Nurse Blake's Tutoring

06/09/2025

Good morning! It's been awhile . Life has been incredibly busy and doesn't seem to want to slow down any.

I just wanted to take a minute to say hello and say I am currently working on returning to the working world of nursing. I will continue to be available for help, to bounce concerns or ideas off of, to be a support to young or older nurses.

My approach to tutoring or educating in general is not always a traditional approach. I believe in order for students or nurses to grow and learn they need to hear the truth of nursing, not just memorizing and repeating facts. I teach through stories of my own experiences, by talking about the evolution of nursing since I started 31 years ago.

I explain how we used to practice and how that taught me how to have not only incredible assessment skills, critical care skills you now have to have a certificate to use, but was every day practice for nurses when I started in Oncology. I also, teach how to cope and deal with stresses of the reality of the job.

Stress management and coping isn't something nursing programs talk about or teach because there isn't built in criteria for it because there is so much to learn. Programs have changed so much in the past 5-10 years with nursing shortage and the pandemic. There are some schools now who aren't even preparing nurses for their every day roles and expectations, but instead basically teaching the bare minimum not only in the disease processes but skills too.

It truly saddens me to see our once beloved profession reduced to what it's becoming. So my hope for this page now is to not only be resource for tutoring but also be a mentor and advocate for my fellow nurses. So, whether you are a student looking for clarity or help, or a new nurse looking for guidance, or an experienced nurse looking for advice or understanding, I am here.

I DO NOT charge for my time or efforts to prepare lessons. I just want to help you and try to save a profession I deeply care for. The profession which has helped me grow in all areas of my life and in ways I never realized until I became disabled from all years of abuse to my body. I have had time to look back, reflect and learn from the years I took care of everyone else, but forgot I needed to care for myself.

Nursing is one of the HARDEST jobs out there and would dare anyone to challenge that fact. The amount of knowledge we have to learn and understand just in the first two years let alone the list of prerequisites we have to complete to even be eligible to apply to programs and the complexity of them is enough to make you question if it's worth it. They don't teach about the stress it puts on your mind and body in realistic terms. Very few professors share their true experiences and struggles. I believe if more did it would humanize the nursing experience for students. All the students I have worked with off and on for the last 15 years, have expressed to me the stories I shared, had not only helped them understand the material better, but had given them a real view into the world to which they're committing.

Hope to hear from anyone who could benefit from my experience or help! You can dm me or drop a comment below and I'll get back to you as soon as I can!

Hope everyone has a safe and fun summer!

03/03/2025

It has been a few months since I posted and I apologize, it has been a crazy few months in our household. I hope the information on the page has been useful to those of you who have checked it out. I thought today I would discuss the assessment process and how to hone your skills.

The assessment process is our number one tool we use every hour of every minute of our day in nursing, so it is critical you make every effort to hone them every single day. We use most of our senses when we are caring for patients. We use our sense of touch, sight, hearing, and smell. If you aren’t or were not taught this hopefully this will give you new insight.

The very first two things when entering a room and greeting your patient we use are our sense of sight and hearing. Our greeting of, how are you feeling today, uses our hearing and we need to listen and not just be using lip service of asking and then not paying attention. I know some patients talk a lot and you’re busy, but I promise if you politely take control of the conversation and stir it in a productive direction with active listening, they will give you the key to what needs to be addressed for them for the day. I know how annoying it feels when you’re really busy and they want to talk a lot, but if you complete your initials first thing before you pull meds, or treatments or whatever else is on your list for the day, you will save yourself a lot of time throughout the day.

I spent my first four years doing team nursing as an LPN with RNs on a remarkably busy 30+ bed Oncology unit. I had to hone my assessment skills quickly because back then RNs and LPNs did what critical care nurses do today without specialty training and certification. Our patients did not leave our unit to go to the ICU unless it was absolutely necessary and then they spent the shortest amount of time there that was needed. We often turned our beds into IMC beds to increase their care needs. We did this so they were not exposed to unnecessary germs and risk hospital acquired infections. I was blessed to work with a group of RNs who were willing to trade skills with me and we helped each other grow and learn.

I often got assigned to new graduate nurses after a couple of years to help them hone their practical skills because that was not a big focus back then when you got your RN. They were taught but it was not the focus like it was for an LPN at the time. So, I taught them things like wound care, colostomy care, enemas, etc. While they taught me how to hone my assessment skills, let me watch them put IVs in and learn their skills by watching their techniques. See back in the mid-nineties not all our patients receiving chemotherapy had central lines. They had to use peripheral lines, but they HAD to be in the vein with one stick with no movement. It was what we called a clean stick. There was one chemotherapy which had to be given with an all-steel needle with no catheter to leave in the vein just the needle. So, IV skills were critical to perfect.
I often helped run codes because I was trusted and respected not only by my own unit nurses but by the code team nurses. I was not afraid to jump in and help. I often either did compressions or gave histories so the RNs could concentrate on pushing drugs and get supplies, because most new graduates would freeze or not know what facts were critical to share to the code team. It came down to experience, not egos.

Insurance companies did not limit us. Our patients stayed sometimes for months at a time in the same room. Now you are lucky if they stay for 2-3 days, which is why your assessment skills are even more critical to hone than they were for me in the beginning.

So, as I said, start your morning off by saying good morning, offering a warm washcloth to wash their hands and face before breakfast. Listen to them, then start your assessment off based on their admission diagnosis and history. Trust me if you do first thing, the breakfast trays will be coming, and no one wants a cold breakfast, so they are quicker to get to the point. I would do a quick mini neuro exam then move down to the heart, lungs, bowels, pulse points, all the time watching how they breathe, their skin tone, texture and looking for open sores or wounds. Looking at their IV site(s), NG tubes, foley catheters, re**al tubes, colostomies, etc. OBSERVING, FEELING, HEARING and sometimes noticing SMELLS, as I went. I made quick little notes, not sentences, notes, standard or more own abbreviations, I could go back to throughout the day. Anything important, vital signs, assessment abnormalities, patient’s needs, meds outside of my normal med pass, were always on my patient info sheet.

This habit helped me when I needed to chart, it helped me prioritize my patients’ needs, it acted as a reference in case something changed in my patient. There are specifics smells for specific diseases you will learn. The first time you smell a lower GI bleed; you will never forget it afterwards. The first tumor you smell will not be your last. I still to this day can smell people’s tumors even just with casual interactions with them in public.
All this data you take in through your senses is critical information to gain, learn and store. When you are floated to other units do not look at it as a punishment or a nuisance, but as an opportunity to gain more knowledge and skills. I will be the first to admit I ABSOLUTELY hated floating to other units, until I changed the way I looked at it. Once you change your attitude towards it, and embrace it as a learning opportunity, it makes your shift a lot easier, and the unit nurses are more willing to help.

I had a few rules as a charge nurse and one I ask you to think about if and when you get into that position. All the assignments I made were based on the acuity of the patients we had, float nurses got the easier assignments, because if they came from specialty departments, they did not always have the same knowledge set we did, and in doing so it kept people happy. I did not show favoritism with assignments, I did not allow my nurses to complain or try to bully me into changing them, it was not up for discussion it was what was best for the patients. You will get Labor and Delivery nurses who have never worked with adults in their career or limited and it is not fair to give them all bedbound, incontinent, or patients needing heavily skilled nursing. I often gave them the patients who could walk and talk and be self-sufficient. I know this was not an immensely popular thing, but I was not there to be popular, I was there to make sure patients got the best care possible.

If you can hone those assessment skills, pay close attention to the seasoned nurses you are assigned to when you are going through orientation, you will pick up little habits, to make your job easier.
Now, if you get a nurse preceptor who is not working well with you or enhancing your skills or knowledge or is mistreating you, do not be afraid to speak up. This is your career, your license, your opportunity to hone your skills under the supervision of a seasoned nurse to make your transition into being on your own, easier. If talking to them honestly and with purpose does not help then you ask for a confidential closed-door meeting with your manager to address your needs.

I know right now, in nursing everyone is burnt out and stressed out, but if you cannot be helpful as a preceptor, then you need to take yourself out of the pool of preceptors, if possible. If it is not possible and you find yourself getting annoyed or short tempered, take a deep breath, and remember this was once you, too. We as nurses often “eat our young” out of stress and annoyance. We must do better with this and extend a little grace to our young. Seasoned nurses I am here to tell you these young nurses are NOT being taught like we were. They are being taught the basics, both in skills and knowledge. It is truly a disservice to nurses and patients alike, but reality. I know this because of the students I have worked with locally and nationally. It is the same across the board. We are churning out nurses and not giving them half of the knowledge and abilities we old school nurses were given. Why it is critical we help them learn. Teach them skills we were taught, and we required out of necessity. It is critical for young nurses to not be afraid to ask questions or be egotistical enough to think you do not need to ask questions or help.

I know by the time you graduate; you never want to look at a book again, but if you are running into drugs, labs, treatments, etc., you do not know, you need to look them up or ask for help. NO nurse comes out of school knowing EVERYTHING. YOU DON’T KNOW, WHAT YOU DON’T KNOW. It is critical you understand this and act accordingly. Remember it’s your license and career on the line, no one else's.

As soon as you are done with your assessments, take the time to look at your labs, and make a list of what needs done for each patient outside of your regular med passes, this will help keep you organized and know what orders you may need to call for or have the charge nurse address. I always did my med pass and rechecked all my vitals as I went because vital signs taken at 5 or 6 in the morning are not going to be as accurate at 8 or 9 am med pass. You should not be given critical meds like blood pressure, IV Lasix, or other meds which can change blood pressure or pulse rates without update to date vital signs. This is a good way to cause a critical error in your patient especially one who is septic or becoming extremely ill.

Do not just look at the numbers you are getting, stop, and think if they have changed and if so what the possibilities behind the changes can mean. Patients can quickly change. Make sure in report you are getting critical pieces of information not just well nothing has changed since yesterday or well their blood pressure went down a little bit and their pulse rate went up, but its level back out, and not ask follow up questions. Report is your first assessment piece of your day. There are several issues these pieces of information can alert you to if you are critically thinking and not just trying to get through report quickly. I know every unit has the nurse everyone finds annoying because they want to go over every little detail, but sometimes those tiny details are clues they haven’t put together to a bigger problem. Not everyone who goes to nursing school has the same level of learning or comprehension of knowledge.

The bottom line to learning assessment skills is learning to put egos aside and help one another. Nursing should be and needs to get back to be a team effort. Nurses now need to try their best to develop a good relationship with their unit managers, and unit managers with their nurses. If you work in an institution where you are ALWAYS short staffed and stressed out, advocate implementing team nursing. Or if you have a nursing union, negotiate for team nursing. If done right, it can alleviate a lot of stress and allow for better patient care.

Team nursing assigns either 2 RNs or an RN and an LPN to the same group of patients, then you as a team, decide how to split duties and care. It really helps when you have high acuity patients, or patients who take a lot of time and skill. Tag teaming a patient to clean them up, do their assessment, give their meds, treatments, bath, and bed change goes a lot faster than doing it alone. It also builds bonds between nurses. I have some of my best friendships still from 30 years ago with the nurses I worked side by side on some of the roughest days and nights of my career. It helps you gain confidence and skills and lowers your rate of burnout. Not going to say burnout is not going to occur because that is not realistic. Every nurse feels it at some point, we are human doing one of the most difficult jobs in the world. But, if you know what to advocate for yourself whether represented by a union or not can make that burn out not come as quickly. I know nursing has changed immensely even in the 13 years; I have been away from it but know there are ways to fight the system. You must think beyond patient ratios and look at alternative ways of nursing to advocate for making your life a little more bearable. You must learn how to manipulate the system and make them think the ideas are theirs. Most nursing managers tend to forget what it was like to be a bedside nurse and the old ways of doing things and need to be reminded. We also have to start going back and getting degrees like healthcare management to take those positions, which can make serious change in the ranks. I know you are frustrated and burnt out and can only focus on advancing your degrees to get the hell out of the hospital, but if you want to make real change look for degrees which can help make real change in these institutions, while you are young and have the fight in you. One of my biggest regrets is I did not do this so I could help keep you all from going through what you are now. Schools need to be advocating for these degrees too, because nothing is going to change until we have nurses in upper management who remember and care for the bedside nurses.

I know this post encompassed different information of assessment, stories, and advice, but I hope something in it helps or inspires you.

Feel free to leave me ideas for future posts, dm me on this page with any questions or advice. Have a great week!

01/23/2025

The scholarship application for all current continuing Ohio University Southern students is now open. Apply online in your MyOHIO Student Center before February 1. 📚🎓 Find more information at ohio.edu/southern/student-financial-aid

01/23/2025

Contemplating doing a series of videos on Med/Surg topics for nursing students. Wondering if this would be more helpful for students? I am thinking of creating a YouTube channel and posting here and IG.

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11/02/2024

If you have any topics, you'd like me to discuss, please leave them below.

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10/08/2024

One question I get often is, how do I retain everything I am reading?
The short answer is when you read 100–150-page chapters at a time, very little if you are just reading.
I encourage students to approach each chapter this way:
Start with the Anatomy/Physiology review at the beginning of each chapter. Then the first notes you should make is a synopsis of how you understand the Anatomy/Physiology works for the topic at hand. This is important because you can memorize all that follows but if you do not understand how it affects the actual organ you are studying then it does no good. If you can understand it you can start putting pieces together.
I tutor my students not to read word for word each chapter. Your professors are going to tell you to, but that is a lot of content to try to comprehend if you are not a good reader or have trouble with comprehension. I see this with a lot of students. I have a reading comprehension problem and have learn to do things to adapt and teach students how they can adapt.
When you go into the chapter first do not go through highlighting and taking notes. Just start going through looking at every chart, table, picture, etc. and the captions that go with them. These are where most of the information is, they are going to test you on, and where the most valuable information in the chapter is neatly summed up for you.
Put the highlighter down!! You do not know how many students' books I look at and am blinding by the amount of highlighter used hahaha. But seriously, the only thigs you need to highlight are the things you want to put in your notes. Things like specific signs and symptoms, specifics meds and treatments, specific nursing interventions.
I would also, encourage you to learn to outline if you do not know already. It saves you a lot of writing or typing, it is organized and makes it a lot easier to scan your notes.
Now retention, this is where it becomes individualized. Some people do well with mnemonic devices. I find it easier to understand and teach material to relate it to something else. For example, the heart is like a filled balloon if you fill it with just enough air to still make it easy to squeeze and you squeeze a lot after a while the walls of the balloon start to weaken. Same with heart failure, if the heart is beating too hard and fast for extended periods of time the heart wall weakens and starts having trouble beating and emptying, and you start to get symptoms of heart failure. You have a visual example. Most people can envision this happening.
Another thing you can do to assure retention is to get in that NCLEX book and supplement questions which come free with it and do 10-20 questions a day. But do NOT get in the habit of just answering them to answer them. When you get something wrong, take the time to read the rationale as to why you got it wrong and make a note. If you get in the habit of doing this it will give you a firm idea of where your weaknesses lay and what you need to spend the time studying. Your study time is precious, and you want to get the most out of it when you do have the time.
When I work with students one on one or in a group, if they are open to it, I teach each chapter by doing head to toe assessments as we go, depending on their level of assessment skills at the time. I do this to encourage and strengthen their critical thinking and assessment skills they are going to use in clinicals. CRITICAL THINKING is the GREATEST skill you are going to use in real life in conjunction with your assessment skills why I focus studying around it. I want you to learn the material, be able to think on the fly, and be confident and comfortable in your skills. I do this because your later clinicals and SIMS are dependent on these and eventually your career. You sometimes have mere seconds to make decisions, and I want you confident before those letters are permanently behind your name with legal and liability repercussions.
The last thing you can do for comprehension is find someone who can read your notes or outlines and have them just read the subheadings and then you talk about the information that comes next. For example: What are the Nursing interventions for said disease process. If you can verbalize this in detail to someone else with confidence then you know the material. Being able to explain a process of anything verbally is a good indicator of comprehension. You can do this throughout your study times. If you have 2 weeks to learn material then the first week should be spent taking notes and studying. I encourage students to read 15-30 minutes of notes per day at bedtime. Reading before bed helps the brain retain information. Then the next week try to have verbal sessions in addition to testing yourself daily. Have the person holding your notes highlight your areas of weakness so you learn to concentrate just on those areas instead a 1/2 a notebook of notes.
The trick to retention, as you can see, is repetition. You must decide what form of repetition works for you because what works for you may not work for the next person.
Hope these tips help and let me know in the comments any other topics you would like me to discuss.

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10/03/2024

Good morning, everyone! Hope everyone is doing well, here at Midterms! Just wanted to take a moment and remind everyone, my tutoring sessions are FREE and are tailored to you specifically, unless I have enough people who want to do a small group. There are a variety of ways I can accommodate you to meet to help, you just need to comment here or private message this account and I will help make arrangements. Don't let yourself get too far in trouble to seek help, either from me or your professors or school tutors! This is one degree, which getting out of a hole is very difficult! I'm going to try to get better about weekly posts, you have topics you'd like me to discuss, leave them in the comments.

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09/24/2024

Vanchesta Lewis

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09/23/2024

I was asked for some study tips for NCLEX, so let's try to address this. My general study tips do play a part in this except, by this point in your nursing school journey, you will or should know your strengths and weaknesses. I know some schools have returned to ATI as the standard with which to test knowledge and understanding. There are some schools who have stayed with what was the new "gold standard" when I graduated which was the HESI. I personally feel like the HESI better prepares you for the NCLEX. But, This is a debate amongst educators. Regardless of which your school uses, you should know where you are behind in your knowledge base.

So, that being said, you should get a report that shows you where your strengths and weaknesses are and this should be the template for your NCLEX studying. If you are strong in one area more than another or multiple areas, those do not need to be your focus.

The NCLEX is a test that is based heavily in MED-SURG, meds, patient safety, delegation, some of your specialties like mother/baby and peds but not a whole lot and if it is it is going to be general information in those subjects because honestly most new grad nurses very seldom get those kind of jobs in the bigger hospitals and if they do they learn a lot more in depth as they go along in their job. Any specialty in nursing is going to require more on the job training in book work and in physical work.

So, I would not spend a ton of time on those specialties unless you're very weak in the basics. Where I would concentrate is learning or making sure you have a strong understanding or memorization of the ends of drugs that help you recognize them as a particular group. Such we know beta blockers end in -lol, we know local anesthetics end in -caine, corticosteroids end in -sone or -lone. These type of med ending are important to memorize because if you get a drug you have no clue what it is but recognize the ending it tells you the general category of what it is and therefore you should be able to know what side effects, purpose, and things to monitor for with the drug.

If you used your NCLEX book as a study guide throughout your MED/Surg class as I suggested in my last post of study tips, you should be used to the way questions are asked and how they are set up. The NCLEX questions will be straight forward unlike the test you took in class. The reason is because the time you get to NCLEX your critical thinking skills should be honed pretty well. This is the reason why class tests have a lot of erroneous information in them. People think it is to through you off the right answer or trick you into think 2 answers are the same but one is always better than the other. This is because the questions are not only testing your knowledge but testing can you critical think through the situation they present you with and decipher the information for what is important and pertinent to the case at hand. Critical thinking is the MOST IMPORTANT skill a nurse has in their arsenal.

So you get into your NCLEX book in the areas you are weak in and it should have additional questions than what comes inside the book. You set up a specific set of time you are going to use to study per day. For example, you say I'm going to study for 4 hours a day for NCLEX. That is not 4 hours straight. AGAIN THIS IS NOT 4 HOURS STRAIGHT. It is going to differ with each person depending on where their weaknesses are in the overall material. Now you take that 4 hours and divide into 1 hour study sessions. Remember, I said in my last post your brain only has the capacity to retain information in 45 minutes to 1 hour increments, anything over that is a waste of your time because your brain has gone into information overload and shuts off comprehension and retainment.
If I remember correctly, excuse my memory, I'm pushing 50 and it isn't what it used to be, :) you can set the questions to give them to you randomly or you can choose diseases of a specific organ. If you feel confident in your Med-Surg knowledge set it to random see how you do. Most importantly, as you do each session take the time to read the reasoning to why you missed a question and make a note of it because this is what you need to be concentrating on as you go through the questions. If you are doing several sessions a day and finding that you are doing better and better with each session start then to decrease the amount of sessions you are doing a day. If you get down to one session a day and are nailing it then stop. Then if at this point you still have a week or more before boards, pick a random day and do a session. Just to keep the test taking skills fresh and decrease the test taking anxiety. You'll learn the more you take notes in the sessions and see you are making the same or similar mistakes the quicker and easier it is to correct them and the faster you can get to that once a day or once a week session.

The biggest mistake I see students make is just studying it all to DEATH. You truly can study too much. You get in there taking question after question, test after test, and don't take the time to take those notes on WHY you are missing the questions, magically after taking a thousand questions isn't going to solve that problem.

Ok now let's also, talk about retention when studying for NCLEX. We talked about the amount of time you should spend on studying based on your specific needs, how to take notes to learn the whys behind your missed questions. Now lets talk about not jumping into the answer but critically thinking through the question. What do I mean by that?

One way to retain knowledge is to apply it. So, one thing I teach my students from the get go is to critically think through every step of whatever it is they are studying. So for example if we are discussing an issue like pneumonia, I have my students learn by imagining what that patient would like like if they had pneumonia. We go through a complete head to toe assessment of the patient but put our focus on the areas which are going to be most important to the disease process. I always start by saying the patient is healthy with no other significant health history. I make them visual the patient in the bed.

First without laying hands or pretending to, what is it we see the patient doing or what do they look like? Are they pale, are they short of breath, do they look sweaty, do they look anxious, do they look relaxed, do they look calm? If they are sweaty and short of breath what should we be doing for them before we even start a physical assessment to make them more comfortable? Do we take vitals first or do we raise the head of the bed first? Do we raise the head of the bed and then immediately take vitals, or do we give them a few minutes to get comfortable then take the vital signs? Then we move on from there. In visualizing and talking through a step by step assessment you are honing your critical thinking skills, you are reviewing and memorizing your patient safety issues, you are reviewing and thinking about what can be delegated to your LPNs and CNAs or MAs, you are honing your assessment skills visually, you are memorizing what should be hearing as different breath sounds, heart sounds, bowel sounds, etc. You are basically learning everything in your chapter in one place at one time by applying it and in applying it you are retaining it. We all know when you are in clinicals you don't always get patients with no significant health history, they have multiple problems which tend to send everything into a cascade of chaos. By taking this approach to studying it helps you to be more confident in what you are learning and more confident in your beginner assessment skills. I increase my assessments based upon where you are in your learning so that by the end you have a very solid foundation to enter the real world or nursing and hit the ground running. It also makes those scenarios schools run in their labs, with the mannequins which can be programmed, easier and less stressful because you've been practicing those skills. In teaching this way, for students who are open to to learning this way, it gives you a way to retain information, to gain assessments skills and they whys behind them, in return it increases your critical thinking skills, your delegation skills and your overly autonomy. Because listen here is the TRUTH about nursing. Once that board is passed and those letters are forever imprinted behind your name, you are fully responsible not only for yourself, the people who work under you, but also for med students, residents, and doctors. They are all human and learning along the way with you and if you learn to respect one another, share knowledge and work together, your days are going to get a lot easier and a lot less stressful.

You are responsible to catching the errors of everyone around you. Is this fair, no! But the sad reality is that is the purpose of our job. This is why nursing degrees are some of the hardest degrees to earn in college. Physicians especially new ones lean on your experience to help make decisions because they are trying to navigate the same waters and by sharing the knowledge that they are not taught to examine as carefully and as fully as we are, we may save a life or may save a patient from going through unnecessary pain or procedures. You cannot let yourself be intimidated because of someone else's degree or even years of experience because medicine is in a constant state of evolution. There are a lot of things young and old nurses have taught me and continue to teach me because technologies and techniques change.

So, take the time while you're doing those sessions to hone the most skills you can while doing the questions. Don't just read them for what they are and move on. Ask the whys and push yourself, will make that test a lot easier in the long run and will make you a better more confident nurse too. I hope these words and ideas are help to you. And know I am always available by messenger to help. I would be more than happy to personally run through an assessment scenario to help fine tune your knowledge or give you guidance on what to ask yourself while studying.

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