Wednesday, February 9, 2022

ACRN certified

 I recently changed my role to clinical services manager, where I solely manage the program that focuses on health of individual living with HIV. I started my role as Clinical Practice Manager in Primary Health Care in 2018. When I started my role as CPM, I was beyond excited since my dream to work in community level came true. Today I am beyond excited to share that I have added few more letters behind my name. I am AIDS Certified Registered Nurse (ACRN). Also so proud to say that I am first Nurse in state of Iowa to get the certification. 



Sunday, August 2, 2020

What I encounter as a Brown Nurse


I have recently started respecting myself and giving a pat on my back myself for what I have accomplished as an immigrant here in The United States. There are lots of aww moment in my Nursing carrier that made me feel that I made a right decision to be a nurse and serve here. I had great co-workers and leaders whom I worked with. I might not have been so successful in my nursing carrier if had not worked with my first nurse manager at Mercy Hospital, Ardmore, Oklahoma. She was always an inspiration to me and a great mentor. I always wished all my manager were like her, but I do not live in a fairy tale. This is a real life and both positivity and negativity exist in this world. I did work with some coworkers who just saw me as a nurse and a person, they never saw my color, they never noticed my accent and the list goes on. Despite the great moments during my nursing carrier, I also had lots of unforgettable gloomy moments that made me stronger and more robust in my views.

I went to one of the finest schools for my nursing degree, I always wished if there was more cultural diversity in our class. I was one of the handful who was international, or who looked like me. I always wondered why I only had three or four friends during my entire undergraduate college. Believe or not out of those three two of them were born and raised outside of the States. I believe I talked with handful of students in that class. Now I wonder why we were not involved in anything that happened in that class. Why I had such a hard time even to start conversation with them. I always felt inferior in front of them. Today when I retrospect, I realize why we two were left out in that college was not only because of our skin color and race but also due to our socio-economic status, culture, religion, language, and nationality. We did not grow up watching Batman, Home Alone, Star Wars, friends, and the Office. When my classmates used to be so excited about the Christmas break and plans about Thanksgiving break, I spent my time in a lonely dorm learning about Christmas and Thanksgiving. I wished if I could get a day off during Dashain and Tihar instead of Christmas or Thanksgiving but who would change the college policy for one person. Wished I had learnt I would be able to take days off without getting penalty if I had disclosed as religious reason. When my classmates planned summer break at beach or international travel or vacation with family. I was planning where to embark my personal stuffs since we must leave the dorm during summer. I would load my 1996 Corolla and start the car without knowing where I was going to crash that night. After summer break I always had hard time going back to school. Every fall, I will unload my car by myself, move everything to that third floor I still ask myself why all my dorm was on third floor. On the other hand, most of the students had their families seeing them off, helping them to settle in a dorm. During those times I missed my family so much and asked myself “What am I doing here, what is the point of this.” I cried alone; of course, long-distance relationship was not helpful at all.

I have very few positive experiences except I had with Adiza and Library. Hold on I had more than that, couple of parties I had with other Nepali speaking students. I was a Mentor for International students, I was President for Nepalese Student Organization at UVA. Today, I reflect and ask myself why all my involvement incorporated only international students or minor students in school. I learned how to cook Thai food, Indian food, Chinese food at so on but I never learned how to cook American food. We were always left out in that class which consisted 90+ students. Our last week before graduation, students went to Myrtle beach, a graduation culture at UVA, but I was just ready to graduate and leave the college as soon as possible.

By the time I graduated, I was already married to love of my life. I was complete with him by my side. I started feeling included, I started feeling respected for what I have accomplished. But I was not aware of the reality. I faced the truth of being minor or colored person after I started working as a Nurse. Experience as a Student nurse was different, I just felt I was not included but I was never abused or any targeted racism.

I picked up lots of hours and night shifts. One day, around 1:00 AM, alarm went off on one of the medical equipment, so I went to the patient’s room whom I was not assigned to take care.  She was in a deep sleep, I decided to turn the phone’s flashlight so that I could trouble shoot the machine without turning bright light and disturbing her sleep. Then I realized that she was already awake because of the alarm. After she saw me with a flashlight, she told me that I could turn the light on. I turned the light on, as soon as I turned the light on, she responded “What the heck you are doing here”. I responded her back that I was there to stop the alarm. She got irritated since it took little longer than expected and commented with “You Mexican get out of my room and go back to your country.” She did not see any of my nice behaviors, only thing she saw was my color. I felt bad for her and answered myself “Smita imagine what her life is like if her behavior is like this with someone like you.” I felt bad for her thinking that every brown person is from Mexico and that brown persons are inherently bad.

Another story I would like to share. After taking care of an acutely ill patient for 5 days, I was ready to discharge him. I was so happy for him and the family that he was finally going back home. I printed out all the discharge paperwork. Got medication planner, got educational materials so that he could manage his Diabetes easily. His response to me during his stay was different from other nurses and I gave benefit of doubt that he is sick and stressed out. But I was wrong when he commented, “Can you please speak in English, I do not understand your language.” I was in shock, I was speaking the same language, English, for last 5 days with him. I was speaking the same language when I was cleaning him up when he was not even able to get up and walk to the bathroom. He understood everything what I said when he was ill. Now he is stronger and better and all sudden I have an accent that even does not sound English and he cannot understand me.

When I was asked if I was Indian, Mexican or some other nationalities by patients and co-workers, I feel offended every time. If you do not know the person, then you do not know where they are from just looking at their skin and their physical structure. Hence please just ask where that person is from instead of making assumptions about Indian, Pakistani, Bangladeshi, Mexican and or any other countries with brown people. I am so happy to say I am from Nepal rather than, explaining why I am not from the country they assumed. Other side of the story is why a patient needs to know where I came from, when I am giving a best patient care they have ever got. Do not take me wrong, I have taken care of patients who genuinely asked me where I was from, but majority of the patients ask because of my color. Most of those questions comes with attitude of “why the heck are you in OUR country”. The questions do not end there, they continue to ask me questions like “do you not like your country? When are you going back?” They are not aware that I left my birthplace 15 years ago when I was 18. I am a US citizen now and this is my country, I belong here but I am not still accepted by public. No matter what my citizenship status is I am never seen as a US citizen without proving myself by explaining because of my skin color.

Targeted racism not only come from patients, I sadly have to say that sometimes it comes from co-workers, leaders too. One day, I was minding my own business, charting in nursing station. Two of the nurses in station were having conversation. I heard the conversation and shocked with their ignorant sense of humor. One of the nurses asked another one, do you know what 25 MPH means in Crawfordsville, IN? and the nurse explains as this, “That means 25 Mexicans per house”, and followed by big laugh. Then I was asked why I am not laughing at their comment. I responded them back as it’s not appropriate, and I did not want to participate. Then I left the Nursing station. Refusing not to participate was the right thing to do but I should have acted on it too. But I failed to do so.

It was another normal day at work when I arrived at work. I questioned about my patient assignment sensing favoritism. I got harsh comment from him “Smita do not complain. If you do again, I will have to call homeland security and you might get deported.” He did not know that I am an American Citizen and worked hard to be a citizen. But that was not the point if I was American or not, the behavior was not right, and that comment was not right. None of the nurses voiced any concern after that comment or and they did not want to get involved. I was the only brown Nurse in that floor or may be in that whole hospital. I had enough after that comment and I left the job. I should have reported to HR but I was not strong enough to report at that time. I was scared and I ran away from the situation.

Above examples are just some comments and behaviors that I encountered during my school and work. There is so much to change on healthcare provider abuse as a whole and mainly racism towards colored nurses. Often, our ideas are overlooked by leaders but when the same idea comes from the white colleagues, they get recognized for similar idea. We must prove ourselves to patients and our leaders that we are asset to the general population and to the organization whom we work for. Proving once is not enough. We must prove every step during our career and life just because of our color. Struggle goes on. Hope our next generation do not have to struggle for this and face this. Am I asking too much from the society where we are and where we belong to?


Tuesday, June 18, 2019

Answering Priority NCLEX style questions

I found this video in Youtube and really felt that this will be really helpful for those who are struggling with priority questions. She does a great job explaining the content and how to answer the questions.
Good Luck

Monday, February 8, 2016

All you need about ECG (Electrocardiogram) information

Great website about the ECG information. Just click on left side what you want information about all about rhythms and heart. Enjoy surfing about the heart.
Thank you ECGguru.com
All about Cardiac Rhythm (Ecgguru.com)

Sunday, December 7, 2014

Kaplan's free RN Prep Study

Kaplan provides some free prep materials like sample classes, strategy seminar, Practice test, Critical thinking seminar, how to survive nursing school clinicals and so on. Some of those seminars are online and you can join from your own computer from your home. And some of them are in class that you can sign up for free. You will really get great information, I suggest all of you to go through it. Here is the website for Kaplan.
NCLEX RN Prep Free Seminars

Wednesday, June 18, 2014

Whose fault is it? and what is wrong if you think little outside the box?

           Nowadays I do have lots of free time since I am in transition of looking for new job, hence most my time is in computer doing school work and facebooking. While going through the facebook, I found this article titled, " 15 Dumbest Patients that doctors have had to deal with. Faith in humanity lost."http://www.tickld.com/x/15-dumbest-patients-ever. I usually don't click on these kind of links but when you have nothing to do, you do everything that you did not used to do. Invested my time to read all those 15 points, while going through each and every it made me to think about our healthcare system and our generation. Our generation thinks that we know each and every aspect of life and if someone does not know anything that we know, we think they are dumb or crazy. There are lots of nurses and doctors out there who does not know where exactly is Nepal, some even does not know that Nepal is a country, and some even does not know that Nepal even exists. That does not mean that those nurses and doctors are dumb for not knowing geography, that's what exactly my point is. If you know all the medical stuff that does not mean you know everything about other stuffs. The patient/person you are referring as dumb may be a farmer who knows each and every thing about farming and he may be your source who is helping you to have a food in your dining table tonight.
        
Here are the some scenarios that I want to talk about:

1) " I once had a 20 year old female patient who didn't know that having sex would lead to pregnancy. She had no idea."

            After reading this point thousands of people might have laughed and shared the story to other coworkers. That 20 year old female may be from different culture or may follow different religion. She might have been not only in abstinence but also restricted from sex education. If someone does not tell you or if you are not allowed to learn about something, how are you going to learn about sex? For those girls, someone who knows about sex when they are 12 years old and gets pregnant when they are 13-14 are crazy and dumb. But in reality no one is dumb or crazy, it is just the reality of different culture, level of education, and their experience of life.

2) " After looking at the patient's chart and seeing she had diabetes
Me: Do you have any medical conditions?
Patient: No
Me: Are you sure, you've never been told you have any disease
Patient: Never
Me: What Medications do you take?
Patient: Insulin, for my diabetes

           What you all think about this conversation, your first reaction may be what?, really? seriously? lol? and so on...... but think from the other side, think as a patient perspective. That patient did not go to medical school or nursing school nor worked in a medical field. None of her family members have any experience about medical terminology. When patient was first diagnosed with diabetes, did any of the medical person sat down and educated the patient about his new diagnosis. Did anybody informed the person that diabetes is a medical condition, or a disease. May be those nurses or doctors were too busy saving lives, that is our excuse most of the time.  Whose fault is it now in this situation and who is dumb or crazy. Hence, before you laugh and say someone crazy/dumb please try to think out of the box and try to stand on their feet.

3) "A middle aged lady in the operating theater once told us at the last minute (as she was being wheeled in) that she's allergic to latex. Everyone freaks out cos so much of the stuff we use in theater has latex in it, so we take her to the latex free theater and do her surgery there. When she's in recovery and awake I enquire as to what reaction she has to latex. " I just don't really like the sound the latex gloves make, dear". I just turned around and walked out."

       If I was that nurse/medical personal who heard that little lady saying she is allergic to latex, I might have same reaction or I might have walked out. But, if we think and evaluate it it is nurse's or that medical personal fault, who asked if patient have any allergic reaction or but does what kind of reaction, or verify it with patient chart. If someone at least had asked what kind of reaction? then they would not have gone through extra hassle.

4) "20- something year old patient comes to ER, chief complaint on the board is "private." This should be good. Go in, he is visibly depressed and sad. Tells a story about how he slept with a women, didn't use protection, and after he noticed she had a "plastic box on her." When she told it was an insulin pump for diabetes he was mortified. Came in immediately to be tested for diabetes. "

      This is similar to the first point I discussed here. It is lack of education. That patient is not aware of disease process of diabetes. If you think as a normal person without any knowledge of medicine, if you get HIV through sexual transmission why not another disease like diabetes. What is our responsibility here? provide education. There is still stigma around HIV it gets transmitted through mosquito, by sharing room and personal items with patients etc. Shouldn't we provide more education. 

5) " Don't eat or drink anything after midnight" Before his 3 year old daughter's surgery the next morning (tonsils and adenoids). While intubating his daughter the next morning, she vomited scrambled eggs, causing her to aspirate them into her lungs. Her heart stopped, and I did chest compressions on her for 25 minutes. We got her back, aborted the surgery, and transferred her to pediatric ICU on a ventilator. Her father's response..." she said she was hungry. I thought you were being too hard on her. It must have been something you did to her."

     We provide education in a way how we want to hear, but providing education means to provide education in the way how that person is going to take it. Do not eat or drink anything after midnight. That is not a education that is instruction or better an order that you are giving to the patient/ family members. You should provide an education when you verify with the patient/family members did they really understood what you are trying to teach. That medical doctor/nurse/ medical representative should have given extra 2 minutes to describe reasons for not eating before surgery. Also another questions arise, did anyone asked the father if patient have eaten anything that morning before surgery. May be not, because we think according to our way, if I said not to eat, patient might not have eaten, right?

6) "The best was the women who was feeding her 3 month old dog every few days for no other reason than she thought a dog should only eat that often. Came in for hypoglycemia(0f course). 
The nurse who spoke with her has no patient for this kind of jacked ignorance, and actually shouted at her "DO YOU EAT EVERY THREE DAYS!?""

      May be she has dementia like our grandmother or grand father have, may be that patient have some psychological problems that might have been ignored by the medical personals. And she might have genuinely thought that's how you feed dog.

 7) "Once had a patient who was prescribed an inhaler for his cat allergy. He came back a week later saying he was none the better. Turns out he was spraying the inhaler on his cat. 

--see below


8) " My favorite was when someone was prescribed estrogen patches and told a stick one patch on herself every other day. At the next follow-up she said she didn't like the patches because she had been running out of space." I didn't think to clarify to her that she should have been placing a new patch and removing the one from yesterday each day. Very amusing. She indeed was covered in sticky patches.

      During my last three of nursing career, I had a great group of co-workers, leaders and supervisors. I learned a lot from them, and still I have to learn more. One of the story that one of my supervisor shared was almost the same like above two. This gentleman came back to ER stating that he did not liked taking suppository for his constipation because it tasted bad. (By the way suppository should be inserted anally.) While she was saying the story she was not laughing and she was not pointing that patient as a dumb or crazy. She had a chance to learn something new during her initial nursing career and teach us about nursing education citing the story. In all the stories described above in points 7 and 8 and story of my supervisor's patient reflects that we are still lacking with good education in healthcare for our patient population. It's not even education. it's 10 second instruction. We still need to be more clear and concise with our patients. Put a patch every other day means putting a patch every other day, we also need to explain them that old patch needs to be taken out before patient applies the new patch. If that inhaler was the first prescription for that patient, we lacked to provide education how to use the inhaler, that's why patient came back to ER. That is not good for patients and also not good for the hospitals. We are using the resources that are always in shortage for some of the stuff that did not need us due to our own fault or negligence.

Out of those 15 examples, I talked about 8 of the above, that I thought there is lack of education for our patients, and lack of our common sense, since we do not think out of the box. Please start thinking something different than you think and please at least start to think what's going on the other end. It is just a feelings and thoughts that I shared here, no one have to think like me and no one have to agree with me too. I may not know how the plants of my favorite foods look like and I still enjoy it and I think a farmer does not expect me to know how those trees look like.

Thank you
Smita Sharma
Indiana.

Thursday, June 5, 2014

Kaplan's Video about NCLEX RN test.....

I really got surprised when I saw these videos yesterday. You might be surprised with the fact that I passed my NCLEX more than two and half years ago, but I do constantly do researches for the NCLEX resources to assist new graduates and for those who is planning to give the test. These Kaplan videos by Barbara Irwin, MSN, RN will be really helpful for you all. First video is overall about the NCLEX test and will help to decline your stress and fear, and will answers lots of questions that are arising in your mind about NCLEX




Thursday, May 22, 2014

How to Transfer your RN license to Indiana from other states

Recently I moved from Oklahoma to Indiana and had to transfer my Oklahoma RN license to Indiana. It was not that much of stressful but still it is taking some time. If you are planning to transfer your license to Indiana here is the "Step by Step" process that I did:

1) Indiana does not have a separate website for Board of Nursing it is under Indiana Professional Licensing Agency (PLA). And here is the link
http://www.in.gov/pla/nursing.htm

2) Transfer of license is called endorsement application. Here is the link below with instructions and it is pretty detailed in the website itself.
http://www.in.gov/pla/2506.htm

3) After you get into the link above application form is underlined as completed application which is on PDF file.

4) You need PDF installed in the computer if not you can get it from http://get.adobe.com/reader/

5) After you download the application form, application form will look like this:
you can type or print, if you decide to type you can save the data.

6) After application is filled, along with your application you need to submit $50 application fee payable to "Indiana Professional Licensing Agency" , proof of license in another state ie (Scan or print copy of your license from your state) and a photograph as described by Indiana professional licensing agency as below:

Include a photograph, approximately 2 ½ x 3 ½ inches, head and shoulders view, black and white or color, of professional quality. Polaroid type or laminated photographs will not be accepted. Please tape, rather than staple, the photo to the application. Please place your signature on the front of your photograph
 Derived from http://www.in.gov/pla/2506.htm 

7) Mail to the address :

Professional Licensing Agency     
Attn: Indiana State Board of Nursing
402 W. Washington Street, Room W072
Indianapolis, Indiana 46204


8) Send your Transcript: from your college directly sent from college in a sealed envelope from the registrar's office.

9) Request license verification from your state, you have to fill out separate form for this step and form can be found in your board of nursing website.You can find the application form for Oklahoma
https://www.ok.gov/nursing/forms3.html it is all the way down in the list called written verification of Licensure and they will charge you $40 (Fee may change)

10) Wait for response from the staff that they got your application.

11) After you get the response your next step is background check you can call or register at http://www.identogo.com/

12) After all this done now just wait for the result.

Good luck and best of luck for your nursing career, I hope you love your nursing career as much as I do or more that I do (I don't think that is possible just kidding........)

Tuesday, January 21, 2014

Beauty of small hospital.

      Today at work, I was able to see almost every aspect of life.  I took care of an 8-months patient who is learning how to hold bottle for his survival, got opportunity to take care of 84-years old lady who has to call for a nurse even for a sip of water. I did hear a story of a veteran who served for the country. Today someone is serving for him and he feels embarrassed about the situation and really thankful for the nurses and staff for the great care. I took care of a pleasant gentleman who heard the news that he is free from cancer after part of his organ was removed. On top of all that I took care of a patient who got diagnosed with cancer which is not curable and there is nothing in this world that could make him happy today. 
       At the end of the day I questioned myself what kind of nurse I am. Today I had a surgical patient, medical patient, I had an ortho patient and surely I had a pediatric. I am a pediatric nurse but I get chance to take care of wide range of population which is the beauty of a small hospital. Although management and administration try to allocate specific area for the patients, sometimes it's not possible and floor nurse end up having fun with gathering lots of experience. At the end of the day, it does not matter where you work and whom you take care of, it matters how much you affected the life of that specific person with your good deed. 

      To all nurses anywhere in the world... love what you do, try to make a space on each and every person's heart and care like your family member, you never know when your grandmother might end up next door. 

Saturday, January 4, 2014

I love being a Nurse....

I took care of 82 years old today, after working in surgical floor for a month two things I have learned is get SCDs and IS for a patient, since she had hard time using IS, I decided to ask her to do deep cough and breathing every time I enter the room, I realized, it went little extreme when my patient started coughing every time when she saw me even while I was walking down the hall. I admit sometime we do torture the patient unintentionally although it is good for them.......I love being a nurse......

Friday, December 6, 2013

Tips for NCLEX test


Here are some tips for NCLEX test for the process and for the exam itself

1) Decision Tree
Decision Tree

2) Test Taking Strategies for Nursing Students by Caralee Bromme'RN, MSN CCRN 
Test Taking Strategies for NCLEX 

3) Official website about NCLEX with detail information 
Make sure you go through every little bit of information you can find in this website especially tips for BeforeDuring and After the examination 

4) National Council of State Board of Nursing 
If you want to learn more about NCLEX examination as a whole follow the link below 
 NCSBN  

Please Enjoy and I will keep posting, if you feel like I need to add something more let me know thank you.

Saturday, November 30, 2013

NCLEX Decision Tree (Similar to Kaplan)

After a long wait and search, I am able to find the decision tree here in internet. This decision tree is almost similar to Kaplan Decision tree. It was very helpful for me. Mostly it is important to those who knows the content but unable to choose the right answer. Helps for critical thinking.
More NCLEX RN Practice questions: Free NCLEX RN Practice questions
Derived from: http://www.slideshare.net/rebeccabowman2/decision-tree-25818301?from_search=11

Top Patient Safety Strategies to implement now

Nowadays I am more interested in quality improvement in medical settings, which includes, nursing, medical, pharmaceutical and so on. Here is the great article that I found while going through Medscape.com. It is short and precise slideshow presented by Laura A. Stokowski, RN, MS. Please click the link below

Top Patient Safety Strategies to implement now




 References:
Picture: Derived from, http://www.medscape.com/features/slideshow/patient-safety, November 30, 2013, Stokowski, Laura A.

Monday, October 28, 2013

Made my day.....

At the end of the shift, 86 years old cute little lady asked me, " are you going to be here tomorrow, I have to leave hospital for whole afternoon tomorrow, if you are going to be here I can leave him alone,(pointing her 90 yrs old husband, who are married for good 64 years) I know you will take a good care of him, I trust you" made my day.......

Monday, August 19, 2013

Site for NCLEX 3500 is working now

Site for NCLEX 3500 was down for a while, it is working now. Here is the link
NCLEX 3500
best of luck
More NCLEX RN practice questions: Free NCLEX RN practice questions

Wednesday, July 17, 2013

Pearsonvue Trick for NCLEX

Just done with your NCLEX test ? Worried about the results?, I will not pay extra money to know the result, here the trick that it is almost accurate.

Try to re-register at Pearson-vue website, if you get the message 'our records indicate that you have recently scheduled this exam. please contact your member board for further assistance. another registration cannot be made at this time. That means you passed. if you do not get message and go straight to the credit card information page, that means you did not pass.

I tried it when I tested for NCLEX and it worked, it's working for almost everyone who is giving test this year.

Good luck and have a great carrier in Nursing.

For free NCLEX practice questions follow the link you can find thounds of practice questions for free including HURST and Kaplan resources. Enjoy
Free NCLEX practice questions


Sunday, June 24, 2012

Achievement in Nursing carrer

Picture speaks itself....

Good luck new graduates

Good luck all new graduates and anyone around the world who is planning to take NCLEX test. NCLEX is not an easy test neither horrible, you need to make sure that you read questions closely, make sure to go through all the options although you are 100% sure about the answer, don't jump to the conclusion. Every one of you is smart and intelligent because graduating from nursing school is not a cup of tea, but we still need to go through the test to prove that you can deliver safe and effective nursing care, able to prioritize the problems. Just relax and answer every questions individually, it does not matter how many questions you have to take 75 or 265, also it does not matter how many times you have to take a test, it does only matters you passed or not, and sure you all will do great.
Good luck all.....praying for all you.
Enjoy the free NCLEX practice questions: Free NCLEX RN practice questions