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January 30, 2004

Dear Nurse Nancy,

I am an RN with over 12 years of acute care experience in Medical-Surgical areas including Oncology and Telemetry. I feel "burned-out" with floor nursing. I already have my BSN and am considering starting on a MSN. I think with my experience I could do many other things such as Case Management or teaching. Do you have any suggestions??

Sincerely,

AT

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Dear AT,

There are so many suggestions - you just have to find out what seems right to you. I would suggest that you begin graduate school, and as you take your required classes, speak to your advisors and colleagues. I always say graduate school changes your life, as you think differently, and really begin to see nursing in a different light.

I wish you the best in whatever you do. Happy exploring! Have a good weekend everyone!

Nurse Nancy

January 29, 2004

Dear Nurse Nancy,

I have been an RN for 23 years, but I do not know how to get a license in another state! I am currently licensed in Tennessee am certified as psych nurse with ANCC. My husband and I may semi-retire next year in Florida. Can you tell me how to start getting a Florida license?

CD

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Dear CD,

Congratulations on your move to Florida. Sounds great to me! And we at NurseWeek.com are here to help you in all of your professional changes. In order to get a Florida license, I would start by looking at the Careers section of the NurseWeek.com Web site, specifically at the regional career section on Florida.

This link will tell you the address of the Board of Nursing for Florida, as well as specifics you will need in terms of continuing education. Florida requires 25 contact hours every 2 years, with some mandatory topics which require a Florida Board of Nursing provider number: HIV/AIDS, domestic violence, and prevention of medication errors.

Also, be sure to inform the ANCC of your move, so that you can renew your certification when that is due.

Good luck.

Nurse Nancy

January 28, 2004

Dear Nurse Nancy,

I work with a Certified Registered Nurse Practitioner (CRNP) as well as a Physician in a Nursing Home/Clinic type setting. I am unable to find a direct answer to this question May I accept verbal orders from a CRNP? She is also qualified to write prescriptions.

Thank You,

DJG

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Dear DJG,

Nurse Practitioners are independent practitioners who have a separate professional license to practice as a nurse practitioner. While they also have a scope of practice, they are able to give verbal orders in most states. I would check your agency's policy about verbal orders in general; most organizations are decreasing their use, or using them in emergent situations only, as they are often a source of medication errors.

The whole point of medication safety is a major focus of the JCAHO. I think all organizations are putting more emphasis on this, and looking at the checks and balances all of the professionals who play a part in medication safety - the prescriber, the pharmacy, and the nurse. The goal is the same - to give the right medication to the right patient with all of the 5 "R"s of medication safety - right patient, time, route, dose and drug.

Thanks for your question.

Nurse Nancy

January 27, 2004

Dear Nurse Nancy,

I have been out of work on disability due to fibromyalgia for 2years.I am 50 years old, and have been a psychiatric nurse in the same position since I was 21.I have started volunteering with my Parish Nurse program. Do you have any suggestions for a position that doesn't require a high level of physical endurance? How do I explain not working for 2 years and why I think I can work now? I really miss nursing.

SKA

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Dear SKA,

You have a great professional background, combining psychiatric nursing and parish nursing. And with your fibromyalgia, I know you have a lot of personal experience in pain management, and the trajectory of chronic illness. If you have an entrepreneurial streak, it sounds like you would be great at running support groups for people who would benefit from your expertise.

I know of two nurse colleagues who started out volunteering their expertise in nursing, and then turning it into a small business. I recommend the book "What Color is your Parachute?" by Richard Bolles. (Published by Ten Speed Press - www.tenspeed.com) He really has some very practical pointers on how to combine your talent with what you want to do.

I wish you good luck.

Nurse Nancy

January 26, 2004

Dear Nurse Nancy,

The infection control nurse has said that chewing gum while feeding a patient, and passing out food trays, is an infection control issue. She can't say why. Why is chewing gum an infection control issue?

WT

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Dear WT,

Well, I suppose in chewing gum you have the potential to inadvertently spray microscopic particulate matter into the air, and since the mouth is a source of bacteria, that certainly is an infection control issue.

I would think the more important issue here is that chewing gum while at work is just unprofessional behavior. Nurses are some of the highest regarded and most trusted professions from the perspective of the public. I guess I would turn the question back to you and ask why would you think chewing gum at work an acceptable behavior?

Nurse Nancy

January 23, 2004

Dear Nurse Nancy,

Eight years after obtaining my BSN degree, I have decided to pursue a Master's Degree in Nursing, with an emphasis on Nursing Education. I have been doing web searches to find information on financial aid for graduate education, but so far all I have found have been sites geared toward undergraduates. Do you have any information or suggestions about how/where to find financial aid for Graduate education for nurses?

Thank you, RLH

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Dear RLH,

Good for you for going back to school; we have a shortage of nursing faculty along with nurses in general, so if that is where you are headed, great. As far as financial aid and scholarships, I agree that most of the money is geared toward beginning practitioners. Most of the colleagues that I know have obtained their advanced degrees through tuition reimbursement, a great employee satisfaction item. Other ideas include specialty organizations that may have scholarship money and alumni associations from your original school of nursing.

One more thought is to look at this scholarship web site. They have a lot of information about money from foundations, companies, etc. I wish you luck as you pursue your education.

Nurse Nancy

January 22, 2004

Dear Nurse Nancy,

I have worked in Renal Dialysis for 33 years. Many great things have happened and it was a very rewarding position. We had time to really assess our patients and make sure their care was well coordinated. Since the take-over of Dialysis units by profit seeking companies, they have cut the professional staff to the bare minimum and expect the same quality of care. It is impossible. Do you have any suggestions on how to deal with this other than what I did----chose to retire as soon as I could.

JT

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Dear JT,

Your issue is a familiar one, and while you are being specific about your specialty, it really could be said about just any of our specialties. There are so many societal forces that are different than when you started your career. I think you need to deal with it the best way you can. What I have seen others do is to examine how you do what you do everyday in an honest, open manner. Do you really need to do things the way "we've always done it"? This analysis needs to be done listing both pros and cons. Nursing is a microcosm of society, as is healthcare. So much has changed around us, not always for the best.
As for how to deal with it, one thing that has helped me is to look at some of the positive outcomes in changing practice. For example, when I worked in orthopaedics, my total joint replacement patients came in 1-2 days preop, we did pre op teaching, all their blood work, etc. They stayed with us for 7-10 days, and we all got to know them as people. Since the financial imperative to reduce length of stay, they have all of their pre op education and lab work done before they get into the hospital, walk into the OR, and leave in 3-5 days. I see less post op complications, and they are followed at home.

I know when you are dealing with a chronic illness like renal failure, it is different. I think another thing nurses can do is to join forces and become active in nursing organizations, so that with one voice we can tell our legislators how serious we are about providing quality patient care. That might help the situation.

Nurse Nancy

January 21, 2004

Dear Nurse Nancy,

I have been a paramedic for 4 years. Unfortunately due to our crazy schedule, 24 hours on 48 hours off, I am unable to attend a traditional nursing school. I have considered the program at Excelsior College. I am concerned about getting employment after finishing this program, as there are no formal nursing clinicals. What do you think of this kind of program?

RO

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Dear RO,

I am glad you are thinking about becoming a nurse. We need you! But you will not be able to attend Excelsior College, as it is a program for individuals who are RNs already, and are obtaining their BSNs on line. There are no clinicals, as these individuals have already done clinicals in their Associate Degree or Diploma programs. And as for my opinion about the program - I have nothing but respect for nurses who complete it. I know many people who have started it, but few who complete it. It is a rigorous program, and when I was in the position to hire nurses, anyone completing that program (or ones like it) were seen as very favorable nurses to me.

If I may be allowed to say a few words about nursing education, (I get many of these letters from people who want nursing as a second career) nursing is not something you can "squeeze in" between your other jobs. It requires serious studying of sciences such as anatomy, physiology, chemistry, and so forth. The coursework is designed to go along with clinical time in order to integrate the classroom work with the "real world" in the clinical arena.

Nurses are intelligent professionals who work alongside with physician colleagues. Often it is the nurse who sees the subtle changes in a patient, and reports this to the physician. We need to know not only the sciences, but pharmacology, drug interactions, and a million other little things during the day. While we certainly need nurses, we need smart nurses. Our patients deserve nothing less.

I wish you well as you consider nursing as a second career. We would love to have you join us.

Nurse Nancy

January 20, 2004

Dear Nurse Nancy,

I hope you can shed some light for me. I am a 29 year old female. I have been considering becoming a nurse for as long as I can remember but I am scared to death. I have this fear which I cannot seem to let go of. My sister is becoming a Physician Assistant and she told me she had to see an autopsy. That freaked me out. Can you tell me during the education will I have to encounter anything like that? Maybe my fear is due to the fact of not knowing what to expect. Any advice would be appreciated so I can make my career decision. Thank You.

AT

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Dear AT,

Your fears are most normal, I assure you. And I agree with you, that you are fearful due to the fact that you don't know what to expect. And there are so many new things in nursing, that nursing faculty are used to helping students get through difficult issues for them. And as we are all individual, different things bother us. As for the autopsy, I would guess that you would not have to see one, but depending on your program, may have to dissect other parts of animals which may be less upsetting to you. I would speak up and tell the instructor.

You will, however, see someone die or be around a dead body while you are in school. I can only tell you what I tell people who say "How can you stand to be near a dead body?" I have always felt it was a privilege to be with someone when they died, to hold their hand and just be with them and say goodbye. It is difficult at first, and I don't think you really get used to it, but you can be pleased that your patient was not alone at the hour of death. And these moments are seconds of your career, not an everyday happening. Focus on the joyous moments you will see - the birth of a baby, relieving someone's pain, making someone comfortable, and so forth. Nursing allows us to be with people at their most profound life moments. Some are joyous, some not. What I love about this profession is that no two days are the same.

I hope you will give nursing a chance. We need you!

Nurse Nancy

January 19, 2004

Dear Nurse Nancy,

I took early retirement out of the OR and moved to a very small mountain community. Can you give me any tips on how and who to contact to do some contract work in Home Health? Thanks.

BC

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Dear BC,

Well, I assume you have done the usual applications to the local home health agencies. I think in a small town, you might have a chance to network in a variety of places. I would first of all get business cards made, and take them every where with you. I am a big believer in networking, and have seen people get job opportunities in the most interesting places….you never know who you will meet in church, at the grocery store, at a cultural activity in your town. Just get out and see who you might meet.

I would also encourage you to contact the Home Health Nurses Association. They have lots of information on their web site, both for networking and education, and also links related to home care nursing.

Good luck!

Nurse Nancy

January 15, 2004

Dear Nurse Nancy,

I just graduated with a Bachelor's Degree in Nursing in SW Virginia. All through nursing school I was told on numerous occasions about the nursing shortage. In the area I live in the local hospital just laid off 20 employees, some of them clinical -- not sure if any were RN's, and 30 minutes down the road a "very new" hospital, which is adding on, isn't hiring at all, they are "moving around within" the organization. I have some friends at this latter hospital and this "moving around within" is causing a lot of stress and nurses are leaving. I finally found a job 45
minutes from my home. What's up? I'm questioning if there really is a nursing shortage. Thanks.

AK

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Dear AK,

First of all, welcome to nursing, and happy graduation! You are certainly entering the profession at a challenging time, but hang in there….As for the lay off of 20 employees, I would be surprised if any of them are RNs. Seems that the nursing shortage is just about everywhere, and I would think it would be a rare situation to be laying RNs off. Your letter does underscore the need to validate data, though, and not make assumptions about who is being laid off.

I agree that the "moving around within" is stressful to nurses, as many of us find a comfort zone and a level of proficiency in our workplace. I suppose you can look at it as an opportunity to learn something new. Things do change, and technology forces shifts in practice arenas. I tell the story of when I was a staff development in orthopaedics for a large hospital in the early 80's; we had 4 distinct adult units, all with ortho patients. The science is better now, and so you don't see patients in traction for 6-8 weeks as an in-patient anymore. That same hospital now has half a unit with adult ortho patients; much of that surgery is now same day - unheard of 20 years ago.

Good luck in your new job. Welcome!

Nurse Nancy

January 14, 2004

Dear Nurse Nancy,

I work in a small community hospital as a unit coordinator on a cardiac/telemetry unit. Recently we have been asked to work out an acceptable protocol with the ED for receiving faxed reports on new admissions. Some of the staff are uncomfortable with this but none of us really know how this might work since none of us have had any experience with this. Can you give me some pros and cons on this?

Thanks.

LB

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Dear LB,

I know it is difficult to change, but I think in this day and age, we are all asked to work harder with fewer resources. My personal experience is that it does work, moves patients out of the ED quickly, and once everyone gets used to it, is a good way to communicate. Hopefully, all of the users will be asked to evaluate it, to be sure the process is working. Here are some thoughts that might make it easier for all:

1. Be sure your fax machine has a receipt feature to it, so you can be sure that the receiving unit gets the information. (and you avoid a phone call to see if the fax arrived)

2. Faxes are useless if the information contained is not clear, accurate and legible. Work with your colleagues to insure that this happens. Hopefully you don't have to duplicate efforts, either - can the information be used as part of the medical record?

3. Ask for a meeting with the receiving unit after using this system for a few weeks. Feedback should be given from both ends - how can you improve the process? What is working, what is not?

Good luck…I hope this works for you, your colleagues, and most of all, your patients.

Nurse Nancy

January 12, 2004

Dear Nurse Nancy,

I have been out of clinical nursing for about 7 years (been in genetic medical sales) and was very successful in sales. I am wanting to return to clinical perhaps back to my Maternal-Child specialty. I have a BSN and some graduate credits. I see "official" reentry courses offered at hospitals and colleges. Are these necessary and what are my options to return to practice? Will I feel like a complete fish out of water??

Thanks.

JT

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Dear JT,

Well, welcome back to nursing! I think each of us is individual, and while this is a question I get frequently, my response is always that it all depends. I would polish up my resume, and go and speak to whoever is in charge of both the college and refresher courses. They are used to working with re-entry nurses, and will know the right questions to ask you about your personal situation.

Something else that might help you is to work per diem at a hospital to test the waters. There you will get a taste of the difference in the seven years you have been away. Be willing to do what it takes to orient to this new role, and ask if you will have a preceptor who can help you get back to where you need to be.

Given the nursing shortage, I hope hospitals and healthcare organizations will be more flexible in their approach to nurses like you re-entering. Let's hope so!

Good luck.

Nurse Nancy

January 9, 2004

Dear Nurse Nancy,

Would you be able to direct me to the appropriate resource to find out how Nurse Executive/Administrator positions are determined (e.g., when you reach a threshold of beds/department/service lines, staff, etc.?) RN to patient ratios are discussed in literature, but I can't find a formula or discussion about executive positions. Any information would be helpful.

VR

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Dear VR,

I don't think I have ever seen a formula, or any kind of quantifiable numbers related to nurse executive jobs. I have seen consistently, over several states and several organizations, that those individuals are often not replaced when they leave voluntarily, and more often, have been downsized and eliminated, leaving more responsibility to the remaining executives.

The organization who would be most interested in this topic is AONE, the American Organization of Nurse Executives. They of course have a focus on the nursing shortage, and some great information about that. I would suggest you go to the library and look at their journal, Nurse Leader and see if you find anything concerning these data.

Good luck! Have a great weekend everyone!

Nurse Nancy

January 8, 2004

Dear Nurse Nancy,

I requested to go part-time this past spring. The paper work had not been submitted, though I was able to work part-time hours. The change on paper went into effect July 29th, but the hospital is trying to make me pay retroactive insurance back to February. I was never notified that I was responsible for insurance payments prior to the end of July. What should I do?

JT

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Dear JT,

It seems that this is an issue for your Benefits Department in Human Resources. It would seem to me if your hours were adjusted, perhaps it was just an omission of paper work on their part, and I can't see how you can be responsible for this.

Hopefully you have all this in writing, and a copy of what was done. This is a lesson to all of us - keep a written record of all of the changes you make in your workplace. Put it all in writing, and keep a copy. So often we don't, and if you have all this in writing it should not be a problem. Keep all of your professional papers in one place - registration, certification, updated resume and correspondence such as you describe. It will save you hours of time if you need them.

Nurse Nancy

January 6, 2004

Dear Nurse Nancy,

At the hospital where I work, we have doctor who says that the nurse has to accompany his patient on a portable monitor to tests such as ultrasounds, stress tests, etc. We have to leave the floor and this leaves our other patients, although we do have a partner nurse who looks in on them. Aren't we liable for the other patients? What can we do about this?

WW

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Dear WW,

I can see where this could present problems for your staffing, but I know you would agree that patient safety comes first. And certainly this is not a new problem in nursing; this seems very familiar to me. I would check your hospital's Policy and Procedure Manual; if it your policy to accompany the patient, then you have to honor that.

If it is a matter of "the way we've always done it", I would suggest that you keep a record of how often this happens, what the impact is on the patients and the staff, how much time is really involved. I would suggest a few months worth of data collection, to get a real feel for how often this really happens. Prepared with that data, I would ask for a meeting with your supervisor, the physician in question, and perhaps someone from Radiology. There might be solutions you have not thought of - but having the data makes it accurate information, and not just a perception of a staffing complaint. Have all of your colleagues participate in this as a Quality Improvement project, since your goal is patient safety.

Good luck!

Nurse Nancy

January 5, 2004

Dear Nurse Nancy,

I am a R.N.-BSN prepared nurse with more than 10 years of experience in different areas of nursing such as med/surg, traveling nurse, intermediate care and some experience in I.C.U.

Why is so hard for a seasoned nurse to transfer to the ICU's, as
opposed to new graduate nurses being hired in critical care with no experience? I want growth and progress, not to digress and feel limited and stagnated. Please respond.

PM

Dear PM,

I am not sure why you are being passed over for an ICU position, but I do believe you have a right to know why. It does not make sense to me either to hire new grads into ICU when you have skilled staff who want the job.

I would suggest you assert yourself. Make an appointment with your Nurse Recruiter, bring your updated resume and recent performance appraisals. If you have a good record, you should be given a chance .Ask the advice of the Nurse Recruiter on what it would take to be considered. If your attendance is poor, or your record is fraught with problems, fix that.

If it seems that you just will never get a position in that particular hospital, move on. There are always others. You deserve to move on, and if not there, find another place.

Nurse Nancy