How to Be New on the Job

UT Austin School of Nursing alumna alumna

Peggy Adams, MSN, RN

Many years ago, my nurse mentor told me, “You’re only new once, so make the most of it.”

She was right — it’s important to maximize the advantage found in those first few weeks or months on the job when no one expects you to function independently as a professional nurse. Most likely, you will be working alongside a preceptor, adding to your clinical knowledge and skills at a rapid pace during this period. This is the time to ask lots of questions and sponge up every ounce of information about your new job.

During your orientation period, your seasoned teammates will recognize that you are on a steep learning curve as a new clinician; however, from day one they will have certain expectations about you as a new co-worker. If you exhibit the behaviors of a responsible co-worker, you will increase the support from the experienced nurses and ease your transition onto the team.

What are those valued behaviors?

  • Be punctual. In the world of health care, on time is late. If report starts at 0645, you should arrive at work by 0630. This gives you time to put your belongings away, get your assignment and prepare to receive report according to unit protocol. The off-going nurses are ready to finish their shift and go home. Nothing will ruin your reputation faster than delaying report due to tardiness.
  • Be respectful. The experienced nurses on your team deserve your respect for their knowledge and skills. Your preceptor will be your main source of training during orientation and you should express appreciation frequently for her expertise, patience and time. Other nurses will be helpful and available to you both during and after the orientation period. But there may be some nurses who are not easily approachable or welcoming to novices. Your respectful attitude will be key in developing relationships with these folks. If you seek their expertise at the appropriate time and express your appreciation sincerely, you may open the door to mutual respect between novice and expert.
  • Be a good listener. During orientation, your preceptor and others will help you build on the clinical knowledge and skills that you learned in school. As a general rule, the person who knows the most should do the most talking. Listen closely, take notes, review and study after work as needed. As a good listener, you should put your phone away during work hours, even if the experienced nurses do not.
  • Be resourceful. Identify the people, their roles, and the hierarchy in your organization so that you know who to go to for questions and help. Locate the policies/procedures/standards of care so that you may refer to them and answer many of your questions yourself. Find the available resources for clinical and pharmacological information so you can access them as needed.
  • Be organized. Each workplace will have its own daily routine and rhythm. The experts know how to manage their assigned work as well as planning for interruptions and circumstances that will occur throughout the shift. Follow your preceptor’s guidance for organizing her workload. You will share in her patient care responsibilities, so continual communication is essential. Review your work with your preceptor throughout the shift to make sure all patient care is completed correctly. Near the end of your shift, you should practice giving report. Shift report is the time when experienced nurses will “evaluate” your progress as a new nurse. They may give you feedback directly or provide it indirectly via your preceptor. Either way, be appreciative of correction, take action immediately to make improvements and continue to grow.
  • Be a follower. There is no shame in being a follower instead of a leader. In fact, it is your duty to become an excellent follower when you are a novice. Watch, listen and learn from the best nurses on your team. Focus on achieving the goal of providing exceptional patient care and customer service. Become a dependable team member who is committed to excellence.
  • Be positive. It takes courage to be the new person. At times, you may feel awkward or even overwhelmed. Expect to encounter “bumps” in the road because your new workplace will not be perfect and your orientation will not be completely smooth. You may run into Negative Nancy or Crabby Cathy along the way but don’t be disheartened. Stay focused on your development as a professional nurse and celebrate your achievements. Commit to maintaining a positive outlook by taking care of yourself so that you can provide first-rate care for your patients and their families.
  • Be flexible. Most likely you will be on a pre-arranged schedule during orientation in order to work alongside your preceptor and attend all required classes. Attempting to make schedule changes for your personal needs will not be appreciated during this time. Your coworkers have made a commitment to get you “on board” and you should reciprocate by exhibiting flexibility and compliance with the orientation schedule.
  • Be productive. Even though you will not have your own patient assignment for the first month or more, you can still contribute to the team effort in many ways. Perform all the tasks and skills that you are permitted to carry out. Seek ways to get “checked off” on competencies as soon as possible and practice new skills at every opportunity. Read and study about the common diagnoses and medications for your patient population.
  • Be responsible. The success of your orientation and your continual development as a new nurse is ultimately your responsibility. Work along with your preceptor to assure that orientation checklists, documents, classes and other requirements are completed on time. Discuss your strengths and weaknesses and make a plan for improvement as needed. You are embarking on a lifetime of learning and growing as a professional nurse.

Congratulations to all of you on your upcoming graduation! It is my hope that these tips are helpful to you now as new nurses starting your careers, and in the future as experienced nurses helping the next wave of new grads who will be counting on you to show them the way.

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.

Let’s Raise Our Horns (and Some Money!)

40 hours for the Forty AcresA lot can happen in 40 hours!

You’ve not heard from me as a guest blogger before, but I can’t think of a better time to ask for your help for nursing education.

This week the School of Nursing will participate, along with the rest of the UT Austin campus, in a time-sensitive fund-raising campaign: “40 Hours for the Forty Acres.” From the wee hours of the morning of April 8 through late evening on April 9, members of the Longhorn Nation will be asked to rally in support of their favorite program on campus.

We hope that you’ll choose to support the School of Nursing. Click here to donate to your favorite school of nursing.

Whether you’re an alumni, member of our faculty or staff, current student, or friend or loved one of a nurse, you know how critical the nursing profession is to health care delivery. Providing a quality education — with plentiful learning and research opportunities — is part of our mission here at the School of Nursing, and we need your help!

During the 40 hours between 4 a.m. on Wednesday and 8 p.m. on Thursday, we are asking for you to choose to support one of the following areas of Nursing with your gift of any amount. Every gift counts!

Student Services/Student Activities: Funds raised will support our newly enhanced career services offerings, including resume-writing workshops, mock interviews and job search seminars. Additionally, funds donated to this area will assist in producing other enrichment events and activities like our AE-MSN Pinning Ceremony, Honors Day, Welcome Back events and Gone to Texas.

Simulation/Skills Lab: We are very excited to start work on the facelift to our 4th floor simulation lab area over the upcoming summer. However, the skills area needs a little more assistance in the spiffing-up department. Funds raised for this area will support the purchase of everything from hospital gowns to medical equipment, skills training modules to enhanced technology — all to provide our students with the most realistic simulation and skills experiences possible.

Area of Greatest Need: Did you know that if UT Austin had to operate on tuition dollars alone that the university would be forced to shut down classes each year in early November? Philanthropy is the key game changer in this equation. Your gift to the Area of Greatest Need within the School of Nursing may go to support our students as they travel to professional conferences to present their research, to bring in speakers and lecturers to enhance learning, for technology upgrades, or to support critical health care delivery in one of our clinics.

As the cost of education continues to increase and the need for private support grows, every dollar helps ensure the future of this university and the School of Nursing. Together, all gifts — big and small — will help us reach our goal. Your participation is key.

So long for now and remember to make your gift. A lot can happen in 40 hours!

Click here to donate to your favorite school of nursing.

—Andria Brannon

Screen Shot 2015-04-06 at 3.40.26 PMAndria Brannon, MS, JD, is director of development and external relations at the UT Austin School of Nursing. Her responsibilities include oversight of all external relations and fundraising activities of the School, including major gifts, endowments, grants, foundation relations, events, marketing/communications and alumni relations.

Previously, Andria served in various non-profit administration positions with The Make-A-Wish Foundation of North Texas, New Beginning Center, Inc., Children’s Medical Center and fulfilled a one year appointment as the research attorney for the Texas District and County Attorney’s Association. She’s currently involved as a volunteer with numerous agencies and causes including  the Texas Association Against Sexual Assault, UT Elementary School, Oak Hill United Methodist Church, the Texas Department of Criminal Justice Crime Victims Services Division and the American Association of Colleges of Nursing – Nursing Advancement Professionals. In her spare time, she hangs out in southwest Austin with her dog Ace, delights friends and family with her canning and pickling abilities, and reads like there’s no tomorrow.

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.

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.

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.

Welcome to a New Semester

Dean of the UT Austin School of Nursing

Dean Alexa Stuifbergen

I always find the beginning of the school year to be exciting and full of promise for the future. A new year always offers a new start, with opportunities to engage with new professors, confront and challenge new ideas and perspectives, and bring your own renewed sense of discovery and curiosity to the academic experience. It’s a time ripe with possibility and intellectual excitement.

Although it’s always a bit slower during the summer months, we haven’t exactly been inactive, and I have something new and something old to share with you all.

First and foremost, this semester marks the start of our new freshman admissions policy. In the past, students were admitted — after a competitive process — 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. A newly revised curriculum will have students taking nursing courses earlier than in the previous degree plan, and as sophomores, they will begin hands-on clinical practice rather than having to wait until their junior year.

As you may have heard, several changes are afoot in health-care education across the country, and the UT Austin School of Nursing is addressing these as well. We were successful in securing a significant grant under the leadership of Dr. Gayle Timmerman, associate dean of academic affairs, to promote inter-professional education (IPE) at UT Austin. This has prompted several initiatives to build IPE into the nursing curriculum as well as curricula in the College of Pharmacy, the School of Social Work and the upcoming Dell Medical School.

This year marks the 25th anniversary of the Alternate Entry Masters of Science in Nursing (AE-MSN) degree. Twenty-five years is hardly “old,” but we were in fact the second school of nursing in the nation to launch a program that opened nursing education opportunities to people from all walks of life. Today, several other schools of nursing provide a similar program.

Designed for individuals holding baccalaureate or graduate degrees in disciplines other than nursing who are interested in pursuing both a registered nurse license and master’s in nursing degree, the program has graduated more than 691 students to date. Students are admitted once a year, and 144 are currently enrolled.

I’m particularly pleased to tell you about changes to our own building. We recently began work on a master plan — about which we will be soliciting input from students and faculty — that we believe will provide the best support for teaching, learning and research. These changes are long overdue, and we are eager to hear your ideas.

Speaking of buildings, Dell Medical School and Seton’s new teaching hospital are now well underway, and our section of Red River Street has changed dramatically. Nursing students, faculty, staff and researchers now rub elbows with numerous surveyors, architects and construction crews. But amid the clouds of dust and monstrous earthmovers, we remain steadfast in our commitment to provide the best quality nursing education to our students and public health care to our community.

Welcome to our busy, productive home of learning, leadership, discovery and individual opportunity.

Dell Medical School Construction Update

Things are changing here at the UT Austin School of Nursing. Seriously changing!

May 7, 2014: Two weeks after the groundbreaking for the Dell Medical School, Centennial Park becomes ground zero.

May 7, 2014: Two weeks after the groundbreaking for the Dell Medical School, Centennial Park becomes ground zero.

Once ground was broken for the Dell Medical School and a new teaching hospital on April 21, it’s been full steam ahead.

Parking lots have been ripped up. A few trees have been taken down. Roads have been closed. A park has disappeared.

May 14, 2014: Another week, another mound of dirt.

May 14, 2014: Another week, another mound of dirt.

And still we stand!

Here are a few photos showing the construction progress next door (which will be the hospital). The medical school will be across the street where the Erwin Center parking lot once was.

Check back in a couple of months for more information and photos of the progress.

May 30, 2014: Looks like all that rain over Memorial Day weekend brought the grass back to life. Notice how the large trees have "collars" around them. This is part of the process of relocating them. Big job!

May 30, 2014: Looks like all that rain over Memorial Day weekend brought the grass back to life. Notice how the large trees have “collars” around them. This is part of the process of relocating them. Big job!

Oh! And if you were concerned about the statues of the three muses that once graced Centennial Park next door, they were safely relocated to Umlauf Sculpture Garden and Museum near Zilker Park.

Background: Last year, the UT System Board of Regents committed $334 million for the construction. Additionally, the Seton Healthcare Family has committed $295 million — a portion of which will come from fundraising — to build a new 211-bed teaching hospital to replace the aging University Medical Center Brackenridge.

June 11, 2014: Still fairly green. And the mound of dirt keeps growing.

June 11, 2014: Still fairly green. And the mound of dirt keeps growing.

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.