ER nursing hacks can be just what you need to make your shift go from terrible to not-as-terrible. As nurses, we aren’t afraid to get ourhands dirty. We take charge, do what needs to be done, and then find a way to laugh about it in the end.
Working in the Emergency Department can be especially draining – physically, mentally, and emotionally. However, just because nursing is HARD doesn’t mean we can’t utilize tips and tricks to make that 12-hour shift a little bit more bearable. Use these “10 Nursing Hacks Every ER Nurse Should Know” to save time, save yoursenses, and save yoursanity!
Please keep in mind the following hacks are anecdotally based. You must use these within your own judgment and within your facility’s protocols. You can read more about this on my disclaimer page.
1 ER Nursing Hacks: Double-Glovin’ in the Oven
As you know, personal protection equipment including clean gloves and gowns are absolutely necessary in a hospital environment. For some procedures, clean gloves are “good enough”. However, for high-risk infection procedures, sterile gloves are necessary.
Foley catheter insertion is one of those procedures, as catheter-associated infections are very common. While putting in a Foley catheter can become like second-nature rather quickly, there can be some difficulties with the sterile procedure.
For one – those cheap sterile gloves that come with the foley kit aretypically a size 5.0. So unless you have baby-hands, I’d recommend grabbing an appropriately sized package of latex-free rubber gloves. You might want to go a half-size above your normal for this method.
After grabbing your foley kit and sterile gloves, position the patient, and then wash your hands (duh). Afterward, put on a pair of clean gloves FIRST, then proceed to open your kit and apply your sterile gloves, and continue the insertion per normal.
Using this nursing hack, once you insert the foley and blow up the balloon, you can take off your previously sterile gloves which are now likely dripping with Betadine and other fluids. Luckily – youstill have a pair of gloves underneath to secure the cath-secure, position the foley bag, and clean up your pile of trash! Once that’s done, slip off the gloves, wash your hands, and you’re done! Easy-peasy-Kegel-Squeezy.
2 Burp that Bolus
This concept is a little more confusing, but it can save time! In the ER, we hang A LOT of boluses and every ER nurse knows that pumps are harder to find than a rectal thermometer. So naturally, ER nurses are resourceful and use gravity. Patients often require multiple boluses, and Lord knows you are
almost always sometimes just too busy to switch out bags before the bag runs out and half of the tubing is now air.
In this predicament, you could flush out the rest of the line in a trash can, then unspike and re-spike your new bag, and THEN re-prime the line. Or you could get a whole new tubing set and just throw out the old bag/tubing.As you can see – this wastes either valuable time or equipment/money!
But what if I told you there was an ER nursing hack to solve this? When you go to prime the original bolus, clamp your tubing and spike your bag. Do NOT squeeze fluid into the drip chamber yet. Now, turn the bag upside down. Unclamp the tubing, and “burp” out the excess air at the top of the upside-down bag.
Once the air is gone and some fluid is forced into the drip chamber, turn the bag right-side-up. Now prime the tubing as normal and hook the patient up. You’ve essentially created a vacuum so that the fluid will stop flowing before it empties the drip chamber – ready for your second bolus when you are.
3 Juice cup? Change it up!
Unless you work at an adult-only ER, you are likely seeing patients that span the clinical spectrum – this includes pediatric patients. One thing about pediatric patients is that they HATE taking their medications.
One particularly difficult medication to give a child PO is Dexamethasone oral solution. Unfortunately, it’s usually made with a good portion of alcohol content, and it smells and tastes like…vodka?
After forcing it down,kids often vomit it up – all your hard work for nothing. One ER nursing hack to avoid having to give an IM shot isswapping oral Dexamethasone for the IV solution.
IV medications cannot always be used orally, but sometimes they can! IV Dexamethasone has successfully been administered mixed with cherry-syrup, juice, or followed by a popsicle – and children take the medicine MUCH easier! Don’t forget though, you must run this by the provider before trying it, as studies are somewhat mixed on the efficacy (pharmacokinetic info here).
4 Septic Sock
Now I KNOW you have smelt some SMELLS in the ER (or anywhere in the hospital for that matter). There is nothing stronger than a nurse’s nose. C-diff, fungi, and bodily secretions aside – sometimes the worst smell comes from down under (the feet – ya nasty).
Unfortunately, working 12-hour shifts where you are constantly on your feet and running around, you might find yourself with some STANKY feet. The good news is, even if you don’t have stinky feet, this ER nursing hack can help you deal with a patient’s particularly putrid piggy-toes. But first, a quick science lesson.
While sweat is the main cause of foot odor, sweat doesn’t actually smell. Instead, it creates a perfect medium for bacteria. These bacteria include Brevibacteria and S. epidermidis (known for their cheese-like smell), as well as propionibacteria (known for its vinegar-like smell).
Regardless of which bacteria are causing the odor, they are all highly acidic. So here’s the hack: If you or one of your patients has particularly powerful foot odor – use an antacid! Lather Maalox or Mylanta on the feet, put surgical booties over top, and you won’t believe how fast it can help! Another option is to scrub the feet with Hibiclens or betadine for antibacterial action. Better yet – do both!
Fair warning though, if there is any fungi growing – these methods might not work as well. To prevent foot odor, it’s recommended to wear breathable shoes, breathable socks (cotton or wool), and wash and exfoliate your feet frequently. A little dab of foot-powder in your shoes every few days never hurt anyone either (Gold Bond anyone? #NotSponsored)
Related Article: Six Steps for Sepsis Management
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Use these sheets to write up on your patients and stay organized!
5 Thinking Outside the Vial
Every nurse knows that lidocaine is extremely helpful as a topical anesthetic for suturing, regional blocks, and even intra-articular injections to numb pain. However, lidocaine is not limited to only these uses. While not quite a “nursing hack”, these alternative uses of lidocaine are important to know so you can offer suggestions to the attending when indicated.
OK, you probably knew this one – viscous lidocaine is often mixed with an antacid and sometimes an antispasmodic to create a “GI cocktail” to help with the pain of gastric or esophageal etiology. This is always a good suggestion for those young chest pain when GI etiology is suspected.
NG Tube Insertion
They have done research to see if lidocaine gel, nebulized lidocaine, and anesthetic spray have been useful for NG tube insertion. Not too surprisingly, patients who get lidocaine gel or spray administered intranasally/orally had significantly less pain with insertion – but can have a more difficult NG experience. Additionally, nebulized lidocaine has proven to decrease pain and increase comfort during NG tube insertions, but can increase the chances of nosebleeds.
Sometimes with persistent laryngospasm, nebulized lidocaine can be used effectively to help with a cough. However, there isn’t a significant amount of research on this, so you likely won’t see it ordered often and will depend on the Provider.
Those experiencing pain in their mouth from a painful lesion such as an aphthous or herpetic ulcers can benefit from viscous lidocaine “swished” and either swallowed or spit afterward.
Foley Insertion (males)
This is also more common, but the provider may order 5-10ml viscous lidocaine to inject into the urethra before a difficult-anticipated foley insertion in males. Luckily, this usually comes pre-packaged in a syringe called a Uro-Jet. This should be injected directly into the urethra a few minutes before attempting the foley insertion. This can help reduce pain and be especially helpful in patients with a small meatus, anatomical abnormalities, or prostate enlargement.
Renal Colic ER
While meds like morphine and Dilaudid are used frequently in the ER and hospital, sometimes there are effective alternatives to opioids that actually work really well. Slow infusion of low-dose IV lidocaine can be used effectively for kidney pain. It’s recommended for use if NSAIDs and Opioids are contraindicated or risky. One study even indicates that IV lidocaine at appropriate doses safely lowered the patient’s pain more than morphine.
Related Article: Opioid Alternative Analgesics in the ER
6 Alcohol Swab Nursing Hacks
There are a few things we nurses usually load up our pockets with. Usually, these consist of tape, band-aids, paper, pens, and alcohol pads. But did you know how versatile alcohol pads can truly be?
This is more of a no-brainer, but when you accidentally make a mess with blood while putting in an IV, patients appreciate it if you help clean up your mess. Busting out an alcohol swab can easily clean up dried blood on their skin. If alcohol doesn’t do the trick, sometimes using KY jelly lube works even better. Alternatively, you could use hydrogen peroxide.
Nausea Nursing Hack
Did you know that a few whiffs of alcohol pad can relieve nausea almost immediately? Sure – Zofran is still our bread and butter, but this nursing hack works pretty quickly!
When your patient is nauseous, break open an alcohol swab and place it right under their nose. Tell them to take 3-4 deep slow breaths. Before you know it – they should start feeling somewhat better. In fact, clinical research suggests that alcohol may even be more effective than oral zofran, or at least a useful adjuct.
Scientists don’t exactly know why this works. Some think it’s purely due to “olfactory distraction” – distraction while following the instructions, taking deep breaths, and relaxing the body.
Pseudoseizure Nursing Hack
In the ER, the nurses frequently experience patients who have not-so-believable “seizures”. These “fake” seizures are termedpseudoseizures, and the patient might not even know that they are “faking”. Typically when this happens, we bust out an ammonia salt and place it underneath the patient’s nose. This tends to stop their “seizures” pretty much immediately. But what do you do if you don’t have an ammonia inhalant on hand?
Not every ER utilizes ammonia salts, and sometimes they can be hard to find. If you experience a patient with what you believe to be a pseudoseizure, try opening an alcohol pad and placing it directly beneath their nose. This may distract them and bring them out of their “seizure”. Please note this is anecdotal and is not in the literature.
Save your Senses (ER Nursing Hack)
Clostridium Difficile (C-Diff) is a common diarrheal infection which can make people pretty sick. We often see these patients in the ER and hospitals. Unfortunately, C-diff is very contagious and tends to run rampant in nursing homes and hospitals. As we all know, C-Diff has a pretty distinct and powerful smell which can be hard to erase from our noses!
Before going into a C-diff patient’s room, add a mask to your PPE. Break open an alcohol swab and place it inside the mask. This way, the isopropyl alcohol overpowers the C-diff smell and you save your senses – or at least make it more tolerable.
If alcohol swabs are too strong for you, you can try rubbing toothpaste or Vix rub inside a double-layered mask. This nursing hack works well for C-diff, but also for other smelly situations including I&Ds, rotting flesh, nasty wounds, and fungal infections.
7 IV Stick Trick
Putting in IVs is super common in hospitals, especially within the emergency department. If one thing is sure – patients hate getting stuck! Some tense up, others look away, and then there’s those who shake, cry, and even syncopize. Ironically, the latter is usually buffed up guys with tattoos all over their bodies! People don’t like needle sticks because the needles hurt. But what if I were to tell you that there’s a way you can decrease pain, without any medication or extra equipment?
This ER nursing hack will help your IV insertions go more smoothly! After you clean the IV site, place the needle flush with the skin right where you are going to poke. Press the needle into the cleansed skin with the bevel up for 3-5 seconds before you puncture the skin. The longer you wait – the more desensitized their pain receptors will become – this should decrease the pain felt.
With less perceived pain, the patient may tell you “is that it?!” or “I could barely feel it!”. It also takes away the “shock” factor, making the patient less likely to jump! For most patients, this technique will be effective, however, some patients still will have a high amount of perceived pain, especially if you dig.
- “10 IV Insertion Tips for Nurses”
- “How to Start an IV”
8 BP not Enough? Use the Bedside Cuff
Vital signs are an important aspect of nursing care and patient monitoring. Blood pressures have a tendency in the ER to be very high or very low. When very low, we give large amounts of fluids as fast as we can. While pressure-bags are a great option and ensure fast infusion, they are not always available.
Many ER rooms have bedside manual blood pressure sphygmomanometers. In place of a pressure-bag, use the blood pressure cuff around the middle to top of the bolus and pump it up until it flows nicely. Like the pressure bag – you will have to occasionally pump in more air as the bag empties.
Related Articles: “5 Vital Sign Errors to Avoid”
9 Neb-wick Air Freshener
After a particularly smelly patient leaves, sometimes the aroma sticks around in the air. Unfortunately, Lysol sprays don’t always cut it. Now I personally am not a huge believer in the essential oil craze, but this nursing hack requires someone on staff to have essential oils or strong smelling lotion.
Take a used nebulizer adapter and squirt some water or saline in the medication chamber. Next, add a few drops of an essential oil of your choice. Turn the oxygen on high and viola. This nursing hack will have the room smellingGlade-scented fresh in no time. Talk about Oxy-Clean!
10 The Dependable Bedpan Nursing Hack
Many patients cannot or should not ambulate while they are in the ED. This is fine until they have to use the bathroom. Bedpans can be successfully used for both #1 and #2, but unfortunately, they have a tendency to cause messes. Whether you are using a fracture pan or a regular bedpan, line the pan with an adult diaper or absorbable pad. Secure it with tape or rubber bands. You can also use a large pull-up inverted inside-out and secure it over the bedpan. Place the bedpan underneath the patient as normal.
This way, any urine or liquid stools are absorbed in the material and do not splash, spill, or cause messes. It also allows for easy cleanup! If you need to collect a urine or liquid stool sample – this method should not be used.
Related Articles: “Comprehensive Urinalysis Interpretation”
Hopefully, you found these 10 ER nursing hacks to be useful. Implementing them in our everyday shifts should help save our senses and our sanity, not to mention our time! As a nurse, we are pulled in so many different directions at once and expected to always be on top of our patient care. Utilizing these hacks will hopefully help.
What are your personal nursing hacks which help save you time and make you a more efficient nurse? Let me know in the comments below, and share this article with your nursing friends!
Check out more general nursing hacks over at FRESHRNhere!
- Forget Being Task-Oriented. ...
- Learn How to Prioritize. ...
- Use Your Expertise. ...
- Ask Questions. ...
- Remember Where You Are. ...
- Art, Science, and Caring.
An ER nurse needs to perform their duties swiftly and efficiently to prevent delays in care and to protect their patients. A high level of skill is needed to perform treatments and therapies, manage complex machinery, and immediately recognize important changes in a patient's condition.
- Delegation. A charge nurse must understand staff members' skills, abilities, and knowledge to appropriately delegate tasks and procedures. ...
- Leadership. ...
- Flexibility. ...
- Self-confidence. ...
- Critical Thinker. ...
- Organization. ...
Patient priority is determined by a triage staff once the patient arrives at the ER. Symptoms are assessed and the triage staff takes a medical history. Those with the most critical injuries or symptoms, such as patients with multiple traumas or those unconscious or not breathing, are first priority.How stressful is ER nursing? ›
The widespread issue of nursing stress and burnout is widely acknowledged. According to a recent article in Nursing World, 75 percent of nurses said they felt stressed, 69 percent frustrated, and 62 percent overwhelmed. Emergency department (ED) nurses face daily stressors on an unimaginable level.What are the struggles of an ER nurse? ›
The ER is a stressful environment
Healy and Tyrrell report that ER nurses and other staff members are routinely involved in stressful incidents, including resuscitation efforts and witnessing the deaths of patients. Working as a travel ER nurse can also be physically demanding, heightening stress levels.
There is some variability by state as to whether a registered nurse can place stitches. Generally, suturing a wound closed is considered to be a “minor surgical procedure.” As such, it is not within the purview of most nurses. But advanced practice nurses and emergency room RNs can sometimes place stitches.What personality do ER nurses have? ›
Personality types. ER nurses are adaptable, calm, and collected during emergencies, quick-acting, big-picture thinkers, adrenaline seekers, loves organized chaos, and their report is something like “the patient is alive.”What is the stereotype of ER nurses? ›
Emergency Department nurses have a reputation for being overly aggressive and strong-headed is another nursing stereotype. They are placed into a working environment where they have to be “on” at all times without any warning for what will be their next patient.Is being an ER nurse worth it? ›
Although working in the ER might be too fast-paced for some nurses, I have found it to be an incredibly rewarding field. As an ER nurse, I have learned valuable leadership, communication and critical thinking skills, while also expanding my nursing knowledge and expertise in a variety of specialties.
It's way more work than it looks like on paper.
Traditionally, nurses work 12-hour shifts, three shifts a week. It's less than a 40-hour workweek, but it's still exhausting: There's virtually no downtime and you're physically on your feet, running around during the entire shift.
While ER nurses can treat trauma patients in small and mid-sized hospitals, a trauma nurse is a specialist who will only rotate through trauma rooms and assist the trauma team of doctors and lab professionals in a facility.Who goes first in emergency room? ›
The ER cares for the sickest and most severely injured people first. If the nurse asks you to wait, let the nurse know if your symptoms or condition get worse. Once you are seen by the ER doctor, they may need to run more tests to determine your needs.What are the 5 stages of triage? ›
The triage registered nurse might assign you a priority level based on your medical history and current condition according to the following scale: Level 1 – Resuscitation (immediate life-saving intervention); Level 2 – Emergency; Level 3 – Urgent; Level 4 – Semi-urgent; Level 5 – Non-urgent.What are the 3 categories of triage? ›
The triage scale consists of 3 levels: category 1 (immediate), category 2 (urgent), and category 3 (non-urgent).What is the hardest job as a nurse? ›
The most stressful nursing jobs include ICU nurse, ER nurse, and NICU nurse. In these roles, nurses work in an intense environment with high stakes. They manage emergency situations and care for critically ill patients. Other stressful nursing jobs include OR nursing, oncology nursing, and psychiatric nursing.What is the highest ER nurse salary? ›
Emergency room nurse salaries typically range between $50,000 and $126,000 a year. The average hourly rate for emergency room nurses is $38.41 per hour.Where do ER nurses make the most money? ›
Highest-paying cities for ER nurses
Bronx, New York: $183,259 per year. Chicago, Illinois: $170,242 per year. Miami, Florida: $154,570 per year.
Another contributing factor to long ER wait times is the time it takes to diagnose each patient. Emergency physicians must first rule out life-threatening conditions and then possibly administer blood tests, X-rays, CT scans and other lab work, depending on the illness or injury.
For most new nurses, it takes around one year to start feeling comfortable and for the anxiety and feeling like an impostor to disappear. Bear in mind that some people adapt faster and may feel comfortable within six months; for others, it may take a full year or even a little longer to feel like a nurse.
Nursing is known as a stressful job since it is associated with complex job demands and needs, and high expectations, excessive responsibility, and minimal authority have been identified as the main stressors .Can nurses intubate? ›
Can a nurse intubate? In short, the answer is yes. Some nurses are trained, and called on, to intubate patients during emergencies. However, due to state practice laws and varying facility policies, most nurses do not perform intubations.Is ER and Med Surg Nursing the same? ›
Emergency department nurses specialize in providing urgent, sometimes critical, care. OR nurses, well, you get the picture. But med-surg nursing covers a vast patient base, and its nurses provide an extensive spectrum of care. On the whole, med-surg nurses provide direct care to hospitalized patients.Can the ER remove stitches? ›
In most cases, you will need to return to urgent care or the emergency room to have your stitches removed. If you'd like your primary care physician to remove your stitches once your wound has healed, then be sure to talk to your urgent care doctor first.Where do the smartest nurses work? ›
Case in point, within all general areas of nursing, the Medical ICU, Trauma ICU, Peds ICU, Neonatal ICU, are perceived to require the highest skill set of nurses.What is better ICU or ER? ›
The ICU is a much more structured and controlled environment than the ER. While life-saving measures may need to be taken, most of the work is to maintain someone's status to help them leave the ICU and on the road to recovery. In some cases, the ICU is also the place for end-of-life patients.What skills do ER nurses need? ›
- Clinical skills. Emergency rooms treat a wide range of medical conditions. ...
- Composure in stressful situations. ...
- Working through emotions. ...
- Being assertive. ...
- Flexibility. ...
- Multi-tasking. ...
- Time management. ...
- Interpersonal skills.
In the hustle and bustle of the emergency room, it is often an all-hands-on-deck situation. In this environment, ER Nurses have more freedom to decide how to treat their patients than in other units. Having to work with critical patients, you learn quickly how to adapt to urgent situations and work autonomously.What are the pros and cons of being an ER nurse? ›
- Pro: Highly rewarding. All nurses help people, but an emergency room nurse helps people who are in urgent need. ...
- Pro: Provides great variety. In the emergency room, no two shifts are ever the same. ...
- Pro: Numerous opportunities for learning. ...
- Con: Stress. ...
- Con: Physically draining.
Least busy hours The best hours to visit an emergency room for far less urgent medical conditions according to a recent study, are between 6 am and noon. During these hours, most hospitals don't have as many patients waiting in line and you are guaranteed to get quality medical care.
The ER Gives Many Nurses Excellent IV Start Skills
With the vast number of medical emergencies coming into the ER each day, it's no wonder why nurses who work there are some of the best at starting intravenous lines.
Employment of registered nurses is projected to grow 6 percent from 2021 to 2031, about as fast as the average for all occupations. About 203,200 openings for registered nurses are projected each year, on average, over the decade.What is the hardest nursing certification to get? ›
Emergency nursing is considered one of the most difficult fields of nursing, and certification in this specialty is highly desirable.What is an ED nurse called? ›
An Emergency Department Nurse (ED), or Emergency Room Nurse (ER), is responsible for assessing, triaging, and treating patients that come through the hospital doors every day; this could entail treating injury, trauma, or acute-onset symptoms.How much does an ED nurse earn in the US? ›
The average Staff Nurse - RN - Emergency Room salary in the United States is $75,503 as of May 01, 2023, but the range typically falls between $67,586 and $84,010.Do ER nurses have PTSD? ›
It's estimated that one in ten emergency workers have some form of PTSD, which is much higher than the PTSD rate in the general population. One reason nurses might be so stricken with PTSD is because of the difficult things they see and go through on a day-to-day basis.Is an ER nurse a critical care nurse? ›
Critical care is just what it sounds like—critical. So nurses in these situations need to be ready for whatever comes through the doors. If you're up for the task, there are many roles that you can pursue as a critical care nurse, including working in the emergency room (ER) or intensive care unit (ICU).What is the difference between ER tech and ER nurse? ›
Further, ER Techs and ER Nurses can both perform a lot of the same tasks to care for patients, but ER Nurses are the ones who have the authority to identify which methods to use when treating a patient. ER Techs then perform tasks based on the recommendations of ER Nurses.How can a nurse overcome shyness? ›
Practice Social Interactions
Better yet, try striking up some conversations with strangers and making small talk. Practicing your communication in various settings will make you more comfortable interacting with hospital staff and your patients.
- Don't be afraid to speak up. ...
- Remember that nursing is a 24/7 job. ...
- Don't pretend to know how to perform a skill if you're unsure. ...
- Keep in mind that tomorrow is a new day with new opportunities.
- Leave work at work. ...
- The patient is always a priority.
Intensive Care Unit (ICU) nurses
ICU is an extremely high-pressure environment and these nurses work with patients who have significant injuries and disease with added morbidity risks. Unstable patients require lifesaving interventions and once stabilized, are transferred to a different unit.
Take a short break if possible, and focus on your breathing. Take deep, slow breaths to help calm your nerves and mind. Deep breathing can help ease stress and put you in a better frame of mind.Can a quiet person be a nurse? ›
Introverts can make excellent nurse leaders because they excel at mentoring and empowering others. There are other reasons why introverts can be amazing nurses. They have strong listening and observation skills which often translates into rewarding relationships with others.What is the best nursing specialty for introverts? ›
- Nurse Educator. ...
- Informatics Nurse. ...
- Nursing Administrator. ...
- Legal Nurse Consultant. ...
- Operating Room Nurse. ...
- Telehealth Nurse. ...
- Forensic Nurse. ...
- Nurse Case Manager. Nurse case managers work with patients and their families to coordinate care.
Although working in the ER might be too fast-paced for some nurses, I have found it to be an incredibly rewarding field. As an ER nurse, I have learned valuable leadership, communication and critical thinking skills, while also expanding my nursing knowledge and expertise in a variety of specialties.What is the daily task of ER nurse? ›
What are the duties and responsibilities of an ER Nurse? An ER Nurse will have a number of duties for developing a patient care plan after evaluating injuries, setting bones, giving blood transfusions or running tests to determine the medical needs of their patients.What do ER nurses do on a daily basis? ›
An ER nurse's primary responsibility is to identify medical issues, determine severity, and provide immediate support to minimize negative long-term effects and, if necessary, even sustain life. An ER nurse is one of the first responders when a patient is admitted to the emergency room.What is a nurses biggest fear? ›
Medication errors are one of the greatest fears of all nurses, regardless of their experience. Making a medication error can put your patient at risk of injury, illness, or even death.How do I know I'm a good nurse? ›
- Caring. ...
- Communication Skills. ...
- Empathy. ...
- Attention to Detail. ...
- Problem Solving Skills. ...
- Stamina. ...
- Sense of Humor. ...
- Commitment to Patient Advocacy.
Nursing requires a variety of skills, including empathy, critical thinking, communication, and more. You do have to be smart for nursing school, but “smarts” aren't limited to just getting good grades. There are different types of intelligence that play an important role in getting through nursing school.