Getting Hired (part 2): Preparing for Interviews

UT Austin School of Nursing alumna

Peggy Adams, MSN, RN

Your job search may include both phone interviews and face-to-face meetings. Be sure to schedule these at a time when you are well rested and at your best. Spend some time thinking about what you want the interviewer to know about you as an entry-level nurse. Your preparation should include formulating answers to the most commonly asked interview questions:

  • Clinical challenge: Tell about a challenging patient that you cared for during one of your clinical experiences.
  • Problem solving: Give an example of your ability to use critical thinking skills.
  • Teamwork: Give an example of your experience in working as a part of a team.
  • Conflict resolution: Tell about a time you had to resolve a conflict with a peer or someone else.
  • Cultural differences: Tell about a time when you cared for a patient with a cultural background different from yours.

Note that these questions are all open-ended, which is meant to encourage the candidate to express a full and complete anecdote for each answer. Detailed, accurate and clinically correct answers will translate into high scores during the interview. A complete answer includes five elements: problem identification, data collection, plan for improvement, plan implementation, results/evaluation.

When I help my clients prepare for an interview, I ask them to write down “scenarios” to answer each of five frequently asked questions. A scenario is a complete answer that includes all five elements usually presented as a beginning, middle and an end to the story. Example (not a true story):

  • I took care of a pediatric burn patient who was terrified every time we had to change his dressings. Pain medicine was given before the dressing change but it didn’t seem to help. I looked up the dosage and it was correct for his weight. But we were giving it 10 minutes before the dressing change and the drug really needed 20 minutes to take full effect. So we adjusted our plan of care and the result was that the patient was much more comfortable when we waited the full 20 minutes. This was documented on his MAR and plan of care so that all caretakers were informed.

You can see that a patient care “scenario” like that could be used to answer a variety of interview questions such as how you dealt with a clinical challenge or solved a problem. Having several real-life scenarios that you can easily speak about will help you feel confident with a variety topics that may come up during the interview. The best scenarios involve a complex clinical challenge; a detailed discussion of the diagnosis, signs/symptoms, medications and therapies; and a thorough description of the patient’s outcome.

Finally, if you are scheduled for a face-to-face interview, you should review these reminders about what to wear and personal appearance:

  • First of all, “wear” your good manners.
  • Choose clothes that help the interviewer envision you as a professional nurse. You don’t need to wear scrubs or a nurse uniform, but you should wear conservative clothing that meets the dress codes in most organizations. This means no denim.
  • Wear solid colors such as navy blue or gray, which connote trust and loyalty. Collared shirts in solid blues or white are preferable.
  • Closed toe shoes with low quiet heels will help you appear stable and secure.
  • Limited accessories are a wise choice. One earring per ear and no dangles.
  • Style your hair so that it is away from your face just as you would wear it on the job.
  • Make sure your nails are trimmed and clean.
  • No perfume or cologne.

These small suggestions add up to an overall trustworthy and professional first impression. Your well-groomed conservative appearance will allow the interviewer to focus on what you’re saying without being distracted by what you’re wearing.

In addition, be punctual when meeting with the interviewer. Actually, this means you should arrive about five minutes early because on time is considered late. Punctuality connotes that you are prepared and organized, as well as respectful of the other person’s time. These are highly valued traits in nursing.

Try to keep your hands free of clutter and accessories other than a purse. Your phone should be turned off and put away. Do not carry a water bottle or other refreshment. If offered a cup of water or coffee, I usually decline. It’s just one more thing I might knock over if I’m nervous!

Finally, when you walk into the office or conference room, you should stand as introductions are made, use a firm handshake if one is offered to you, and be seated when you are told where to sit. Keep your hands lightly on the table or in your lap if you are not at a table. Sit up straight and keep both feet on the floor. Make good eye contact and get ready to wow your interviewer with the wonderful story of you!

About the author:
Peggy Adams received her BSN at The University of Texas at Austin School of Nursing in 1978 and her MSN at Texas Womens University in the Texas Medical Center in Houston in 1987.

She worked for 10 years in pediatrics at Hermann Hospital (now Memorial Hermann) in Houston. She currently has a consulting business (Adams Consulting) that specializes in individual and group training for those in nursing leadership and management positions. She also coaches new graduates who are seeking their first professional nursing position. Her interview preparation strategies are based on:

  • firsthand experience interviewing and hiring nurses as a supervisor,
  • personal knowledge of the professional nursing culture of many health care institutions, and
  • carefully honed writing and speaking skills.

Vaccines and the Retreat from Common Sense

vaccineThis thing of American parents refusing to vaccinate their children makes about as much sense to me as countries that don’t educate their female children. Both are choices based on ideologies that defy reason; both can cause irreparable harm.

We all know by now of the measles outbreak of more than 100 cases since January including five babies from a suburban Chicago daycare center who were too young to be vaccinated. How the (expletive) could this happen after measles was declared eliminated in the year 2000?

Truth is, I could see this coming. When I began working as a staff nurse in neonatal intensive care in 1980, all my co-workers got the flu shot every year. All the babies got their immunizations. No questions, no doubt, no hesitation. Boom.

The ax fell in 1998 when the British medical journal The Lancet published a study by Andrew Wakefield, who now lives in Austin. His study, which had only 12 study subjects, linked the measles, mumps and rubella vaccine with autism.

As we now know, news of his study ricocheted around the world and use of the vaccine plummeted worldwide. An anti-vaccine movement was ushered in. The Lancet reassessed the scientific methods and financial conflicts of Wakefield and in 2010 retracted the study; his medical license was subsequently revoked. But the damage had been done.

In 2004, I had no trouble getting parents to immunize their children. That year, only 0.09 percent (just under 3,000 kids) of Texas’ overall school-age population had nonmedical exemptions to school immunization laws. But in the 2013–14 school year, that percentage jumped to 0.75 percent (more than 38,000 kids). That’s almost a 13-fold increase in 10 years, and that aligns with my experience in neonatal.

In 2009, three years before I retired from neonatal, Central Texas experienced a large pertussis outbreak, the first in 50 years. Pertussis in our hospital! With a shiver, we feared it was the canary in the coal mine. It was. About the same time parents began to refuse to sign vaccine consents, and nurses even began questioning flu shots.

I’ll never forget a prescient 12-hour shift in the winter of 2009. I received report from a night-shift nurse who was wearing a mask because she had refused the flu vaccine. Rondah Kentch, a nurse with a limp from polio she contracted at age 4, and I cared that day for eight premature babies in our neonatal intensive care bay. All of them were adorable, nearing discharge and had unsigned immunization consents on the fronts of their charts.

With 65 years of neonatal nursing experience between us, Rondah and I could handle the babies. The tough part was obtaining consent from the parents to protect their children from communicable, deadly diseases. The poor, uneducated parents didn’t hesitate; they were grateful their children could receive the vaccine. It was the educated parents, those empowered with all of the information in the world at their fingertips, who balked. Scientific reasoning did no good. It was obvious at that point what the future held: a retreat from common sense.

But wait. The story gets better. Since I retired in 2012, the same ilk of parents who refuse vaccines is also refusing the vitamin K injection to prevent hemorrhagic disease and antimicrobial eye ointment to prevent blindness. I’m glad I’m not there to witness that.

Measles is awful. It makes you very sick. It can kill you. It can blind you. Pregnant women exposed to measles can miscarry or give birth to infants with deformities. Are pediatricians justified in closing their practices to children whose parents refuse to immunize? Absolutely. Are schools justified in requiring unvaccinated children to stay home for 21 days (the length of time between exposure and the beginning of the rash and fever) after an exposure? Of course.

What I don’t understand is … every baccalaureate degree requires passing basic science courses. Yet it’s the educated parents (and some health care workers) who are refusing vaccines. Immunization science is 65 years old and about as basic as evolution science. Resistance is especially odd coming from people with degrees that have the word “science” in the name.

About the author:
Toni Inglis, MSN, RN, CNS, FAAN, retired neonatal intensive care nurse, is a writer/editor with the Seton Healthcare Family. She writes a monthly opinion column for the Austin American-Statesman editorial page. She received a BSN from The University of Texas at Austin School of Nursing in 1979 and her MSN in 1992.

Getting Hired (Part 1): Maximizing the Online Application

UT Austin School of Nursing alumna

Peggy Adams, MSN, RN

Good news: Soon you will graduate from a highly respected nursing school and then you will pass the NCLEX with flying colors.

Bad news: Other top notch recent grads, as well as experienced nurses, will be competing with you for nursing positions in many excellent health care centers.

How do you get the position you really want?

Navigating the pathway to landing your first job can be daunting. The process may include online applications, telephone interviews, group interviews and one-on-one interviews. The competition is tough in places where there are few job openings. But you can prepare yourself to stand out among those who are vying for the best residencies, internships and other coveted positions. Here’s how…

Conquering the Online Application

For most large institutions, the gateway to the job search process is the online application. Start early and become familiar with the required forms, questions and documents since they are similar for most health care career websites. Formulate your content carefully so that it can be adapted to various formats. At this point, you may find that your amazing nursing experiences and skills seem flat and banal as you insert the information into the online structure set up by each employer. How can you set yourself apart from the other excellent candidates when all you have is an electronic application that consists of your resume and some generic information and short essays?

Powerful writing and customization

Remember that you are introducing yourself to an organization, so make every word count. Perfect grammar, strong verbs (not “being” verbs), concise wording and clear messaging are all important. The ability to present an accurate picture of yourself in words is critical to making a good first impression.

Another key to a superior written application is to make it customized even though it is a standardized process. This means that you will include your most important strengths, skills and experiences so that a complete picture of you is created even though the system may seem to limit these opportunities. You can do this by strategically using every option available: cover letter, resume, references and short essays. On all your documents and forms, thoughtfully fill up each space with meaty information that exhibits your current clinical knowledge and abilities and your capacity to learn and grow.

The nurse everyone wants to hire

What are the basic qualities that every employer is looking for in a professional nurse? Think about the nurses you most admire and would enjoy working with and then make a list of their outstanding attributes. Hopefully, some of these qualities also describe you! Select a few of these qualities and sprinkle them throughout your application documents. Here’s a list to get started:

  • Passionate about clinical excellence
  • Intelligent, teachable, good listener
  • Critical thinker, analytical, able to “connect the dots”
  • Energetic, healthy, not afraid of hard work
  • Organized and detail oriented while also aware of the big picture
  • Safety conscious
  • Attentive to customer service

Know your strengths

Make a list of your own personal strengths. Canvas your peers, teachers and family to get an accurate snapshot of yourself. Then weave these personal strengths into your application so that the reader can picture you as an individual. For example, a recent UT Austin School of Nursing grad noted that she could be calm during a crisis, looking for solutions in the midst of chaos. What a valuable asset in her new PICU position!

Know your potential employer

Educate yourself about the health care institution of interest to you. Look at its mission statements, values, model of patient care, professional statement about nursing, and ongoing opportunities for growth and development. Make sure that your values align with those of the institution so that you can truly support them if you decide to work there. Then select one or two values and integrate them into your written application.

Appreciate the investment

Understand the cost of hiring a new nurse. The institution that hires you will be making a huge investment in you throughout your orientation as well as your continual development and education. What will you give back? Take time to state what you intend to contribute to the organization; such as, loyalty to their mission and values, longevity in years of service, plans for career growth or other goals. Although they won’t ask you directly, your interviewers will want to know how long you plan to work for their organization. In other words, will you be a good investment for their institution? Make sure that they know you are committed to their success as well as your own.

Preparing for an interview

Once you have opened the door with your outstanding online application, you will embark on the path of interviews both on the phone and in person. What questions will employers ask? What is the best way to formulate an answer? What questions should you ask? What questions should you avoid? Stay tuned for the next blog…

Peggy Adams received her BSN at The University of Texas at Austin School of Nursing in 1978 and her MSN at Texas Womens University in the Texas Medical Center in Houston in 1987.

She worked for 10 years in pediatrics at Hermann Hospital (now Memorial Hermann) in Houston. She currently has a consulting business (Adams Consulting) that specializes in individual and group training for those in nursing leadership and management positions. She also coaches new graduates who are seeking their first professional nursing position. Her interview preparation strategies are based on:

  • firsthand experience interviewing and hiring nurses as a supervisor,
  • personal knowledge of the professional nursing culture of many health care institutions, and
  • carefully honed writing and speaking skills.

Notes from the Jungle: Construction Update

The Law of the Jungle: a system or mode of action in which the strongest survive, presumably as animals in nature or as human beings whose activity is not regulated by the laws or ethics of civilization.
construction site

It’s a jungle out there! Red River Street (facing east)

Construction continues near the School of Nursing — in every direction — so that finding a way to and from the building has become increasingly challenging.

We’ve always been situated in what can only be described as the hinterlands of UT Austin, but now we’re completely encompassed by a growing jungle of construction and mayhem.


The former Centennial Park, looking south

These days students, faculty and staff must gingerly traverse unchartered territory, past chasms and barriers, dodging cranes and bobcats (diesel-powered ones, although it could hardly seem more dangerous than if they were of the animal kingdom variety).



Two cranes sighted near a river (Red River, that is)

Pity the unsuspecting, but intrepid visitor who must scout the terrain and follow the confusing signage in order to arrive safely at the School of Nursing. Even Hansel and Gretel would be hard-pressed to navigate this ever-changing landscape.

But never fear! It’s business as usual in these hallowed halls. We are gearing up for a new semester beginning Tuesday, January 20. Soon students and faculty will once again be on hand to beat back the darkness of ignorance, search out nursing science concepts and blaze a trail to improved health care.


Tennis, anyone? Not any more! (Former site of UT Austin tennis courts, looking west)

And we’ve been told that Red River Street may actually rematerialize in a few months.

Check back in a couple of months for another update and photos of the, gulp!, progress.

Background: In November 2012 Travis County voters approved a proposal to increase the tax rate for Central Health, the countywide hospital district, to support a new medical school on the campus of The University of Texas at Austin.

Soon after the UT System Board of Regents committed $334 million for construction of the medical school, which was later named the Dell Medical School. In addition, the Seton Healthcare Family committed $295 million to build a new 211-bed teaching hospital to replace the aging University Medical Center Brackenridge.

Seton Medical Center at The University of Texas will serve as the medical school’s primary clinical in-patient teaching facility and enhance services to residents of Central Texas. The medical school, teaching hospital and supporting buildings will be located along Red River Street and west of the School of Nursing


What a Difference a Semester Makes

Dean of the UT Austin School of Nursing

Dean Alexa Stuifbergen

It seems like only yesterday I was welcoming you to a new school year, one that I felt would be full of promise for the future. And it certainly has been!

We got off to a great start in September when several hundred visitors and UT Austin colleagues attended a soiree at the School of Nursing welcoming Dr. Clay Johnston, the inaugural dean of the Dell Medical School. Our guests braved road closures and construction debris in order to hear Dean Johnston share his inclusive vision for the new medical school. By all accounts, it was worth it, and we look forward to a fruitful collaboration with our new neighbors.

Academically, we have a good report on all fronts — from undergraduate to master’s to doctoral programs.

  • Our new freshman admissions policy made a seamless transition. As you may know, in the past students were admitted into the nursing program as juniors. This fall, freshmen admitted to UT Austin who declared nursing as their first choice major were admitted directly into the four-year Bachelor of Science in Nursing program. The newly revised curriculum has students taking nursing courses earlier than in the previous degree plan and feeling a part of the School sooner rather than later.
  • We recently observed the 25th anniversary of the Alternate Entry Masters of Science in Nursing program. Twenty-five years is hardly “old,” but we were one of the first schools in the nation to launch a program that opened nursing education opportunities to people from all walks of life. Several of our alumni came back “home” on a cold and rainy Saturday in November to help us celebrate the program’s success.
  • And last but not least, I am very pleased to announce that the School of Nursing has received approval from the University of Texas System Board of Regents to launch a doctor of nursing practice (DNP) degree program. This professional doctoral program is designed to prepare graduates for today’s increasingly complex health care practice and clinical leadership roles and will help meet the demand for more practitioners able to provide leadership at the highest levels of health care and for highly prepared clinical faculty for schools of nursing.

This semester 85 students will graduate. Of those, 64 will receive a bachelor of science in nursing, 17 a master’s and three a doctorate. Congratulations to these scholars and nurses. I’m proud of each and every one of you.

But it hasn’t all been a bed of roses: We’ve experienced our share of inconvenience as well, with construction encroaching on us from every side. I’m grateful for how students, faculty, staff, and visitors have continually adapted to the many barriers and frequent rerouting in order to make their way to the School.

Change is rarely easy. However, in keeping with everything else at the School of Nursing these days, the situation is looking up, and I’m happy to tell you that Red River Street will reopen in early 2015.

It’s been a wonderful semester. As it draws to a close, I would like to say thank you to the faculty and staff and our donors and friends for making it a stellar one. I can hardly wait to see what next year brings!

In the meantime, I wish you all a very happy new year.

Get Involved With Your Nursing School

Member of the University of Texas Nursing Students Association

UTNSA members

The University of Texas Nursing Students’ Association (UTNSA) is a gateway for nursing students to become involved with the community, fellow nursing students, health care workers, faculty and so much more.

Every other week at 7 p.m. on alternating Tuesdays and Wednesdays, UTNSA holds meetings at the School of Nursing where we discuss upcoming events and occasionally host guest speakers who are members of the health care system. Fall semester 2014 has been full of activities and opportunities.

UTNSA students at pumpkin-carving event

Pumpkin carving

To help UTNSA members mingle, we host “socials.” A few of the socials this semester included a trip to Amy’s Ice Cream where UTNSA members all met up at Amy’s to relax and enjoy some ice cream; a pumpkin-carving social on the main campus where members carved pumpkins in groups of about four per pumpkin; and a Mozart’s social where we gathered at Mozart’s coffee shop to grab a coffee and study together.

UTNSA also puts on many volunteer events. Some of the events we have hosted/participated in this semester are:

UTNSA students in canoe

Olivia Baker and UTNSA “crew”

Lady Bird Lake Clean Up, where members teamed up in pairs of two, got in a canoe, and paddled around the lake while collecting as much trash as possible;

The Homeless Resource Fair, where UTNSA helped the homeless to find reading glasses that best suited them and gave mini-ear exams and much more;

“Aid 480,” a canned food and clothing drive, where UTNSA members attempt to provide clothes for 480 individuals in need.

UTNSA also has a mentorship program at Austin Reagan High School at which our members carpool to Reagan once a week to talk with high school students about college, nursing and any other questions they may have. During our visits, we also teach or put on an activity such as how to take blood pressure and pulse rates. UTNSA mentors keep in touch with their mentee through email and help to get them on the right track to college.

These are just a few examples of how UTNSA volunteers in the community!

At our last meeting we had a guest speaker from hospice speak to us about what hospice is, what nurses’ roles are in providing care to patients and how to become a volunteer with hospice. In an upcoming UTNSA meeting we are planning to have a UT nursing graduate who now works in a hospital speak about her experience after graduation.

Each semester UTNSA also provides opportunities for anyone at UT to become CPR- and first aid-certified at a discounted price through the American Heart Association and to order medical supplies through our organization at a discounted price.

Becoming a member of UTNSA is easy! Dues are $20 a semester or $35 annually. In order to remain an active member, individuals must attend three meetings a semester, attend two socials and provide six hours volunteering at UTNSA events.

For more information on UTNSA and upcoming events, you can visit our website or like us on Facebook!

—Olivia Baker, BSN with Honors,  UTNSA President

Where Seldom Is Heard

UT Austin School of Nursing alumna

Peggy Adams, MSN, RN

In the late 1800s, an otolaryngologist named Dr. Brewster M. Higley wrote the words to the familiar cowboy song “Home on the Range.” The last line promises that “seldom is heard a discouraging word, and the skies are not cloudy all day.”

Apparently, the western range was an idyllic place for cowboys to work and live. Who wouldn’t thrive in such a pleasant setting?

Ironically, in today’s health care settings, the very places that boldly promote health in body, mind and spirit, we sometimes encounter just the opposite of a peaceful, encouraging work environment. As nurses, we may find ourselves in a very discouraging place with cloudy, stormy, tension-filled skies all around. What happened to encouragement and where can we find it when we need it?

In the several decades of my nursing career, I’ve experienced a wide variety of work environments and cultures. Some places were lacking in the necessary support for nursing both from the top down and also laterally among the peer group. Nurses simply survived the day-to-day routine until burn out set in and they left.

However, I have also worked in places that oozed with life-giving energy and mutual encouragement among the members of the health care team at every level. It was a joy to go to work there each day.

The word encouragement contains the word courage, which comes from the French word coeur, meaning heart. So literally, to encourage someone means to give heart, to embolden. As nurses who continually give of themselves to care for others, we also need that therapeutic dose of encouragement every day.

Where do we get it?

First, encouragement should come from the top down in every organization. In health care, this habit can be hardwired into the nurse leader’s daily routine. While making rounds to ensure the delivery of excellent patient care, he or she should also take the time to sincerely extend the gift of encouragement and inspiration to the nurses in his or her charge and notice people doing things right and acknowledge their efforts.

Real encouragement is specific and genuine, not general and banal. Just a few timely words such as, “Now that’s a thorough assessment!” will be long remembered by a hard-working bedside nurse. Meaningful acknowledgement from the top helps to set the tone of respect and appreciation for professional nurses throughout an organization.

The second source of encouragement should come from one’s peers. It is most likely to bubble up in a department or unit where co-workers feel valued and each job is infused with importance. When the leader is supportive, fair and attentive in his or her dealings with every employee, he or she provides a measure of calm assurance and decreases the likelihood of jealousy among the staff. No one has to “fight” for the boss’s attention. There is no favoritism. This opens the door for mutual respect among the peer group and provides the opportunity for encouraging one another.

I recently worked in a large, women’s services department where the nurses had created a system for publicly recognizing the good deeds of their colleagues. They wrote “thank you” and other acknowledgements on star-shaped paper and pinned them to the bulletin board for all to see. When praise is received from a professional nursing peer who can truly measure and appreciate nursing expertise, that praise is a tremendous source of encouragement.

Finally, at some point nurses must figure out how to encourage themselves and to make self-care a priority. Why not give yourself a pat on the back for a job well done and reward yourself with time spent on maintaining your own health? This includes physical, psychosocial and spiritual choices that promote wellness and wholeness.

I have learned to purposefully schedule time to enjoy the people and activities that invigorate my life. Spiritual nourishment, strenuous exercise, support from respected colleagues, and laughter with family and friends are my prescription for daily encouragement.

I think Dr. Higley would agree.

Peggy Adams received her BSN at The University of Texas at Austin School of Nursing in 1978 and her MSN at Texas Womens University in the Texas Medical Center in Houston in 1987.

She worked for 10 years in pediatrics at Hermann Hospital (now Memorial Hermann) in Houston. She currently has a consulting business (Adams Consulting) that specializes in individual and group training for those in nursing leadership and management positions. She also coaches new graduates who are seeking their first professional nursing position. Her interview preparation strategies are based on:

  • firsthand experience interviewing and hiring nurses as a supervisor,
  • personal knowledge of the professional nursing culture of many health care institutions, and
  • carefully honed writing and speaking skills.

Staff Nurses and Evidence-Based Practice

Editor’s note: The following blog is by Linda Yoder, PhD, MBA, RN, AOCN, FAAN, Robert Wood Johnson Executive Nurse Fellow. Dr. Yoder is an associate professor and director of Nursing Administration and Healthcare Systems Management at the University of Texas at Austin School of Nursing.

The original research article “Staff Nurses’ Use of Research to Facilitate Evidence-Based Practice” mentioned below was published in the September 2014 issue of the American Journal of Nursing (AJN). The article was featured in the AJN blog Off the Charts, in which the bloggers discussed the importance of these findings. To read that blog, click this link.


Professor Linda Yoder

Dr. Linda Yoder

I was thrilled to be part of the research team that conducted a study on staff nurses and their use of evidence-based practices and pleased that the American Journal of Nursing recognized the importance of the topic and chose to publish it.

Unfortunately, the findings support other research from the past two decades stating that bedside nurses do not have sufficient skills to read and critique the research to determine if they should change practice based on research findings.

Also, with nurses working 12-hour shifts, they have clearly indicated that they are not willing to engage in research usage or evidence-based practice (EBP) activities unless they received paid time to do so. In other words, this is not an activity that they are willing to do during their personal time.

The findings from this study create a challenge for senior leaders in acute care hospitals. They must determine whether EBP activities are important enough to support financially and they must provide additional education for nurses so they can gain the skills needed to accurately critique the science.

Partners in Research, Health Care and Education

Two UT Austin deans

Dean Alexa Stuifbergen and Dell Medical School Dean Clay Johnston

On Tuesday, Sept. 16, Alexa Stuifbergen, dean of The University of Texas at Austin School of Nursing, welcomed visitors to the Jack and Laura Lee Blanton Lecture in Nursing, which featured Clay Johnston, inaugural dean of the UT Austin Dell Medical School.

The evening was a celebration of the new medical school and all the opportunities that affords for future interprofessional collabortion as well as a recognition of the consortium of educators, civic leaders and health care organizations who had worked for many years to change the landscape of health care education and delivery in Central Texas.

dean at podium during lecture

Dean Stuifbergen’s opening remarks

Dean Stuifbergen reminded the audience that as recently as Nov. 6, 2012, Proposition 1, which assessed a small property tax increase to pay for changes to the health care delivery system, was passed by Travis County voters.

In addition to providing for a medical school and teaching hospital, Prop 1 outlined ways to increase access for the underinsured and uninsured, efforts that complement the school of nursing’s long-term mission and history of strong clinical training and community-based research — particularly research efforts to improve the health of the underserved.

This video includes opening remarks by Dean Stuifbergen and Dean Johnston’s presentation “The New Dell Medical School: Joining the Team Promoting Health.”

The Big Picture

Shannan Needleman and her daughter Taylor

Alumna Shannan Needleman and her daughter Taylor

In May my mother-in-law experienced a syncope episode while shopping at the outlets. Luckily she felt dizzy and sat down before she passed out.

My father-in-law became paralyzed with fear, but gracious bystanders came to his aid. The emergency medical service arrived as my mother-in-law regained consciousness. They took her vital signs and determined her blood pressure was low and decided it was best to transport her to the local medical center.

Completely flustered by the incident, my father-in-law scoured the parking lot but was so worried about his wife that he couldn’t find the car. He meandered around for nearly an hour and was then unable to find the hospital on his own. Nearly two hours after my mother-in-law was transported by ambulance, my father-in-law arrived at the hospital.

The CT scan revealed that my mother-in-law’s known benign meningioma had doubled in size. Though this was not determined to be the cause of her fainting episode, the hospital staff recommended she be transferred to a bigger hospital for evaluation by a neurologist. Two days later she was advised to have the tumor removed from the frontal lobe of her brain.

My in-laws have been married for 55 years. They have a co-dependent relationship. My mother-in-law (age 73) is a strong woman totally capable of taking care of herself, but heavily relies on my father-in-law to meet her daily living needs. She never learned to drive, rarely works in the yard or empties a trash can. He makes all the phone calls and does most of the grocery shopping. My father-in-law has also relied on my mother-in-law for three square meals a day, clean clothes, his medication and instructions on how to move through his day. Together they have clearly defined roles. Apart they can’t seem to function independently. It was a scary realization for my husband and me.

Thankfully the surgery was successful. The neurologist called us with an update and said if all goes well she could be discharged in three to four days. However, he was a bit concerned about discharging her to the care of her husband. The neurologist commented that my father-in-law was clearly frazzled by the situation and unable to focus on any medical information given to him. We quickly determined I needed to help them through this difficult time.

Upon arrival I was shocked to find my father-in-law disheveled and exhausted. His color was not good and he looked like he had lost quite a bit of weight; clearly he had not been coping well over the past few days. He admitted he had been overly stressed by Mom’s sickness and felt he was unable to take care of himself without her. I said that now was not the time for him to feel sorry for himself, that he needed to be there for her, which meant he had to take care of himself. A harsh reality, but something he needed to hear.

Fortunately I was able to help my mother-in-law through the discharge process. Shortly after we arrived home, I realized that she had been sent home with another patient’s discharge information with completely different instructions and no follow-up orders. I had to call to clarify her orders.

Deciphering the steroid tapering instructions was tricky for me — a well-seasoned nurse — and nearly impossible for an 81-year-old poorly functioning spouse. In an attempt to divide the pills into doses, I noted the pharmacy had put 10 extra pills in the bottle.

I share this story because I worry that this medical scenario may be commonplace in the geriatric population. It bothers me that the neurologist and ICU nursing staff were aware and documented that my father-in-law was not functioning well and yet no one really made any attempt to help him. He is a heart patient and wears a medical bracelet. How easy would it have been for a nurse to take his blood pressure? Or ask him if he has been taking his medication properly? Would a social work consult have been appropriate in this situation? I shudder to think how my father-in-law would have coped with my mother-in-law’s discharge had I not been there.

I think back to my excellent training as a student nurse at The University of Texas at Austin School of Nursing and remember how the teachers embraced the concept of family-centered care. This was especially important in my field of neonatal care. As primary care nurses for babies, my colleagues and I cared for the entire family and often identified parenting issues and financial burdens, and worked hard to seek the proper outside resources for families to ensure that their baby was safe and healthy upon discharge and beyond.

As nurses we inherently understand that new parents often need assistance, but when it comes to the aging population, we tend to feel they have a lifetime of knowledge and experience to help them cope. We take for granted that the elderly have the physical, emotional and sometimes mental capacity to cope with a major life-changing event, such as illness.

This experience made me realize that as a nurse it is important to remember to not only treat your patient, but to take into consideration the patient’s support system. Recovering from open brain surgery is difficult at any age, but imagine experiencing this event in your 70s.

Although hospitals may consider a quick discharge a successful case, the entire hospitalization is pointless if the patient fails to safely transition at home. Often, older spouses do not have the mental resources, cognitive flexibility and physical stamina to cope with an unexpected health situation. Their entire world changes in the blink of an eye, and they become paralyzed.

It behooves nurses to explore beyond a patient’s physical well-being and determine what needs must be met for both spouses during the hospital stay and upon discharge.

By “seeing the bigger picture,” you are not acting as just a caregiver, but truly a lifesaver.