come in.

Doing a PhD is an investment in yourself and your career for the long term.  It requires sacrifice but I can assure you, it will pay off in the end.

I Can Still Work for Extra Money?

Yes, most PhD students still work at least one to two shifts a month for extra money. Most will pick up shifts during breaks and summer months too.  It requires more of a calculus to figure out how much you're going to need to cover low points in the semester, but when finals come around and you need to study and work on papers, the extra cushion is worth having.

Don't Work Too Much.

This is a trap many nursing PhD students fall into.  We are used to being able to do multiple jobs, projects, commitments at the same time. We think we can still do that during a PhD program.

You can't. Really.

You will most likely fail out of your program if you work too much outside of school.  That is a lived experience you want to avoid if you really want a career in academia or research.

Thursday, August 13, 2015

A Better Way to Get Rid of Your Nursing Student Loans OTHER Than Working Another Job

Social media recently tuned me into a great resource every nurse with loans should know about: Student loan repayment through volunteer work. SponsorChange is a non-profit committed to helping people repay their student loans.

Here's why it is a better option for you than working a second job to repay those loans.  And yes, I know many of you do.

1) Working more than three 12 hour shifts a week is bad for your health and your patients.

More and more research shows that 12 hour shifts are bad for you.  How come?  Let's think about it. The shift starts at 7am.  You're up at 5:30 or 6 so you can commute and get there on time unless you live within a short walk to your job, which most people do not in the US.  So your day really starts at 5:30am.

You work all day long and give report, which ideally means you finish report at 7:30pm and then you leave.  But that never happens right?  So, you stay to finish up everything and maybe get paid overtime for documenting on your patients and then say you get to leave around 8:30. By the time you leave work, you've already been up for 15 hours.  Then there is the commute home where maybe you get to come in, eat something, and then possibly go to bed.  What time is it?  I'd guess probably about 10:30 or 11pm.  Your day is now, at a maximum, 18 hours.

If you have to work the next day, you'll get at most 6 hours of sleep.  That's under what the latest sleep research recommends, which is 7 to 8.  Over time, this builds up and has physical and psychological health consequences. Don't believe it?  Look it up on PubMed.  I know you learned how to do that in your research class.

What if you make a mistake with a patient because you're sleep deprived?

What if that toxic personality working on your unit is that way due to years of sleep deprivation?

Think about it.

2) Volunteering will remind you about the importance of community health and keeping patients out of the hospital.

Seeing healthy people not at their worst, like they are in the hospital, can remind you about keeping that holistic perspective about patient health. Seeing people in communities and helping them with an activity that produces a more immediate result than what we normally see in a healthcare setting can be very rewarding.  And hey, if it helps pay off more of your student loans too, that's a bonus.

It also won't require 12 hours out of your week.

Something else to keep in mind.  Most US nurses work in hospitals, but the market is going to shift in the next 5 years. Inpatient care is going to involve only the sickest patients.  It is more cost effective to keep people in their homes and in the community. That's where the jobs will be. Your volunteer work could eventually lead to a different kind of nursing job or maybe back to graduate school.

3) If you keep volunteering for overtime, management has no incentive to hire the right number of staff for your floor.

Always working 1 or 2 nurses short?  Your manager or scheduler always asking if anyone wants to pick up extra shifts, and there are always lots of openings? That's the sign of a problem.  There's not a reason in the world why there should be lots of overtime options on your unit.  It's a sign of a problem manager who has lousy retention rates because of how they manage.  They think not hiring someone will make their budget numbers look good.

Totally not the case. Don't contribute to poor management practices by picking up extra overtime.  Your health and sanity aren't worth the extra money.

So think about your options before you take another job or pick up all those extra shifts.  There are better ways to repay your student loans.