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February 27, 2004
Dear Nurse Nancy,
I work in a busy hospital-based GI unit. With staffing
cutbacks, and an increase in volume of procedures, it
has become impossible to take a break during a 9- to
12-hour day, and forget about having a lunch break.
Is this legal? I just worked a 9-hour day, and asked
my charge nurse for one 10-minute break in between cases,
and was denied because ,"there is no time for you
to take a break, we have to get all of the procedures
done" This isn't right, and I was wondering what
legal stance I have to stop this from continuing. I
don't mind working hard,
but I feel that I deserve at least a break in the day
at some point after working six hours straight, and
after being denied a break, working another three hours
before going home for the day. Please advice. Thanks.
NC
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Dear NC,
You are right on several accounts. While I am not an
attorney, and usually do not comment on legal issues,
I am confident in saying that yes, there are labor laws
that protect you so that you have a break in your day.
Discuss this with your human resource department; you
are entitled to a break during the day.
That being said, I think your manager is just asking
for trouble for allowing you to work this many hours
without a break. The potential for error is huge when
you are this exhausted, and you are working in an area
where there is opportunity to give the wrong medication,
miss a patient drifting into sedation, wrong procedure
done to the wrong patient and so forth. Given the major
emphasis there is on patient safety, I can’t believe
your manager would even consider letting you work this
hard, let alone deny you a break. Take a look at the
ISMP (Institute for Safe Medical Practice) information
at www.ismp.org.
I would also encourage you to keep careful records
of how many hours you work overtime, how many days you
don’t get lunch or a break and so forth. You need
data to take to your nurse manager, and this might help
change the staffing patterns. I have seen staff nurses
influence this kind of change, and I encourage you to
do the same.
Good luck. And take a break.
Nurse Nancy
February 26, 2004
Dear Nurse Nancy,
I am at a loss on whether I will resign as a clinical
instructor and
go back to work at a hospital in order for me get hired
by hospitals there in the United States .Someone from
here said that it's a red flag when recruiters see that
I am not currently working in a hospital. I really would
like to know your opinion about my dilemma. I am a Filipino
nurse with 13 years of experience in hospital,clinic
and nursing education. I really would like to work there
in the United States, but I think that
this present job of mine is what's keeping me from getting
hired.
Your advice will be very much appreciated.
MA
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Dear MA,
I would suggest that you be sure that your résumé
reflects what you did as a clinical instructor. Working
in a clinical setting, you have done the same kinds
of work that nurses who are working in a hospital do.
Be sure to give yourself credit for the many clinical
skills you teach, and I think any recruiter would consider
that recent clinical experience. For example, if you
teach nurses about ventilators, give yourself credit
for knowing how to manage a patient on a vent, and to
list skills like that. That suggests more current experience
than teaching in a classroom.
Good luck in finding a new job!
Nurse Nancy
February 25, 2004
Dear Nurse Nancy,
I am a director of nursing at a drug and alcohol rehab
facility. I was promoted to this position from a charge
nurse position and had no prior management experience.
Upper management has made a major readjustment in the
way the nurses are documenting. This is time consuming,
but it can be done. However, I do not think I can accomplish
all the job duties my company is asking of me. I am
to work the floor, only being in my office no more than
90 minutes in the day. I have been doing this for two
weeks now and I have not been able to address any of
my DON duties. I do this with three other staff, with
anywhere from 40 to 55 patients. I now suspect that
I am going to be expected to do this with only two other
staff. I feel like my company is wanting a DON and a
charge nurse, but that they want to pay only one salary
to get the two. Also, I have two staff members who are
on Mondays through Fridays days who are crucial to the
daily operations. My company has stated that they will
have to work weekends. Is this fair practice? These
nurses
paid their dues working other shifts before this one.
I have been
instructed to show upper management my staffing schedule
so they can determine how I should staff. Finally, when
all of the changes were made, management approached
nurses with this information in a commando style approach.
I am exhausted. I continually justify nursing\medical
decisions to a company that does not have one medically
trained person in upper management or at the corporate
level. Is it reasonable to expect a DON to only be in
the office 90 minutes a day, work the floor and be able
to get all reports done, etc? Please help. I am about
ready to throw in the towel.
TT
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Dear TT,
My first reaction to your letter is that many DONs
would be happy to have 90 minutes in their offices.
Most are out at meetings, and doing all sorts of other
things that keep them away from their work. That kind
of comes with the territory. Going from a charge nurse
to a DON is quite a steep promotion. You likely need
some help with time management, prioritization and so
forth. Is there a job description for your position?
I would ask to have it reviewed, as I imagine doing
direct patient care is
not in it.
We are all doing more with less; that is the way of
health care today. I would suggest you sit with your
direct supervisor and quantify what it is you are being
asked to do, and explain that it can’t all be
done by you. I understand the difficulty in working
with non-medical people. Give it your best, document
all of your conversations with your supervisor and keep
your professional demeanor. Only you can decide if it
is worth it, but if you try to communicate, document
and make the change, at least if you do leave, you will
feel like you gave it your best shot.
I wish you luck, as I know you are in a tough place.
Nurse Nancy
February 24, 2004
Dear Nurse Nancy,
I recently got hired working as an RN at a laser center
for hair removal and would like to know if I need to
be certified to operate the laser machine. I have gone
through their orientation and hands-on training with
the RN trainer. However, I am not sure if this is sufficient.
Most of the nurses who are working there do not hold
a certificate or additional license other than their
California RN license.
SJ
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Dear SJ,
This sounds a bit risky to me, as a laser is certainly
a serious piece of equipment. I am not sure of your
liability, but would encourage you to check with your
Board of Nursing to see if this is within your scope
of practice. Also, if you have a risk manager, I would
speak to that person to see if you are covered should
something go wrong.
I do know nurses in the operating room work with lasers,
but they also have competencies to document what they
have been taught. They also have routine eye testing
to protect their vision.
We can all be educated to do just about anything, but
you do need to think about your professional liability.
Nurse Nancy
February 23, 2004
Dear Nurse Nancy,
I am an RN currently employed in a tertiary care facility.
I have been doing adult surgical critical care for more
than 20 years. Recently, I have begun to consider a
change to neonatal intensive care. I have always had
an interest in pediatrics and have maintained certifications
to teach ACLS and PALS. I have interviewed for an open
position .Do you have any suggestions for making me
more attractive to the new manager? Also, I have maintained
my CCRN for multiple years. Will I be required to stop
using the designation or will there be a certain
time frame in which I would retest with the neonatal
material? Is there any way to maintain both certifications?
This whole process has been complicated by an on-the-job
injury that required me to have extensive emergency
surgery that has an expected long recovery .Do I have
any hope at all? Thanks.
JK
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Dear JK,
Of course there is hope! Always! You certainly have
a good background in critical care, and I always believe
in transferable skills. To make you more attractive
to your new manager, I would suggest you think positively,
tell him or her what you can offer and don’t dwell
on what you don’t know. Ask about the orientation,
if you will have a preceptor and so forth.
As far as the CCRN, good news. You can renew as a neonatal
nurse, as the qualifications for renewal are to have
an unrestricted RN license, and 432 hours of direct
bedside care (includes adult/neonatal/pediatric) in
a three-year period preceding the certification period,
with 144 hours in the year preceding the application.
To read more about this process, go to www.aacn.org.
You have great credentials. I wish you well in your
new career. Good luck!
Nurse Nancy
February 20, 2004
Dear Nurse Nancy,
I will be starting a new career path in a youth corrections
center. Are there any certifications or special training
you can get with this type of employment? My concern
is that after a period of time, if I choose to change
career paths, what certifications in this area would
assist me?
Thank you.
BLPW
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Dear BLPW,
Your new career is very specific, so I wouldn’t
expect you to have many certifications. We list all
of the certifying agencies on our site, and there is
a certification for pediatric nurses. Here’s the
link: www.pncb.org/ptistore/control/index.
Another idea, as this is such an interesting area for
nurses, and one that most will never see, is to write
up your experience and submit it to NurseWeek.com for
publication. That is a great résumé builder,
and we encourage you to share your story once you get
into the routine of your new job. (Beth and Tina…..do
we encourage authors like this, or do you go and get
your articles? Feel free to change this if I am encouraging
something
you don’t do)
Good luck in your new job!
Nurse Nancy
February 19, 2004
Dear Nurse Nancy,
I recently had to retire on disability due to a
new diagnosis of chronic asthma and would like to go
into another branch of nursing. Can you suggest areas
where I would not be exposed to triggers for my asthma?
Also, my doctors want me away from patients because
my immune system is compromised because of other illnesses.
Thanks.
WS.
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Dear WS,
There are many opportunities for nurses these days,
you just have to look for them. You might do well in
insurance work, or something you can do on the phone.
If you can’t be near patients or people, it may
take you a little longer to find your niche, but keep
at it and you will find something.
In the meantime, network, network, network. Get those
business cards made, and have them with you everywhere
you go. You just never know when you will meet someone
who can help you.
Good luck!
Nurse Nancy
February 18, 2004
Dear Nurse Nancy,
I am interested in starting my own nurse registry
in California. However, I am unable to find any valuable
information. I would assume that I am not looking in
the right places. Can you lend me any advice?
JJ
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Dear JJ,
An interesting question. I had a friend who had a similar
situation, and I will share with you what she did, since
it was successful. This is a business proposition, so
I would treat it as such. Looking on the Internet for
free is likely not going to get you the business information
you need.
What I would suggest is that you find a company that
does what you want to do, but not in your vicinity (so
you won’t be competing with this person or agency).
Call and ask if you can make an appointment with them,
and offer to pay an hourly fee for the information you
seek.
If you are seen as seeking information, but not a direct
threat—make it far enough away so that you are
not competing for the same nurses—it might work
in your favor. Another resource is your local small
business association—most communities have them—who
may give you some tips on the business aspects of starting
a nurse registry.
And of course, attend as many meetings you can to network
among the people who need nurses—nurse recruiters,
nurse administrators and so forth. Conventions, meetings,
just network wherever you can.
Good luck to you.
Nurse Nancy
February 17, 2004
Dear Nurse Nancy,
I work in Los Angeles and have heard a rumor that
the BRN is
considering grandfathering in the current LVNs of California
as actual RNs, due to the intense RN shortage. Could
you clarify what's going to happen? Would an RN certification
through this process be open to reciprocity with other
states?
RA
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Dear RA,
I think the operative word in your question is rumor.
One of the great things about the Internet is you can
get information quickly. The California Board of Registered
Nurses posts the minutes of their meetings on their
Web site. In the latest meeting, there is nothing about
this: www.rn.ca.gov.
My opinion is that, despite how bad the shortage gets,
both RNs and LVNs work under a separate practice act,
and there will always be the two professions. What is
happening across the country is more opportunity for
LVNs to become RNs, but there is always an educational
process. I would encourage you to take a look at the
board’s minutes, as they have a mission which
they clearly are honoring. It is all about protecting
the public, and in reading their minutes it is clear
that they are questioning all of the alternate-type
learning experiences (distance learning, for example)
to ensure safety for all of our patients.
Thanks for your question.
Nurse Nancy
February 13, 2004
Dear Nurse Nancy,
Are jobs as a nurse practitioner worth pursuing?
I'm almost
30 years-old and a male. Does this offer more job security
than my plan to complete an AAS in nursing would and
where would I find jobs with high demand and better
pay? What does a new graduate RN from a community college
earn in his first year?
KR
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Dear KR,
I definitely think there is a future for nurse practitioners,
especially those with strong clinical backgrounds who
are flexible. Many residency programs are closing, or
declining in size, and the nurse practitioners are caring
for the patients. (Where I work, for example, the neonatal
ICU is totally run by NPs—24/7, with an attending
physician)
To become an NP, you have years ahead of you. You need
to finish your BSN, and then master’s, which can
be done concurrently with your NP education. The time
will be useful, as you will be exposed to different
clinical situations, and you can see not only what interests
you, but where the vacancies are.
As for salary, that differs regionally. Check our salary
wizard on NurseWeek.com. Click here: http://www.nurseweek.com/salary
I wish you well as you find your way. The time goes
quickly—good luck!
Nurse Nancy
February 12, 2004
Dear Nurse Nancy,
There is a very pressing problem going on at my job.
The question is about the signing of surgical consents
for foreign-speaking patients. Our policy does not address
it, but our nurse executive is insisting that we co-sign
this form or we'll get written up. Usually an interpreter
speaks to the patient and the nurse does not understand
what is being said. I would really appreciate some help
in this situation and also some direction. Thank you
for helping us. We appreciate your time and consideration.
HU
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Dear HU,
Good for you for checking your policy. I would encourage
you to take another look at it. Most of them say that
the RN who witnesses the signature is responsible for
witnessing the signature, not the explanation. The explanation
is generally the responsibility of the attending physician.
That being said, I understand your concern. I would
speak to your patient representative department, and
see if you don’t have a language bank in your
hospital. Most do. If this is not satisfactory, another
place to discuss this concern is with your ethics committee.
I hope you find a solution to this issue. Thanks for
being such good patient advocates!
Nurse Nancy
February 11, 2004
Dear Nurse Nancy,
I am an RN administrator in community health. I
am thinking about changing to a different career in
nursing. However, I am concerned that I may not have
the skills that are needed in other fields of nursing.
I have been in community health for seven years and
only had about 10 months of medical-surgical nursing
after I graduated from nursing school. Do you have any
advice for me?
Thank you.
JJ
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Dear JJ,
My first piece of advice for you is to take a deep
breath! You are not giving yourself credit for all you
did in those seven years—time management, organizational
skills, hiring/firing, scheduling, to name a few. All
of those skills will be useful in any nursing job you
might want.
Find a position where you will have a good orientation.
Talk to the nurse manager; discuss what you think you
will need to succeed. Given the nursing shortage, I
am sure there is a place for you somewhere. I hope you
take the time to find the right fit for you.
Good luck!
Nurse Nancy
February 9, 2004
Dear Nurse Nancy,
I work in a hospital-based peritoneal dialysis
clinic in which our previous practice was to have the
drug Erythropoietin dispensed by our hospital pharmacy
and labeled for home use for each client requiring this
drug. Our supervisors have now changed our practice
to having the RN give the client a monthly supply of
this drug without a pharmacist's assistance. The drug
is labeled with the client's name, but there is no dosing
information on the package. The drug is now stored and
billed through the dialysis unit without a pharmacy's
labeling or a pharmacist dispensing the drug. Since
this is a prescription drug, we are not comfortable
with this new protocol. Does the dispensing of prescription
medication in this way for home use by the client violate
the Nurse Practice Act or any other laws? Thank you
for your help.
LL
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Dear LL,
This does sound problematic to me. Given the emphasis
the JCAHO has placed on patient safety, I would think
that it is an incident waiting to happen. The role of
the pharmacist is critical in dispensing, not only in
the labeling, but in the pharmacist’s review of
the patient’s medication profile for drug interaction
information.
I would approach this problem from the patient safety
perspective. Supporting data about how important this
is can be found on the JCAHO Web site www.jcaho.org.
Most nurse practice acts address this (not by drug
name, but by who can dispense medications) also. We
have a list of all of them on our site, state by state,
at http://nurseweek.com/special/resources.asp
I wish you well in your endeavors. It seems that dialysis
is one of those areas where finances are really dictating
(and changing) practice.
February 6, 2004
I quit my job as an RN to take care of my husband.
He passed away Nov. 23 of this year. I called to apply
for the same job. My supervisor told me that I should
start by doing only one day a week and increase my schedule
as I go. Is it a good idea or is she worried that I
cannot do my job properly because of premature return
to work? It would have been two months after my husband's
death. Thank you kindly.
CC
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Dear CC,
First, I am sorry for the loss of your husband. I hope
you take some comfort in the fact that you were able
to help him in his last days.
As for your supervisor, I think she is being kind to
you, as it is very soon after your husband’s death.
We all grieve differently, and I think she is giving
you an opportunity to ease back into work. I would take
her up on it, see how it goes and when you think you
can come back full time, discuss it with her.
I wish you well as you return to work. Take it easy,
and take care of yourself.
Nurse Nancy
February 5, 2004
Dear Nurse Nancy,
I am challenged to join the U.S. Army Nurse Corps.
What advice could you give me as far as how to prepare
to join this organization?
PB
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What a great career opportunity for you. The mission
of the Army Nurse Corps is to provide nursing leadership
and quality nursing care both in peacetime and during
contingency operations, within a professional military
system and in support of the Army Medical Department.
In World War II, more than 59,000 nurses served in the
ANC.
In terms of preparing, I would assume that they are
looking for nurses in all specialties. Advanced degrees,
certification in one’s specialty and general good
health seem to be obvious criteria. The educational
benefits are usually excellent. I would suggest that
you speak directly with a recruiter for the ANC. Go
to their web site to see where there is one close to
where you live. It is http://armynursecorps.amedd.army.mil.
I wish you the best – and thank you for your
service to our country.
Nurse Nancy
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