10 Prep Ideas for Retirement – The Working Years

Can’t wait to retire? Will you be ready? How much money will you need to live your dream-retirement? How long will it take to save enough money?


What are some tricks you can use to move you toward your goals during your working years?

Let’s get started.

  1. Learn how to start making your money work for you. Rich Dad Poor Dad: What The Rich Teach Their Kids About Money That the Poor and Middle Class Do Not!
  2. In the meantime, work extra shifts – as long as it doesn’t interfere with your family or your health. Besides the money, it looks good on your performance review.
  3. Keep an eye on your 403-B or 401-K’s performance and the overall health of the country’s economy. Intervene only if really necessary.
  4. Daily, spend time day-dreaming about your desired retirement. The more you do, the more your subconscious prompts you to move you toward your goals. Think and Grow Rich: The Landmark Bestseller – Now Revised and Updated for the 21st Century
  5. Buy quality, and take excellent care of your belongings to make them last longer. 925 Ideas to Help You Save Money, Get Out of Debt and Retire A Millionaire: So You Can Leave Your Mark on the World
  6. Advance your own physical, mental, and financial health. Don’t allow dysfunctional people to drain your hard-earned assets. Boundaries: When to Say Yes, How to Say No to Take Control of Your Life
  7. Give to charities according to the way God leads you. Do not be coerced.
  8. Whenever possible, get needed surgeries and treatments completed before you retire. That way you get paid during recovery – with FMLA and/or PTO.
  9. Never allow credit card debt. If you have it, get rid of it fast. Rich Dad’s Advisors®: The ABC’s of Getting Out of Debt: Turn Bad Debt into Good Debt and Bad Credit into Good Credit .
  10. See the post just previous to this one. Do your best. Learn about money. Diversify your investments. Never stop dreaming.

A lot of nurses worry that job-hopping (common among nurses) might hurt their retirement goals.  Not as much as you might think! Just remember to always keep rolling your 403-B or 401-K over to your next job.

And if you do job-hop, you might consider travel nursing. You can even stay in your same city, the agencies offer more than all the usual benefits, and travel nursing generally pays a lot more than working for any hospital.

*****Do you want to use Dave Ramsey’s investment calculator for free? This Dave Ramsey article lets us do just that. Just go to his article and clicking the link there.

Dave Ramsey has also brilliantly written some good news about: Retirement for All Ages: A Planning Guide for Your Retirement At Any Age . He shows the steps to get you from where you are to where you want to be.

The recommendations here are from various named sources and from my experience. Verify before taking action on any of it. Hope this helps! What are some of your savings tricks?


11 First Steps: Retirement Planning Tips

Here are some of the things I did to sabotage my own retirement plans during the initial phase of my nursing career.001

Upon landing my first GN job in 1987, I was thrilled to earn $11.00 per hour! We had been struggling financially during nursing school – and it was finally time to celebrate! We started immediately on our “well-deserved” upgrades.

Meantime, student loans, from nursing school, would soon require monthly payments. With me as the only support for three people, I soon realized that our money left after bills was going to be less than before I landed that great job.

So, when a US Army recruiter told me we would get free housing, free medical, and my student loans would be deferred for as long as I was working as an Army nurse on active duty, I grabbed the chance.

I should have begun my early phase of retirement planning right then. But the starting salary of a Lieutenant – nurse or otherwise – was not much. Even after my two year raise, we were still struggling and getting further into debt.

We could have budgeted better, but we were stationed in Honolulu. We “needed” all of the Hawaiian things that other nurses’ families had.

Some friends worked another nursing job on their days off. But I had two kids, and we wanted quality time together. So instead of making money, we made (semi-expensive) memories.

What could I have done differently, and what strategies do I recommend?

  1. Don’t take student loans if you can avoid it. Work a job to pay for as much of nursing school as possible.
  2. Burn off your excess energy and frustrations by working a physically active job instead of paying money to go to a gym.
  3. Live with family or get an honest, reliable roommate – especially when you are a single parent. Even if they don’t contribute any money, you will still usually get free help with child care.
  4. Shop thrift stores. But watch prices and ask for better deals. Some will negotiate if you ask.
  5. If you have a neighborhood co-op near you, find out what tools, yard equipment, etc. you can borrow. You might be able to – say – borrow equipment, for free, to paint somebody’s bedroom for $100.00 in your pocket!
  6. Grow some of your own food – organically. You will save money – and nurses know the importance of eating healthy.
  7. Save 10% of each paycheck toward your one-year savings account to sustain you in case you are ever out of work for up to a year. And do not ever dip into it except for a true emergency.
  8. Start, the day each child is born, to save for their college.
  9. Deliberately live below whatever lifestyle your nursing income allows.
  10. If you want/need something big, save for it and buy it with cash.
  11. Never take on a car payment again, and make your current car payment your last.

I learned this from experience as a new nurse – and there are even more great tips in this terrific little book: 925 Ideas to Help You Save Money, Get Out of Debt and Retire A Millionaire: So You Can Leave Your Mark on the World This book will save you tons of money!

P.S. Its not that we nurse just for the money. But in order to pay our own way through life, we need to manage what we earn as well as possible. So, plan early – and live long!


Snakebit – Patients who Hiss at You

128px-The_Grass_Snake_-_Natrix_natrixWhat does it mean when a patient hisses at you?

Could it have been ICU Syndrome, mental illness – was he a terrorist – or maybe he was raised by snakes???

Ridiculous? Maybe – but here is my story.

I remember caring for one particular non-English speaking patient when I worked in the ICU at the county hospital in 1987. I was a fresh new grad – had not even taken state boards. Yet, I was being groomed in the SICU. So fun!

They let me care for extremely critical cases with all kinds of monitors, drains, and devices! It was a teaching hospital, and every day was new and exciting.

We got the rare and hopeless cases that other hospitals could not afford to take – because of their need to keep their scores high. We were not in competition. We accepted everybody. Nothing was too hard for us!

But this one angry patient was probably my biggest challenge in those days. He was in his early 20’s, slim, dark skin, black straight hair, and buck-naked. He violently refused to wear gown or covers. So there he was, day after day, wearing only his foley strap.

He was handcuffed to the bed (not unusual for our hospital), but nobody could communicate with him. His police guard didn’t understand his language any more than we did. Staff of various ethnic backgrounds also tried to understand his speech – but to no avail.

Communication was nearly impossible for staff – except for facial expressions and hand gestures. But he would make deliberate, angry, piercing eye contact, wriggle like a snake in the bed, say words I didn’t understand, and hiss.

Oh, yeah – and he would spit at us too.

My most memorable day with this patient was when his serum potassium level rose high enough to treat with Kayexalate – but he was NPO. Uh Oh. Not good news for him, for me, or for all my helpers.

I’ll bet you can imagine how many milliseconds he retained that enema. And – no – my flying leap was not fast or far enough!

After that, I had a couple of days off. When I returned this patient was no longer on our unit. Nobody knew what happened to him, and I never saw him again.

Not much later, I was recruited into the US Army to serve in Honolulu. New nursing job. New life. But, for a long time, I could still sometimes see those angry eyes and hear that sound in my memory. And I always wondered why he wriggled like a snake and hissed at us.

What was your most unusual patient encounter?

Here is something that might tickle your funny bone: Snakebit: Confessions of a Herpetologist


When Panic Attacks Interfere with Your Life

006Have you ever had a panic attack? Then you know how frightening it can be. Do you think you may have panic disorder? See a compilation of what is involved and how you can help yourself.

What is panic disorder? ScienceDirect says panic attacks “result from the catastrophic misinterpretation of certain bodily sensations”, (mainly: palpitations, breathlessness, dizziness etc.) These are perceived as much more dangerous than they really are

A panic attack may have a known cause or occur for no apparent reason. It can even wake a person from sleep according to HelpGuide.

Onset is abrupt. They usually peak within 10 minutes and end within 20-30 minutes. Rarely, one may last a whole hour.

JAMA reported individuals with PD (panic disorder) frequently use both emergency department and general medical services, presenting with high rates of unexplained cardiac symptoms, dizziness, and bowel distress. These patterns continue indefinitely.

Light on Anxiety says a panic attack is sudden and is accompanied by at least four of the symptoms listed below.

  • Chest pain
  • Shaking or trembling
  • Racing heart or palpitations002
  • Numbness or tingling
  • Dizziness, fainting
  • Feeling a sense of unreality or detached from surroundings
  • Choking sensation
  • Fear of dying, losing control, or going crazy
  • Nausea
  • Sweating
  • Chills
  • Hot or cold flashes
  • Breathlessness or hyperventilation

For self help ideas see: When Panic Attacks CD: The New, Drug-Free Anxiety Treatments That Can Change Your Life

People who have panic attacks worry, not only about all of life’s events, but also about when their next panic attack will occur.

Some have to avoid certain situations or environments, to decrease the number of attacks, and so it affects their quality of life. For this reason, many articles discussing panic disorder or panic attacks also address agoraphobia.

What are some things that can trigger a panic attack?

  • Major project or life change event
  • Extremely stressful event like a death, divorce, job loss…
  • Large crowds005
  • Bridges, tunnels, cinemas, shopping malls
  • Being alone
  • Physical exertion
  • Sexual relations
  • Hot shower
  • Drinking alcohol or caffeine

Other physical causes include:

  • MVP (mitral valve prolapse)
  • Hyperthyroidism
  • Hypoglycemia
  • Drug withdrawal

Who might be more prone to panic attacks than others? It affects about 6 million American adults.There is a possibility that panic disorder may run in families. Note that having just a few panic attacks does not qualify a person for the diagnosis of panic disorder.

Suicide? Really? A study done by The New England Journal of Medicine found that the suicide ideation and attempt rate in panic disorder patients was actually higher than that of patients with major depression. So panic disorder, and its array of associated symptoms, deserves close attention.

Techniques to delay or minimize panic attacks: Cognitive-behavioral therapy and controlled exposure therapy can be effective for reducing the fear associated with panic attacks. Studies show that adding an antidepressant increases effectiveness.

Medications include daily administration of antidepressant med – and a benzodiazepine on an as-needed basis. Be aware of and adjust for side effects.

How to help yourself: when possible, get treatment for or stop the underlying cause, learn about panic disorder and anxiety, learn controlled breathing techniques, and diligently practice relaxation techniques.

It helps ease the anxiety of others when people warn those around them that they have a panic disorder.  This way, people can be more supportive and will be less likely to needlessly call 911 for an attack that will likely end within 20 minutes anyway.

Great thanks to: LightOnAnxiety , JAMA and JAMA , Nature , ScienceDirect , The New England Journal of Medicine , and HelpGuide .

Hope this helps answer some questions. For more information, consider: When Panic Attacks CD: The New, Drug-Free Anxiety Treatments That Can Change Your Life


Haldol – a Nurse’s Best Friend

Vitamin HH letter

What are some of the main indications for Haldol use?

  • Uses the callbell too often
  • Talks too long
  • Repeatedly comes out of room to find nurse

No – really – just kidding!

Official indications for Haldol administration is to gain therapeutic control of the patient whose behavior may be a danger to themselves.

In hospital – Haldol (haloperidol lactate) – fast acting antipsychotic – pharmacological class: Butyrophenone – Old Faithful


Indications Schizophrenia (Moderate), Psychosis Schizophrenia (Severe), Psychosis ICU Delirium Ticks and outbursts as in Tourette’s Dementia related psychosis
PO 0.5-2mg Q8-12H prn 3-5mg Q8-12H prn – up to 30mg/day 0.5-2mg Q8-12H initially. May need to increase to 3-5mg Q8-12H. Some have had up to 100mg/day. Not approved due to increased risk of death
IM 2-5mg Q4-8H prn (may require Q1H prn initially) See note below table Not approved
IV (off-label) 2-10mg initially. May repeat Q15-30min (doubling initial dose sequentially. Then 25% of last bolus Q6H & taper off as able) Monitor EKG for prolonged QT intervals. Not approved
Geriatric dosages 0.25-0.5mg Q8-12H initially Less and less often than adults under age 65 0.25-0.5 Q4H & watch EKG for prolonged QT intervals Not approved
Negative (potential) side effects EPS, Tardive dyskinesia, Prolonged QT interval, Torsades de Pointes, Neuroleptic Malignant Syndrome (NMS), can affect blood, blood pressure, GI, liver, skin, endocrine, electrolyte balance, ability to drive -> -> -> ->Highest risk group for Tardive dyskinesia, Death
Contraindications CNS depression, coma, Parkinson’s -> -> -> ->
Use caution in patients with Allergy to Haldol, severe CV disorders, neutropenia, seizure disorder on meds -> -> -> ->
Potential interactions Neurotoxicity if on Lithium, potentiated by many other meds
Storage In syringe, in your pocket (just kidding!)

If Haldol is being given to a person with bipolar in the manic phase, they could quickly move to depressive phase after receiving med.

IM or PO haloperidol decanoate (depot)  is for home use – not for hospital use. Dosages are different and it is longer acting.

Thanks to: RxList.com ,  MedScape.com ,  and Drugs.com .

So there is your handy-dandy snapshot of Haldol – a nurse’s best friend! (when used with caution) Here’s a great resource to find out more: Mosby’s 2015 Nursing Drug Reference, 28e (SKIDMORE NURSING DRUG REFERENCE)

Thanks for checking in! Let me know if you want more med summaries like this.


Confused Elderly – Is it Delirium?

Guess what I have been dealing with the last few days? Altered mental status in a parent. So I am digging in to learn more about dealing with it. And you get the benefit of catching the highlights.

Confusion in elderly can originate either from delirium, dementia, or a whole slew of other diagnoses. A marked recent change is usually a sign of delirium, but a thorough history and review of medications helps to differentiate.

The major physical causes of delirium that I found are:

1. Metabolic disorders, for example:

  • Withdrawal from alcohol or sedative(s)
  • Drug abuse
  • Fluid & electrolyte imbalance
  • Infections like UTI or pneumoniaYou have what it takes
  • Damage from a stroke
  • Poisons
  • Hypoxia
  • Heart failure
  • Hypercapnia
  • Kidney failure
  • Thyroid disorder
  • Nutrition disorder

2. Infection like:

  • UTI
  • Pneumonia

3. Medications such as:

  • Anticholinergic agents
  • Benzodiazepines
  • Cardiovascular agents
  • Xanthines
  • Narcotic and nonnarcotic analgesics
  • OTC meds that can also cause delirium include:
  • - Antihistamines
  • - Anticholinergics

4. Surgery

Physicians usually consider delirium as a flag waving at a potentially life-threatening problem. The good news is that delirium is transient, most often has a treatable medical cause.

What does delirium look like?

  • Changes in cognition and consciousness are usually the first to be noticed
  • Psychomotor and/or emotional abnormalities
  • Orientation compromise
  • Alertness may alternate dramatically with lethargyRedding and Family 012
  • Alternating hyperactivity with hypoactivity
  • Fearful, anxious, angry
  • New onset of incontinence
  • Memory deficits
  • Change in sleep-wake cycle
  • Altered perception and sensation
  • Hallucinations, delusions, misperceptions
  • Inability to perform math calculations
  • Abnormal language substitution
  • Misidentification of environment
  • Impaired reasoning and judgment
  • Labile moods – euphoria to depression

The greatest risk factor for delirium is advanced age. And a certain percentage of patients presenting with delirium actually die from the underlying cause.

Some tests and orders you might see:

  • Full Neuro exam including cognitive and motor eval
  • Neuropsych exam
  • Bloodwork and urine test
  • CXR
  • Head CT
  • Head MRI
  • EEG
  • CSF analysis

The goals of delirium treatment are to treat the underlying cause, adjust medications where needed, and promote patient safety.

Delirium often lasts about a week, and recovery can take several weeks with treatment.

A few ways to prevent or manage delirium in hospitalized patients:

  • Careful initial assessment
  • Early mobilization – eliminate barriers – ask for a PT consult to help prevent falls
  • Early catheter removalRedding and Family 038
  • Patient use of hearing aids and glasses
  • Maximize oxygenation, hydration, and electrolyte balance
  • Promote nutrition and bowel function
  • Monitor labs and other test results
  • Promote rest
  • Encourage family visits – only two or three at a time
  • Avoid restraints
  • Discourage TV
  • Use music, massage, and relaxation techniques
  • Ask family to help with patient history, preferences, and to bring in something familiar from home
  • Be sure family brings in POA or conservatorship papers early.
  • Involve disciplines and family in EARLY discharge planning

The information is according to: American Family Physician and MedLinePlus , Journal of Neurology, Neurosurgery, and Psychiatry  , The 2008 Summer Nursing Conference . The Mayo Clinic talks about how hyponatremia causes similar symptoms in the elderly.

The sandwich generation is in for quite a lot of work with parents who are living longer and requiring more and more care. So, for more information on this timely subject, try this: What Do You Do When Your Parents Live Forever?: A practical guide to caring for the elderly


Should Nurses Have to Be All Things to All People?

You have what it takes

On being all things to all patients – and some tips to getting through the shift in one piece.

So needy – Why is it that patient’s emotional needs can wear you down faster than their physical needs?

Super-size me – And don’t most patients want you to pile on the time, service, and sweet-talk all the way to the ceiling? Plus they think you should know every latest about their case.

On any given shift, a typical patient mix will be extremely diverse. And patients’ emotional needs are as varied as their diagnoses.

Here’s what experience taught me -

You’ve got the stuff – It can be done – And you are well able to make each patient happy when you set your priorities and communicate well. Even new nurses are well-received and respected when they are open about needing advice occasionally.

Comprehension is key – I found out that the quality time I spent with the patient, early in the shift, made all the difference. When patients truly understand their plan of care for that day – what to expect from all the disciplines and their own role – they relax more and their compliance increases.

Share the love – When your patient understands who does what, they call for you less often. Make sure they have the phone extensions of their CNA, social worker, RT, the kitchen, business office, and the like. Give this information in a positive way that empowers them.

You are brilliant – You graduated college and passed boards. You are a professional in a well-respected vocation. You have a good heart. You serve others to the best of your ability. Most patients, whether or not they ever tell you, appreciate your work and how you made them feel.

They don’t define you – Those patients who do not appreciate you are usually too caught up in their own problems to appreciate anything outside of themselves. So don’t be concerned if they complain. They are defining themselves – not you.

So, can a nurse be all things to all patients? For the most part – yes, you can. And you can do so without hurting yourself. There will always be the exceptions; but as long as you look and behave as a professional, you will be considered as one. When you stay focused, organized, and compassionate, you win their confidence. And their decrease in fear makes a big impact on their speedy recovery.

Next up is the story about the death-CNA. This one will freak you out.

But for now, here’s something that will make you laugh out loud! ”Only A Nurse Could Laugh at This…” – Funny Stories and Quotes from Real Nurses for When You’re Having “One of Those Days”



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