Electronic Clinical Documentation In Nursing

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Nursing documentation is a format that is used to communicate patient’s progress among interdisciplinary team members. Standardized clinical documentation in nursing remains complex. There is clinical evidence in literature associating delivery of nursing care to clinical documentation. Electronic documentation promotes accuracy, continuity of care and nurse patient interaction. Health care facilities have invested greatly in electronic health record to maximize reimbursement and benefit from grant and other incentives. In the near future, Nurses must become computer literate to remain competitive and competent. The profession will significantly change with the adoption of electronic documentation in healthcare worldwide. There will be an increase demand for electronic gadgets with advanced technical features.

Informatics has been around since the early 1800 with Herman Hollerith who invented the Tabulating Machine. Health informatics started evolving in the 1950 with the integration of computer in health care. This new method is progressively replacing paper charting which is often cumbersome, hard to read, time consuming and difficult to archive for an extended period of time. Paper or manual documentation has been the accepted format for many years in nursing, and baby boomers nurses are very comfortable with paper charting. With the evolution of electronic documentation, the Center for Medicaid and Medicare-CMS requires health care facility to convert to Electronic Health Record (EHR) to maximize payment. The electronic system is very well promoted and accepted across the United States. In 2011, Institute Of Medicine (IOM) “strongly recommended the use of electronic solutions to improve quality of care provided to hospitalized patients” (Tiffany et al. 2011).

Clinical documentation is accessible to several team members simultaneously and is easy to store in the data base. Many clinicians believe that “ much of the national attention around the use of electronic solutions assumes that there is a potential for improved patient health outcomes” (p.155). With the adoption of clinical documentation, nurses will communicate more effectively with interdisciplinary team. In addition, the system will also promote nurse to patient rapport while collecting clinical data. Nurses no longer have to rely on human memory to obtain pertinent information during assessment to document in paper charting because electronic system contains approved nursing diagnosis and care plan options based on admitting diagnosis or clinical symptoms.

Millennial nurses are younger and very receptive to electronic record and “ nurses reported being able to complete their work quicker with electronic documentation than paper-based” (p.156) .The integration of electronic charting will enable nurse to perform on time charting at the bedside and improve patient nurse therapeutic relationship.

Following the implementation of Electronic Health Record in a Florida hospital, a doctoral student from the University of Miami and a PhD instructor conducted a pilot study on a medical surgical unit to evaluate quality of care using electronic versus paper-based documentation. In a 560 beds medical center, 139 patients record were reviewed and analyzed in comparison to manual charting. A descriptive study was completed ,and there was evidence that electronic documentation improves quality of care because “ nursing documentation has shifted from the written medical record to the electronic health record because use of the EHR is considered to be beneficial to the quality and safety of health care” ( Li, 2012). The study also established direct relationship between electronic documentation and communication among interdisciplinary team members. Furthermore, it also showed the ability to collect and analyze data and trends in nursing documentation for consistency. Overall, the author and his colleague found eleven out of one hundred thirty-nine documentation inconsistent and incomplete. Inclusion criteria was electronic documentation in nursing and the study was conducted in one setting. This was a limited study because documentation focused mainly on pressure ulcers in acute care.The author suggested further studies to evaluate the effectiveness of electronic documentation.Nursing is very broad and will require more complex studies to evaluate documentation in other nursing areas and specialties. 

Implication for Practice

With the evolution of informatics in nursing, there are many opportunties for nurses to advance their knowledge in electronic data management systems. The Center for Medicare and Medicaid Services (CMS) encourages providers and health facility to adopt EHR to improve patient outcomes and care delivery. A former United States executive was very supportive of electronic health care record and “In an effort to support the development of IT systems in health care settings, President George W. Bush proposed that the fiscal year 2005 budget include $100 million for projects to test the effectiveness of using electronic health records in DSS” (O’Meara, 2007). This really validates the impact of electronic record on patient care and encourages health care professionals to be receptive to the new informatics trends.

Nurses will be expected to be proficient in technology and able to complete electronic documentation as established by healthcare facilities. Nurses ought to adapt to new informatics perspectives and comply with electronic record regulation. Clinical documentation will enable nurses to perform on time charting at patient’s bedside and access patient record remotely . Some nurses might be apprehensive to changes in the electronic documentation due to knowledge deficit in technology. Further clinical studies are deemed appropriate to evaluate the relationship between clinical documentation and patient outcomes. There should be more studies focusing on patient’s perception about clinical documentation and impact on delivery of nursing care. There should be studies analyzing the amount of time nurses spend to perform electronic charting each shift, and more studies should be conducted on nursing attitude toward electronic documentation. Finally, studies should be conducted across the country in different setting using mixed sample with different background.

Conclusion

 Clinical informatics has changed nursing in many ways, and nurses are expected to be proficient in electronic data management to comply with the current trends. Paper-based documentation will soon become obsolete over electronic clinical documentation. Many facilities have invested millions of dollars to expand health care delivery and comply with federal recommendations in managing patient record. After thorough analysis of peer reviewed articles, it is evident that the integration of electronic documentation has directly impacted delivery of nursing care. Nurses are expected to complete training and acquire new knowledge about the new system and associated features. The costly investment is an incentive to higher reimbursement for services provided, and nursing trends will continue to exhibit the expansion of electronic clinical documentation to promote positive impact on patient outcome and satisfaction. Therefore, there is a significant need for nursing curriculum to incorporate informatics and technology in the program.


BULLYING IN NURSING

Bullying is a form of aggressive behavior in which someone intentionally and repeatedly causes another person injury or discomfort. Bullying can take the form of physical contact, words or more subtle actions. ( apa.org)

Growing up in a poor and corrupted country, I experienced oppression and bullying at an early age. Freedom of speech did not exist, and the justice system was very biased and partial. Beauty was defined as being light skinned with curly hair and European’s facial features. Only about 5% The of the population matched that description. I remember some former classmates used to bully me about my brown complexion and non European’s features. I told my mom about my experience, and she said” tell them you did not create yourself. I love you the way you are, and I wish I had another daughter like you” my mom has a very strong personality, and really empowered me to be the best at everything that I do.

I remember telling some of my classmates to stop bullying me because their comments were often very offensive, but they enjoyed the oppressive and ridicule jokes and ignored my feelings. I wonder if I was their sole victim? I internalized most of my feelings to pretend that I was a strong person. I am so happy that my mom thought me about self esteem and courage because her advice truly kept me motivated and focused. I forgave all my oppressors because I realize that they are often unhappy and miserable people who experienced some type of abuse or oppression at some point in their life.

As a new graduate nurse, I never thought that bullying existed in nursing. I quickly noticed some apprehension toward new graduate nurses based on generational differences. At the beginning of my orientation, some of the senior nurses told me that they might have graduated a while ago, but they have been on the unit for many years and are very proficient. They also mentioned that I needed to listen to them and accept my patients’ assignments without complaining. They expressed the importance of challenging myself in order to become a proficient nurse. This was an oppressive strategy designed to discourage new nurses to advocate for change at the workplace.

I was confused about the senior nurses’ comments and perception. I shared my opinion with other new graduate nurses, and they validated my observation.My patients’ assignments were often very challenging in comparison to senior nurses. I decided to accept the assignments to avoid conflict and wanted to exhibit resiliency and team work, so I could fit in. I later realized the more experienced nurses were going home on time and had time to take lunch breaks while I struggled with time management and patients’ care. I approached someone else to inquire about the strategy to complete my work on time, so I could also leave early. I was told that I needed to impress the charge nurses first by accepting patients’ assignments without rebuttal.

I finally realized the rationale behind the constant frustration that most nurses often expressed about their assignments. I witnessed multiple arguments between charge nurses and other staff nurses over patients’ assignments. Some nurses call it ” unfair or unsafe assignments” because they are often composed of multiple discharges, new admissions and patients with complex medical needs. When a nurse has to discharge multiple patients early during the shift, the nurse becomes available for early admission. There is a comprehensive nursing assessment and data collection that must be completed upon admission. This process can be lengthly when patients are unable to provide some of the information due to cognitive deficit or other medical reasons.

Nurses! It is unacceptable to tolerate bullying at work in fear of loosing your job or for other reasons. Some of my peers often try to intimidate me during nursing handoff i.e change of shift report because they believed every task should have been completed before end of shift. However, nursing is a 24 hour duty, so a nurse will not be able to complete all patient’s care in one shift. Some nurses attempted to educate me at the patients’ bedside, I immediately stopped the behavior and reminded them that the patients’ bedside was inappropriate for such activity. I am sure many of you can relate to my experience. Workspace bullying should never be accepted and should be reported immediately to your chain of command or Human Resources.

I learned to advocate for myself because I am not the problem. Unfortunately, I cannot live to please everybody. I can only strive to be the best that I can be. I refuse to be bullied following the horrible experience during my novice years as new graduate nurse. I also acquired some knowledge in labor laws and able to reference some of the regulations to my peers and my superior whenever I express my concerns at the workspace. It is very easy to blame yourself when being bullied or oppressed because the goal is to feel intimidated and uncomfortable. I have become an advocate for myself and others because the impact of bullying can be detrimental and sometimes irreversible. Lastly, I love my brown skin and have accomplished great things in my professional career. One of the best moment in my life is when I was chosen to guide the royal couple – Prince Charles and his wife on a tour as a clinical nurse supervisor. As you can imagine, I became more confident. I know that God created me perfectly because my facial features were not part of the tour’s inclusive criteria. Believe in yourself and you shall accomplish great things.

Sophia Georges, MSN,RN


NURSE STAFFING AND PATIENTS’ OUTCOMES

Everyone needs to advocate for safe nurse to patients’ ratio!

Most healthcare facilities strive to maximize patients’ satisfaction and outcomes. In 2007, the reimbursement system experienced some changes and currently requires healthcare facilities to publish their quality improvement and patients’ satisfaction data to increase payment. Nursing staff plays a vital role in patients’ care and outcomes. They spend more time at the bedside compare to non nursing staff and provide lengthy hours of direct patient care. Evidence has shown a direct relation between patients’ results and inadequate nurse staffing. How does nurse staffing affect patients’ outcomes and quality of care? Nursing school does not prepare nurses to cope with the shortage that healthcare facilities often experience. As a new graduate nurse, I remember my struggle with time management due to high patient ratio on a medical surgical floor.

I was expected to care for six patients with complex medical needs every shift. I quickly realized that I was physically overwhelmed following my twelve hour shift. I went to the bathroom on multiple occasions to cry due to work related stress and physical requirement of the profession. How can healthcare facilities prevent adverse patients’ outcomes as a result of inadequate nurse staffing? Evidence has proven” inadequate nurse staffing and heavy workloads threaten care quality and patient safety and adverse reactions, events such as nosocomial infections, shock, and failure to rescue” (Unruh, 2008) patient dissatisfaction could result in “financial loss, adverse outcomes, readmissions, failure to respond to treatment and possible injury and death” (p.64) I will discuss the correlation between inadequate nurse staffing and patients’ outcomes in the paragraphs below.

Adequate nurse staffing may positively affect patients’ outcome and satisfaction. Many studies have shown that patients respond to treatment better when there is sufficient nursing staff. According to Gordon West, MHA, “hospitals with lower proportions of RN have higher rates of death overall, death following complications (that is , failure to rescue) and other adverse events” (p.22) many healthcare facilities have made improvement in nurse staffing to increase patients’ outcomes and reimbursement. Nurses spend many hours providing direct patients’ care and are able to monitor and assess them for subtle changes. When overwhelmed, nurses have a higher chance of making adverse errors that could potentially affect patients’ response.  Nurses should perform care at their highest level to promote safe result. In the article, staffing matters-every shift, West, MHA reviewed findings from the Military Nursing Outcomes Databases to investigate the effects of staffing levels on the probability of patients’ outcomes.

He reviewed data from annual surveys and patients’ factors i.e. census, acuity, admissions, discharges and transfers. The Military Nursing Outcomes Databases researchers “demonstrated that inadequate nurse staffing is associated with adverse events for patients and injuries to nurses” (West, 2012) the researchers used logistic regression to demonstrate probabilities of error type.  Their analysis showed that “ a decrease in the number of RN’s working on a shift resulted in a decrease in the total nursing care hours per patient per shift, which in turn was associated with an increase probability that a fall would occur on the shift” ( West, p. 25)

In the Nurse Staffing article, Unruh, PhD, discussed the importance of adequate staffing and balance workloads to achieve positive outcome. The author made recommendations based on evidence associating insufficient nursing staff to poor patient’s result and quality of care. Based on her conceptual model “inadequate nurse staffing and excessive workload contribute to a difficult work environment – such as tight time constraints, inadequate supervision of support staff and generally chaotic or stressful work environment” (Unruh, p.64) her model describes the relationship between inadequate staffing, patient, nurse and financial outcomes.

According to her analysis, poor staffing leads to patient dissatisfaction which often leads to injuries, adverse events, failure to rescue, and readmissions. Nurses expressed lack of interest in their job, feeling overwhelmed, stressed and frequently ill which result in absenteeism, turnover and job vacancy. She also addressed the poor financial outcomes which include nonproductive workforce, lower productivity, unnecessary patient care costs and lower patient care revenue. She mentioned that seventeen out of the twenty-one articles that she reviewed concluded there is significant relationship between nurse staffing and patients’ outcomes and quality of care.

Based on literature and evidence, health care facilities will benefit from adequate nurse staffing to maximize patients’ outcomes and quality of care. West, MHA and Unruh, PhD concluded that nurse staffing directly affects patients’ care and outcome. Nurse leaders and administrators should strongly consider reviewing the evidence about staffing and patients’ outcomes to promote patients’ satisfaction and maximum reimbursement. When nurses are physically exhausted, it affects their judgment and delivery of care, so leaders ought to promote a safe work environment with adequate staffing. Facilities should strive to adopt consistent assignment and fewer mandated work hours. They should consider creating float pool, hiring travel staff, developing retention/incentive programs and other strategies to assist with nursing staff shortage. As a nurse, I can validate some of the findings mentioned above because I experienced burnout many times during my career and believed it was normal.

I hope you think about strategies to influence staffing change in you current workspace. You can engage in conversation and evidence based project to help lead the way in your organization. You can be a change agent, and your decision will impact a large group of professionals across the United States and around the world. I encourage you to keep your current job despite staff shortage because I learned that the problem is within the industry. Finally, the grass is really not greener on the other side as we all learned.

Sophia Georges, MSN,RN

Unruh, L (2008) American Journal of Nursing: Nurse Staffing and Patient, Nurse, and Financial Outcomes. 108(1): 62-71

West, G et al (2012)American Journal of Nursing: Staffing Matters- Every Shift. 112(12): 22-27


EVOLUTION OF THE NURSING PROFESSION: IOM RECOMMENDATIONS

Be a Leader!

The Health care delivery system in the United has become very complex and promotes professional development and accountability. Nursing which accounts for a big percentage of health care professionals in America is no exception. The profession has evolved along with healthcare technology, and nurses are no longer bedside technicians who implement prescribed care plan without critical thinking. They have become advance licensed professionals with drug prescriptions and medical diagnoses privilege. In some states, Advance Practice Nurses are independent health care providers who are licensed to work in all care setting. What a major progress from Nightingale’s era?  In October 2010 the Institute of Medicine (IOM) released a report addressing nursing issues in regard to health care complexity and made some recommendations to maximize nursing performance and patients’ outcomes.

The impact of the report on nursing practice is very crucial to the evolving trends of Advance Practice Nurses, Clinical Nurse Specialists, Nurse Anesthetics and other specialties. Medical doctors follow an approved scope of practice with respect to their specialties and are granted independent provider privilege across the Nation. The time has arrived to promote nursing as an honorable profession, and to standardize its scope across the country. Advance Practice Nurses have different level of privilege according to the state they are licensed in. The Institute of Medicine recommends the adoption of a nationwide scope with respect to speciality. the committee believes that Advance Practice Nurses should practice equally across America. Advance Practice Nurses should be educated at the doctorate level in order to manage complex clinical cases.

Some of the proposed recommendations are admission privilege, membership on medical staff, clinical privilege, prescriptions privilege across the country and many more. The nursing pioneers would have been proud and delighted to have witnessed the evolution of Nursing Practice. Higher degree should enable nurses to compete for advance clinical and leadership role. Nurses should strive to maintain current clinical knowledge and approved skills as the profession continues to evolve. The committee also encourages nurses to improve their critical thinking skills and self development. Nurses should participate in local community healthcare events, and Join local or national nursing organization or clubs. Continuing education will promote professional engagement, improve clinical performance and foster changes.

The nurse’s role as leader is also one of the significant change mentioned in the report. The committee suggested the direct involvement of nurse leaders in boardroom and reform committees (Institute of Medicine, 2010). Strong nursing experience is an advantage to nursing leadership because it enables Nurse Administrators and Executives to make appropriate clinical decision to improve nursing outcome. The Goal of the committee according to the Institute of Medicine report on October 2010 , is to double the number of Doctorate Nurses by 2020. The committee believes this will transform nursing greatly and facilitate the standardization of the profession. The higher level of education will also ensure safe replacement of retired nurse leaders, researchers, educators and advance practitioners. The leadership role will promote high quality of nursing care by identifying problems, developing care plan, evaluating outcomes and making adjustment to meet higher level of care as mentioned in the Institute of Medicine 2010 report. That role will also improve professional networking and redefine the nursing profession.

The IOM recommendations will greatly impact the nursing profession because nurse leaders will become change agents and lead culture change in their organizations. Advance Practice Nurses will benefit from the evolution of the profession . Nurses will take pride in leadership position and executive decision making. Bedside caregivers will deliver high quality of care, and they will become experts in their specialty. Nurse leaders will make great impact in their community in collaboration with their peers to promote patients safety and positive outcomes.


SURVIVING NURSING SCHOOL

The way I felt when I was in nursing school!

After choosing a school to attend, most students often lack the knowledge about nursing school physical, mental and intellectual requirement. Nursing school can be very challenging to many and specially foreign students whom English is not their first language. I remember that I was very nervous the first week of school because I did not truly understand how rigorous the program was going to be. I truly felt that school orientation was meant to discourage procrastinators and those who were apprehensive about the program. I guess the school’s Administration wanted to retain the top performers.

I as overwhelmed with information and quickly realized that the next two years were going to be exigent. I had to develop some organizational skills in order to manage orientation week due to all the instructions that I received. I met almost every staff in the nursing school department and received a hand book that contained some bylaws and code of conduct. Can I just say that I did not know what a ” urinal” was when I started nursing school? I had no prior clinical experience and looked forward to my clinical rotation.

If you never cared for anyone before, you just have to believe in yourself, and you will achieve your highest potential. I suggest that you identify your learning method or style, so that you can develop individualized strategies to succeed in nursing school. I was required to take both lecture and clinical on different days of the week. Some days were better than others, and I successfully managed my stress and anxiety level by participating in study group and opening hours at the school library even on Sundays. I also remained in contact with an assigned mentor who shared her success story with me.

The lectures became very intense, and instructors did not have time to cover all the topics mentioned in the syllabus. Self study is very common in nursing school due to the vast curriculum that should be covered. I spent many hours in the library studying specially before the exams. When I was in school, 75% was passed and rounding up was not allowed. Any students who failed either clinical or the lecture portion, was dismissed from the program with a chance to return in the future for one last time.

I must admit that the first semester was the easiest , and the learning objective focused on fundamentals of nursing. I learned about ergonomics, safe patients’ mobility, activity of daily living, bed making and all other basic patient care needs. I completed a final exam on the lecture portion and skills demonstration for the clinical portion. The most fascinating experience was when the faculty sat in a room behind a window to observe my performance, but I could not see them from the room. It felt like I was being interrogated! This was a unique and memorable experience. Did you know nursing students in the state of Maryland can apply for Certified Nursing Assistant (CNA) license after successful completion of fundamentals of nursing i.e first semester of nursing school.

At the end of the hallway, there was a line of students waiting to obtain the result of their clinical performance. Do I need to mention that were all very stressed about the result? Unfortunately, many students dit not make it to the next semester, and it was the beginning of a new adventure. I share some tears with my classmates and realized that I must remain motivated and resilient in order to complete the program. By the second semester, most of the classes lasted six weeks. Therefore, I had to learn at a faster past and study harder. The classes became harder, and I started recording the lectures to promote repetition away from school. This strategy worked for me because I am an audio visual learner. You should complete a free learning style assessment online to find out the best way for you to learn. Can you imagine learning all about Pediatrics, Mental Health, Obstetrics/Gynecology , Pharmacology, Health Assessment in six weeks course? You bet the books contained hundreds of pages with a plethora of new medical and nursing terminology.

By the third semester, I was so stressed that I decided to cut my hair short at the ear level. It felt so good cutting my hair at that time that most people thought I wanted to look cute. The sleepless nights and long hours at the library paid off because I graduated soon after and passed my board. My nursing fellowship lasted thirteen weeks at a local hospital, and it was well organized. I believed that my nursing orientation contributed to the nurse that I have become today.

I was able to work about fifteen hours a week while in nursing school, and many of my classmates shortened their work hours to focus on school. Nursing school remains challenging due to the complexity of the profession and critical thinking skills requirement. Most students can succeed in nursing school with a SMART ( specific, measurable, achievable, relevant and time limited) plan. As a student, you should engage in learning activities that will enhance your academic knowledge and performance while in school. You will benefit from a study group and nursing network. It might be difficult now, but it will be gratifying following graduation. I highly recommend that you attend a school with high passing rate and a comprehensive program.

Sophia Georges, MSN,RN

Learning style assessment:

http://vark-learn.com/the-vark-questionnaire/


MOVING UP THE NURSING LADDER

As a nurse, people often ask me how was I able to leave bedside nursing so early in my career. I often laugh because I get confused about the question. The answer is simple because hard work always pays off. As a new graduate nurse many years ago, I was very inquisitive and looked forward to learning about trends and new evidence in nursing. I asked my unit manager to assign me to a nursing committee, so I could network with my peers. This is management 101! You have to manage your network in other to expand your career, your business and so forth.

Soon after my request, my manager informed me that the unit practice council had a vacant position that I should consider joining the team. I did not hesitate and immediately contacted the chair and voiced my interest in joining the council. I was invited to the next meeting and officially became a member. I was hesitant at first because I did not think I had significant clinical knowledge to make recommendations to the team. I voiced my apprehension, and the other members quickly made me realized that new graduate nurses are very valuable because they recently completed their degrees and possess current knowledge about nursing practice.

I met nurses with 20+ years of experience with different clinical background and different cultural origin. I felt very comfortable working with my team because every member had a voice. I quickly begun to review patient’s record for compliance, audit nursing documentation and review recent patient safety event or hot topics from the unit. This collateral enabled me to challenge myself and to become a prudent nurse. I became fully aware of the significant of nursing documentation and on time charting. I was able to summarize audit findings and submit to the group with recommendations for improvement.

Can you tell that I was a clinical nurse and an unofficial compliance nurse at the same time. My supervisor acknowledged my participation in the nurse practice council committee during morning huddle and staff meeting. Unfortunately, I left that job and accepted a position at a local hospital with different vision and mission. Because I was an experienced nurse, I asked the manager about unit based activities and committees so I could join one. That hospital offered paid clinical ladder to nurses with good standing, so I immediately requested information about the paid clinical ladder and later joined the Unit Practice Council (UPC)

Image result for nursing ladder

The hospital paid an additional $3.000 for each ladder level up to level five. Can you imagine how much additional money a level five can earn? As a nurse, you control your destiny and career. I took advantage of the additional pay and submitted my binder per hospital requirement with clinical narrative, current degree, unit and hospital committee involvement and other internal requirement. It was not hard to organize the binder and to obtain a preceptor validation. The clinical ladder board interviewed me, and I made it to Ladder LevelI before leaving the hospital for a management job.

I volunteered to assist my unit’s manager whenever she needed assistance, so she started sending me to some of her leadership meeting . I even attended budget meeting and other important discussion that affected staff nurses. I realized that the unit manager was like a sandwich receiving pressure from executive leadership and staff. What a challenging role? Why was I interested in management?

I developed a network with many of my peers and some of the unit managers. Can you tell I was positioning myself for future vacancies in other units? I started building my professional reputation on and off the unit. If you want something, you have to work really hard and your goal will become reality. You have to be consistent, determined and very resilient because you will hear a lot of noise from distractors. I also noticed that an advance degree will enable me to transition away from the bedside sooner.

I enrolled in school and obtained my BSN followed by my MSN. I was offered a clinical nurse manager soon after my graduation, and I really needed it following a recent surgery. I mentioned all of my accomplishments as a staff nurse while participating in different nursing committees. I knew where I wanted to be within five year of my career, and I accomplished that goal by working hard, staying focused and committed. You have to keep your eyes on the prize when you need something and avoid noise as much as possible. Some people will try to boycott or sabotage your effort and dedication but stay calm and determined.

I have acquired significant clinical knowledge throughout my career and successfully transitioned from staff nurse to nurse manager and most recently nurse consultant. I love the consultant role because it is very complex position yet fascinating. In my current role, I collaborate with nurses and professionals from other specialties that I have never worked with before. This role truly contributes to my personal and professional growth. Please do not limit yourself and follow your dream. You should conduct a self evaluation to identify some of your weaknesses, strengths and knowledge gap. Once you make the decision to improve yourself and to accomplish your goal, you have to develop a plan with deadline. Next time you go to work, think about where you want to be in a few years and ask yourself how can you get there.

Sophia Georges, MSN,RN


FINANCING NURSING SCHOOL

I would like to congratulate you for deciding to become a nurse. I know the academic pathway will not be easy, but the outcome will be rewarding. Now that you have been accepted to officially attend nursing school, I would like to share some information about financial aid/ scholarships available to nursing students or professionals who would like to obtain a higher degree in nursing.

I would like to state that you should choose a nursing school based on program success, passing rate, national rank, location and other factors that will affect your individual success in school. You should not choose a school because of the name or just to brag about it. You should keep in mind that regardless what school one attends, the same board exam will be administered.

First, you have to complete the free federal student aid application to identify your eligibility for federal aid. Please complete the application even if you think you won’t be qualified. You might benefit from your school’s funding surplus and become eligible for aid. It is important that you visit your financial aid office to explore all your options.

After completing the free federal application, you should explore your state education website to identify tuition assistance and loan repayment program. If you work while attending nursing school, you should contact the Human Resources office to obtain information about qualified degree program that your employer will sponsor. I received funding from my previous employers for school with the commitment to work a few months following each disbursement.

I currently live in Maryland, so I will share funding available to nurses from the state, local schools, employers and other sponsors. Maryland Higher education currently offers multiple funding options available to nursing students and nurses. There is a nursing loan repayment program based on income, nurse faculty loan repayment program and other available scholarship. you will need proof of degree completion, nursing licenses, income verification and other pertinent information. you can access the link on my page using the menu bar or by accessing the link below.

University of Maryland currently offers full scholarship to qualified nursing students. Please access their sites below and review if you might benefit from the funding. You can also consider a local Community College to complete a free “Associate Degree” based on your household income. Montgomery College located in Montgomery County, MD offers multiple type of scholarships to nursing students. you can also visit their website below to explore your opportunities.

you can enroll in Military Reserve Officer Training Corps(ROTC) while in nursing school and obtain free tuition with commitment to enroll as active duty nurse upon graduation for a required number of years. This is a great option for many nurses because you might be eligible for additional benefits while on reserved status. Please visit the United State Military website for admission criteria.

As you can see your opportunities are endless as a nursing student. you will acquire a wealth of knowledge as a nurse upon completion of your program. I highly encourage you to carefully research the school you would like to attend for accreditation, violations, performance citation and more. It is wonderful to be able to complete school without accumulating massive debt. However, you should not be discouraged if you are not qualified for any aid because you can always apply next time or receive loan repayment assistance from your state or your employer following graduation. Most healthcare facilities offer tuition with the hope to retain their best employees.

Best of Luck!

Sophia Georges, MSN, RN

Link to Financial Aid/ Scholarships

https://studentaid.ed.gov/sa/

https://www.goarmy.com/rotc.html

https://www.nursing.umaryland.edu/admissions/financial-aid/umson-scholarships/conway/

https://www.montgomerycollege.edu/search/?placeholder=&q=nursing+scholarship

https://mhec.maryland.gov/preparing/Pages/FinancialAid/descriptions.aspx


Why I Became a Nurse

I am new to WordPress, so I am using my forum to discuss why I became a nurse today.

Nursing has evolved in the past decades, and has become one of the fastest growing profession according to Bureau of Labor Statistics. Furthermore, nurses on average hold a bachelor degree and make between $34.48/hr. or $71730.00/year. ( bls.gov) I love my profession, and have been fortunate to work in Medical Surgical Nursing, Short Stay, IMC, Progressive care, float pool. With my 10 year plus experience, I also became an Adjunct Nurse Faculty , Clinical Nurse Supervisor and most currently a Nurse Consultant in patient safety.

When I was younger, I thought nurses only clean patients and seek medical guidance from independent providers prior to each nursing intervention. I realized that nurses were very educated and knowledgeable many years ago following genetic counseling. The nurses were very professional ,and I saw them more then I saw the doctors. I immediately developed a passion for health education and decided to return to school to major in nursing. I earned credit for most of the general courses and was only required to take 5 science classes in order to apply to the program. I completed the classes in two semesters and was accepted into a community college with free tuition based on grade point average. In return, I had to work in state for 2 years which I did. I passed my board on the 1st attempt ,and I was overjoyed.

I returned to school within a few years of my career and obtained a Bachelor of Science in Nursing and a Master’s degree in Nursing from a local state university. I did receive a state scholarship, but it was not enough to cover all the tuition. I used some student loans to finance most of my graduate studies because my job did not offer tuition assistance at that time. I feel that nursing is the most rewarding career because I can choose my specialty and work in clinical setting or Administration. Lastly, nursing students should not choose nursing for financial purpose because nursing is overwhelming and one should be mentally prepared to care for unstable patients who rely on nurses’ support and empathy. I love caring for patients and enjoy educating them and their significant others. I hope to write about many trends in nursing such as, Associates Degree in Nursing vs Bachelor of Science in Nursing, Bullying in Nursing, Cultural Competence, Conflict Resolution, Nursing Documentation, Scope of Practice, Nursing Management and Leadership, Moving up the ladder and more.

Sophia Georges, MSN,RN