January 31, 2005
Dear Nurse Nancy,
How did the trend of quality improvement start in nursing?
PY
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Dear PY,
I think healthcare followed in the model presented in the business world by statistician Edward W. Deming. Deming introduced the concept of PDSA (Plan – Do – Study – Act) which is a continuous quality improvement model. In this model, which has been adopted by nursing, we do the following for individuals or organizations:
PLAN plan ahead for change, predicting results.
DO execute the plan, doing this in small steps
STUDY sometimes referred to as check – study the results
ACT improve the process and take action
Certainly this applies to most of what we do for patients, and this is how process improvements are made.
Nurse Nancy January 28, 2005
Dear Nurse Nancy,
Is there help out there for nurses with addictions? I know someone who is trying hard, but I think she needs more help. Addiction is a terrible disease and it seems that nurses are not immune from this disease. I hate to see it happen, but it does.
FG
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Dear FG,
I agree – we are not immune, and I have seen several of our colleagues impaired over my years. One word of caution – if you feel that a colleague is working and impaired, please don’t try to cover up for this person. The individual needs to be removed from the clinical setting immediately. Call your supervisor, and be sure that this person is not giving patient care while impaired.
The American Nurses Association has a position paper on this topic, and it would be helpful for all of us to know about it. Go to www.aana.com/peer/resolution0520002.asp. They list support groups for nurses with addictions by state, which hopefully will help you. I hope your colleague gets the help she needs.
Nurse Nancy January 27, 2005
Dear Nurse Nancy,
I am an operating ooom nurse and new to Michigan. Can you tell me where I can find out if there is an OR nurses group in Michigan?
MR
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Dear MR,
I looked on the website of AORN – the Association of periOperative Registered Nurses. I did not see a specific group, but noticed in their minutes that their Executive Board approved affiliate status for the Michigan State Council in November of 2003. While I could not find that on their website, I encourage you to go to their website and you can find out the information directly. If you are not a member, I encourage you to join AORN – it is one of the largest specialty organizations, celebrating their 52 nd anniversary. The networking and education I know will serve you well.
Good luck!
Nurse Nancy
January 25, 2005
Dear Nurse Nancy,
How do you go from floor nursing to other positions like management?
PC
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Dear PC,
I think some of the best managers I know were excellent staff nurses. How you get there is to find a manager mentor who can help you reach that goal. Obviously, you want to do a good job at work, have a positive attitude and a good attendance record. If you have a charge nurse position, offer to take on this role and practice your leadership skills.
I would let my manager know that I was interested in becoming one (there seems to me to always be positions for first line managers in nursing) and see how he/she got started in management. Of course, your education and resume are important also; make sure they are top notch.
This does not happen overnight, so I would caution you to go slow but follow that dream; we need good managers who really influence the way the unit works.
Good luck!
Nurse Nancy January 24, 2005
Dear Nurse Nancy,
I am a Public Health Nurse with the elderly and disabled population in California. My clients often need assistance with picking up medications, setting up medi-sets and general education. Community services are not always available, so I help my clients with setting up their medications. I consult with a physician as needed regarding medications, but was wondering if this is in my scope of practice.
TE
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Dear TE,
What you are describing is not prescriptive, so it seems within your scope of practice to me. Families and unlicensed health care providers perform this service for patients; filling the medi-sets is merely following the prescription directions, so that should not be a problem.
It is actually an opportunity to see how much your clients know about their medications, which is part of the teaching role we have as nurses. You are likely preventing medication errors this way.
Nurse Nancy January 21, 2005
Dear Nurse Nancy,
I am curious – what part of the United States has the highest rates of vacancies for RNs?
TY
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Dear TY,
According to the US Department of Health and Human Services, Bureau of Health Professions, it is easier to list which states do not have a high vacancy rate. They project that by 2020 the shortage (as high as 29%) will be in 44 states and the District of Columbia.
The states not projected to have a shortage then are the following: Kansas, Iowa, Kentucky, Ohio, Vermont and Hawaii.
Nurse Nancy January 20, 2005
Dear Nurse Nancy,
I have been an RN for 19 years. I have an ADN, have started my BSN but not finished. I have 4 semesters left. I like my work and my time off. I still worry about needing that BSN someday, but I do not have any further career goals in mind. I find it very stressful to work and go to school. I wonder if the stress is all worth it, if I plan to stay at the bedside anyway. Do you have any advice for me?
LW
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Dear LW ,
I think you never know where your life and career will take you, so I think finishing that BSN is a good idea. I know it seems like 4 long semesters, but the time will go by quickly is my bet.
I went to school part time after going to a diploma school, and while it was difficult during that time, my BSN opened many professional doors for me. I wish you the best….you are investing in your future. Do it!
Nurse Nancy January 19, 2005
Dear Nurse Nancy,
How does one find out what universities, colleges and nursing school pass rates are for NCLEX's? Specifically, I was interested in Villanova University and Dixon School of Nursing-Abington Memorial Hospital in PA.
MMc
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Dear MMc,
These are questions you can ask any of the schools to which you apply. Both of these institutions are accredited by the National League for Nursing. Aside from NCLEX passing rate, I would be concerned that Villanova leads to a BSN and Dixon is a diploma school. If you want a career in nursing, you will need to go back and get a BSN (at a minimum) which will take a long time.
For the diploma nurses out there, I am not bashing diploma schools; I went to one and got a great education. I also acknowledge that for those of us who did go to diploma schools, it has been added stress to return to school while working.
Nurse Nancy January 18,2005
Dear Nurse Nancy,
I have been off work for 5 years due to work injury requiring three surgeries. I'm unable to return to hospital nursing. I have been struggling to find another career in nursing that I can and feel confident doing. I will be able to use Vocational rehab training that is available to me. I live in a rural community and do not have a lot of options. Can you help? Thank you.
BE
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Dear BE,
I am happy to hear that you have the ability to utilize the services of Vocational Rehab. Hopefully they will be connected to positions that might be more suitable to you. There is always case management, working for an insurance company or HMO, chart reviews, and so forth.
The other thing you might consider is volunteering. Sometimes that grows into a paid position. Give it a try. Good luck.
Nurse Nancy January 17, 2005
Dear Nurse Nancy,
I have been a Home Health nurse for 7 years and have always written orders from the physician for discontinued meds, samples sent home with patient with no written instructions, and if there was a change in meds such as a coumadin change. I was told by our Director of Nursing and Administrator that this was not necessary. Please tell me what is correct.
JK
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Dear JK,
You are working on your license, not your Director’s or Administrator’s. If something did happen, you would be responsible for your professional practice.
It seems to me that changing coumadin orders, taking new medications (samples) and discontinuing medications required prescriptive authority which RNs do not have.
In cases like this, I would check with your State Board of Nursing for their direct advice. I think you are correct in your assessment of this situation.
Nurse Nancy January 14, 2005
Dear Nurse Nancy,
I am a traveling nurse and have had two of my contracts breeched. What legal action can I take to prevent this from happening again? In one case, I purchased a $400. airline ticket and spent $200 for a nursing license for Hawaii. One week before my departure, my recruiter called and said there was a misunderstanding at the hospital. In another situation, the same excuse was used 5 days before the start of my written contract. Not only the shift was changed, but the start date was moved up. I have lost my trust in people and their word. What can I do?
SE
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Dear SE,
Well, obviously I am not an attorney, but it seems to me that you are entitled to a discussion about this with your agency. First I would encourage you to read your contract again, including the fine print. I am wondering if there is a clause in there that would cover the above situations. The other thing I would suggest is not to accept people’s word; this is a business and you should ask for everything in writing.
If this is not doable, I would consider changing agencies; there are many out there and I would find one that keeps their word. Good luck.
Nurse Nancy January 13, 2005
Dear Nurse Nancy,
I made a med error yesterday, and I can’t forgive myself. Fortunately, nothing happened to my patient, and I reported it right away and filled out the paperwork. I work on a rehab unit, and have to pass meds to 22 patients. I am afraid this will happen again. Help!
JH
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Dear JH,
First of all, please realize that we all make errors, as we are all human. You did the right thing in reporting it; that is very important so that your organization can track any patterns and improve systems. Regulatory agencies expect organizations to have errors; think of the denominator of all the meds you give to 22 patients over time – surely a mistake is bound to be made occasionally. Thankfully nothing happened to your patient.
A great place for you to take a look at is the Institute for Safe Medication Practices. There is a lot of practical information there that might help you feel more secure about giving medications. Trust yourself – you sound like a great nurse.
Nurse Nancy January 12, 2005
Dear Nurse Nancy,
Please solve an argument about whether nursing is a profession or not. Some say it is; I am not sure. What qualifies nursing as a profession?
AP
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Dear AP,
There are several criteria which define a profession, but the one I like the best comes from the Concise Oxford Dictionary of Sociology (1994). They describe a profession having the following characteristics:
- Central regulatory body
- Code of conduct
- Careful management of specific knowledge
- Control of the numbers in the profession
ursing meets each of these criteria, and in my mind, it is clearly a profession. Another good reference for this discussion is the website of the American Nurses Association who also describes this.
Nurse Nancy
January 7, 2005
Dear Nurse Nancy,
I was diagnosed with dyshydrotic eczema and have been off work for several months because of it. I have ten years experience in ICU, ER, and Cardiac Cath Lab. I doubt if I will be able to go back to a job where I have to wash my hands dozens of times a day. I was wondering if you have any suggestions for work. I have considered case management, teaching and legal work. I have my BSN and am willing to go back to school.
AL
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Dear AL,
I think you are correct in looking for another job, as hand hygiene is an essential component of clinical practice. If you are willing to go back and get your Masters, that will definitely open your options, as well as expose you to interesting faculty and colleagues who can open your professional world.
As far as other jobs – send your resume out and see where it leads. Most teaching positions require a Masters, but you just might find a great job out there. Good luck!
Nurse Nancy January 6, 2005
Dear Nurse Nancy,
I am a RN working for a Home Health Care agency in Santa Fe, NM. My supervisors have asked me to get training and certification in wound care management. Could you please advise me of the first steps involved in getting this certification? Thank you.
GVJ
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Dear SP,
The Wound Ostomy & Continence Nurses Society accredits programs, and offers the certification in these specialties. On their website there are seven listed. None of them are near you (the closest would be in Houston, Texas) but one is an online program, WebWOCN in partnership with Metropolitan State University in Minneapolis, MN.
Also listed on this website are the names, phone numbers and email addresses for regional and affiliate presidents. There are two listed for New Mexico – Albuquerque and Tucson. Perhaps those individuals could help direct you in this endeavor.
Wound care nurses do great work. I wish you well in this field.
Nurse Nancy January 5, 2005
Dear Nurse Nancy,
I am an RN with a systemic Latex allergy and am interested in obtaining a list of Latex-free hospitals in the United States. Can you help me with this?
CS
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Dear CS,
This is a difficult situation, as it is very expensive to make a hospital or health care facility totally latex free. There is an interesting article on our site addressing the efforts that hospitals are making toward this goal; we all agree it is an important one for health care workers who could be allergic to latex.
The article lists two health care facilities which have made great efforts in decreasing the use of latex: Marshfield Clinic in Marshfield, Wisconsin and the Shriners Hospital for Children in Sacramento, California. Even these facilities don’t claim to be totally latex free, but both have made significant efforts. Latex allergies are serious; the FDA received more than 1000 reports of adverse health effects from latex exposure, including 15 deaths.
The problem that I wonder about is consumer products. While hospitals may be able to control medical products containing latex, they have no control over personal products.
I wish you well in trying to get back into the workforce with your latex allergy. Good luck.
Nurse Nancy
January 4, 2005
Dear Nurse Nancy,
Do you have any suggestions for a manager who wants to go back to direct patient care? I have been unable to find any formal RN reentry programs in the San Francisco Bay area. There are internship programs for new grads and foreign nurses. What about those of us with clinical expertise that need support with a review of the basic skills?
LB
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Dear LB,
I think you should take a look at Community Colleges in your area. They are more likely to offer refresher courses for nurses who want to go back to the bedside. Alternatively, if you have been working as a manager, you might just need a facility that has a great orientation program with preceptors. You probably know more than you give yourself credit for – go for it!
Nurse Nancy
January 3, 2005
Dear Nurse Nancy,
I am interested in learning more about the heart, and wondered if you know of any good websites that I can use. Thanks.
SP
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Dear SP ,
There are many great websites that have audio so you can not only review the anatomy and physiology of the heart, but also actually hear the differences in heart and breath sounds. One that I have found useful is from UCLA. It was written by Christopher Cable, MD and is copyrighted. It reviews heart sounds, heart murmurs, and breath sounds. I think you will find it helpful.
You can find this site at http://www.wilkes.med.ucla.edu/intro.html
Nurse Nancy |
