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March 31, 2004
Dear Nurse Nancy,
I am a 49-year-old AND nurse with 23 years experience
in nursing. I am finding out that a lot of doors are
closed to me because I do not have my BSN. I am told
that there are grants and money out there, but I can’t
seem to find then to return to school. Can you help?
KN
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Dear KN,
Good for you for being willing to go back to get your
BSN. I agree that it opens many doors. As far as money
and grants – you just have to look for it. I would
suggest taking a look at a website that lists foundations,
opportunities for minorities and ethnic groups, corporate
sponsors, and so forth. It is www.scholarships.com.
Also think about your alumni association where you
went to school – they often have scholarship money
for their alumni. Professional organizations usually
have scholarship money also. If you take a course at
a time, you will see that you will get done sooner than
you think.
Good luck to you.
Nurse Nancy
March 30, 2004
Dear Nurse Nancy,
I would like to know how I can find out about charting
by exception. Does this take place of long, exhaustive
narrative nursing notes? Thank you for your help and
input.
DL
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Dear DL,
Charting by exception does replace long, (often meaningless)
nurse's notes. Those who use it tell me that they like
it because you develop a problem list, and then just
document facts of the assessment, analysis of problems,
care planning and evaluation. No narrative notes (which
often have inappropriate comments such as blame, gossip,
and so forth), less time, more factual data. Sounds
like a winner to me!
Nurse Nancy
March 29, 2004
Dear Nurse Nancy,
How do you handle difficult physicians? I work with
one doctor who consistently orders Demerol long term
for his patients, although we all know that Demerol
should not be used for more than a few days. I have
tried to speak to him about this, but each time he just
looks at me like I am crazy. Any thoughts?
DL
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Dear DL,
This sounds very familiar to me, despite the fact
that most academic medical centers and hospitals have
taken Meperidine (Demerol) off of the formulary years
ago. One thing that has worked for me is to give the
MD data. There is an excellent meta-analysis of the
troubles with Demerol that I give to house staff and
attendings. I carry copies in my bag to help educate
our colleagues. Here is the reference:
Latta, K.S., Ginsberg, B. and Barkin, R.L. (2002) “Meperidine:
A Critical Review.” American Journal of Therapeutics.
9(1), 53-68.
Most of all, don’t get discouraged. Just keep
advocating for your patients and do the right thing.
Good luck!
Nurse Nancy
March 26, 2004
Dear Nurse Nancy,
What can you say about nurses as independent contractors?
Nurses marketing themselves and delivering care directly
to the consumer and being self-employed. Is this possible?
If so, what are the advantages?
BG
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Dear BG,
While nurses certainly have an independent license,
I am not sure how you would market yourself to deliver
care independently. We can certainly make decisions
related to nursing issues, but work under the direction
of a physician or a nurse practitioner (who is working
in a collaborative relationship with a physician). We
have clear parameters on what we can and can’t
do—like prescribe medications.
Self-employment would also suggest self-pay for health
benefits, no paid vacation or sick time and so forth—some
of the best benefits of working in a health care organization.
Your question reminds me of the saying “Be careful
what you wish for.” The advantages, for those
with entrepreneurial souls is also autonomy. You just
have to find the right niche for yourself. I wish you
luck as you explore.
Nurse Nancy
March 25, 2004
Dear Nurse Nancy,
I have many years of experience as a nurse administrator
in acute care hospitals. I recently applied to be a
director in a long-term care facility, and they told
me that because I never worked in LTC, I was not qualified
to interview. How hard can those regulations be to learn?
Don’t we all have to learn at some point?
KB
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Dear KB,
I have had the experience of interviewing for a similar
position, and not getting the job because I did not
have LTC experience. I know the regulations are different,
and lengthy, but there is a bias in the LTC field that
you must have that experience in order to lead.
I tried to argue that they can be learned, and that
we come with transferable skills—customer service,
professional development, performance improvement and
so forth. It did not work with the person who interviewed
me. And yes, we have to learn and start somewhere.
Good luck in your job search.
Nurse Nancy
March 24, 2004
Dear Nurse Nancy,
Where can I find out information on becoming a lactation
consultant?
SL
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Dear SL,
There is an organization of lactation consultants,
the International Lactation Consultant Association.
Their Web site is www.ilca.org.
They have been incorporated since 1985, and the mission
of this group is to advance the lactation consultant
profession through leadership, advocacy, professional
development and research.
Given the worldwide emphasis on breast-feeding, I think
this is a great profession to be a part of. Check out
the information, and I think you will find what you
need. Good luck!
Nurse Nancy
March 23, 2004
Dear Nurse Nancy,
I am interested in working as a nurse care coordinator/detective.
There are so many people at a loss when it comes to
putting together all of the pieces from the several
health providers we have to work with.
I would like to provide this service to patients and
their families. What can I do to get a job like this?
I am an RN with more than 25 years’ experience,
and a bachelor’s of science in organizational
behavior.
Is there a niche for me?
DK
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Dear DK,
Well, it certainly seems like a good service for families.
It sounds somewhat like the role of a case manager to
me. The trick will be payment—while families might
need this, will they pay for this service?
You will need to put together a business plan, and
gain entrée to an organization. It is certainly
worth exploring. I would suggest that you go slowly
with this, and see where it takes you. If you have that
entrepreneurial spirit (and it sounds like you do) you
will chip away until it happens. Good luck!
Nurse Nancy
March 22, 2004
Dear Nurse Nancy,
A hospital in my area offers a hire-on bonus to nurses,
except those in the Health Professions Diversion Program.
Isn’t this discriminating? Their justification
is that they are helping these nurses enough by just
hiring them.
EP
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Dear EP,
It does seem mean spirited to deny a group like this.
I admire the nurses who have worked through their illness
and go back to work. I expect that it is difficult to
get back into the hospital scene.
I imagine the hire on bonus is contingent on successful
probationary period. I would think they would treat
both the new nurses, as well as these nurses with a
history of impairment, the same.
Nurse Nancy
March 19, 2004
Dear Nurse Nancy,
How many nurses have left the profession due to burnout?
How can this be stopped?
OP
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Dear OP,
Well, I don’t know that we have data as to exactly
how many nurses have left the profession due to burnout,
but I agree we need to all get it under control and
try to stop it. There are so many stresses in our lives
– both at work and at home. Managing the stress
surely is a good beginning. Prioritize what is really
important to you, and do the best you can to match those
priorities. We have to face it – we can’t
have it all, much as we would like to.
Many of the specialty nursing organizations are concerned
with burnout, of course, especially the AONE (American
Organization of Nurse Executives). Take a look at their
website (www.aone.org)
for further information.
Nurse Nancy
March 18, 2004
Dear Nurse Nancy,
I am interviewing for a job as a staff development
instructor, and as part of the interview, I have to
do a short in-service to my colleagues. I am very nervous
about this, as I am worried that I really know the material.
Any thoughts on how I should do this?
JU
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Dear JU,
Good for you for applying for this new role in your
career. As for the in-service, preparation will increase
your confidence. If you can select the topic, pick something
you know well, and are comfortable with. Be sure to
have audiovisual aids, and handouts for your learners.
Also be sure that you respect the time allotted for
your in-service. If they ask you for a 15 minute in-service,
be sure to time yourself so you are not there for an
hour.
Take a deep breath, feel good about yourself and good
luck.
Nurse Nancy
March 17, 2004
Dear Nurse Nancy,
I work in an ICU where many of my colleagues have
completed coursework as NPs. Some of the doctors allow
them to do things that “regular” nurses
can’t. I don’t think they should be practicing
as NPs unless they have been hired as such. One told
me “I have the knowledge, so I plan to use it”.
Please let me know what you think of this.
YS
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Dear YS,
I think whoever told you this is misinformed. In some
states, nurse practitioners work on a separate license,
so if the individual nurse is working on his or her
RN license, he or she is not covered for advanced practice.
As hard as people work to become advanced practice
nurses, it is difficult for me to understand why they
would not take the role seriously. Certainly much of
what is learned can be integrated into daily practice,
but providing care as an NP is different from an RN.
For example, an NP has prescriptive authority, but if
not employed in an NP role (including sanctioning from
the hospital’s credentialing committee) it would
be wrong for he or she to be writing orders for their
patients.
Nurse Nancy
March 16, 2004
Dear Nurse Nancy,
I love maternity nursing, and think I want to be a
certified nurse midwife. I am afraid once I get into
this, I may not like it. Can you suggest what I can
do to see if I would like to be a CNM?
PW
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Dear PW,
I would suggest that if you want to be a Certified
Nurse Midwife, that you educate yourself as much as
you can as to what they do for patients each day. There
is an organization for nurse midwives, and their website
is www.midwife.org
Take some time to read about what they do, both legislatively
as well as educationally.
Another idea is to speak to people who teach in academia,
in programs for certified nurse midwives. Ask if you
can speak to some of the students, and ask their experiences.
As to whether you will like it or not, that remains
to be seen. Most nurses I know who work in this area
love it, and have longevity in the field. Explore all
your options….good luck!
Nurse Nancy
March 12, 2004
Dear Nurse Nancy,
Given the nursing shortage, what are hospitals doing
to help not only new graduates, but also about the shortage
in general? It seems to me that they should be trying
to help recruit new graduates by helping them. Have
you seen anything like this?
ER
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Dear ER,
As the shortage continues, my guess is that we will
be seeing more recruitment incentives. I did see something
in my local newspaper recently that impressed me –
loan forgiveness. Some hospitals are agreeing to pay
off student loans for new grads – that is a great
recruitment incentive!
This, of course, is a great expense to the hospital,
but I think it is a good idea, as it might cut down
on recruitment costs in the long run.
Nurse Nancy
March 11, 2004
Dear Nurse Nancy,
My nurse manager is always getting after me for being
late. I am not usually that late – only 20-30
minutes – and I do a good job. Why is she making
such a big deal about 20 minutes?
GW
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Dear GW,
Lateness is not tolerated in most businesses. It is
just one of the rules with which we have to live. In
our profession, there is report to be given, rounds
to be done, narcotics to be counted and so forth.
It is a big deal. Your colleagues cannot go home until
you arrive to work. Buy yourself a better alarm clock
and save your job.
Nurse Nancy
March 10, 2004
Dear Nurse Nancy,
Where can nurses find resources on staffing requirements?
I work in a small hospital in an isolated unit away
from any other unit. Unless we have five patients or
more, I am left alone with no aide. I work in a drug
and alcohol unit, so the patients are unsteady on their
feet and can be dangerous. I feel this is unsafe. Any
ideas?
MC
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Dear MC,
Staffing requirements certainly have been in the literature
with the nursing community for the past few years. California
led the nation in mandatory staffing ratios, which predominantly
address med-surg units and critical care areas. Check
our Web site to read about the work of the California
Nurses Association: www.nurseweek.com/news/features/01-09/ratios.html
Your situation is different, however. Small units with
fluctuating census are difficult to manage and staff.
Your personal safety is important, though, and you should
speak up. Perhaps there are environmental safety measures
you can suggest – a panic button to alert security,
protective glass barriers for you to sit behind and
so forth. Perhaps the nursing supervisor could station
himself/herself on your unit when not making rounds.
I hope this is helpful.
Nurse Nancy
March 9, 2004
Dear Nurse Nancy,
I work for a health care office and it just switched
management. The problem I have is that the new owner
is bringing in physical therapy and radiology to the
office, and he wants me to be trained by them to do
the therapy. As an RN, I do not feel comfortable reading
tests and doing the work of a physical therapist. He
tells me “no one will find out,” and is
insisting.
I personally feel that this is not in the best interest
of the patients, and am looking for another job. Any
suggestions?
CS
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Dear CS,
Of course you are right in questioning your role there.
You have a right and a responsibility to work within
your professional scope of practice. Being “trained”
to do certain tasks is not the issue here. What is at
stake is your patient’s safety, which you mention.
With the emphasis on patient safety with the JCAHO,
your new owner needs to be educated in your professional
role.
You did not mention tasks specifically, so I would
check with your State Board of Nursing to see what your
license covers you to do. If you are being asked to
do diagnostic things (like reading X-ray results) I
would refuse, and keep careful notes. If it is way too
uncomfortable for you, find another job where you can
practice nursing safely.
Nurse Nancy
March 8, 2004
Dear Nurse Nancy,
I am wondering if you could provide some resources
regarding where I can start looking into writing for
publication? Thank you.
CF
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Dear CF,
This is a great question, as I am a big proponent of
nurses writing. We have so much to share, so many stories
to tell….good for you for wanting to do this.
There are several books out there telling you how to
write, and one of my favorites is From Proposal to Publishing:
An Informal Guide to Writing About Nursing Research
(Pearson Education, June 1999) written by Elizabeth
Tornquist. Don’t let the title scare you; there
are many practical points in this little book.
I would encourage you to take a look at the journal
you in which you wish to publish. Look at the length
of the articles (generally, four double-spaced typed
pages equals one journal page), the way they are divided
by subheadings, and what the tone is of the writing.
Call, write, or e-mail the editor. They are usually
very happy to discuss the manuscript with you, and can
give you some direction in what they are looking for.
All journals have author information somewhere in the
journal; take a look at that and pay attention to what
they are asking for. Then just start somewhere. I find
most people don’t write because the first sentence
usually is the most difficult. Don’t start with
the first sentence if this is the case; you can always
go back and fill it in.
Just take a stab, and find someone who has published
to help you get on track. This is also a critical step,
as you need someone who will be honest with you, and
give you good feedback. I know most of the specialty
journals are looking for articles, so I would encourage
you to start there.
Good luck! It is so much fun seeing your own name in
print!
Nurse Nancy
March 5, 2004
Dear Nurse Nancy,
I have a bachelor's degree and am interested in pursuing
Nursing as a second career. I am going to be a first
time mom this June. Due to prerequisites, I can't apply
to the BSN program I want to until 2005. I can however
get into an associate’s program this fall (2004).
I think at least I could get my foot in the door sooner
and eventually go back to school for BSN completion.
Are there downsides to my plan? Are there jobs I won't
be able to apply for? Many positions I've seen that
require a BSN also require two to four years hospital
experience as well. Please help!
Thanks so much.
MM
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Dear MM,
Life is all about choices. I would encourage you to
look in your area for a BSN program for second career
nurses, so you can utilize your first education, and
build on it to get the BSN. With the nursing shortage,
they are in many schools of nursing. This would be the
easiest, as the length of the program is generally 12
to 18 months.
My bias is always to get the BSN (I didn’t, and
it took a long time to get it). But as I said, life
is about choices. With a new baby, will you have the
time and energy to work, care for the baby and go to
school? Certainly some people can, and do.
As to job opportunities, clearly the BSN will open
doors for you. It is attainable after the associate’s,
but it will be difficult.
Whatever you do, we are happy to have you and welcome
you to the profession!
Nurse Nancy
March 3, 2004
Dear Nurse Nancy,
I'm a diploma nurse since 1973. I do not have a PHN
certification. Do I have to have a degree to obtain?
Thanks.
CLP
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Dear CLP,
I believe the public health nursing certifications
are done at the state level. For example, in California
you do need a BSN to be a certified PHN. I would encourage
you to look at the state Department of Health Web site
to get more information.
I do know that it is not offered by the American Nurses
Credentialing Corporation, also known as ANCC. They
have a list of certifications requiring a BSN, but this
is not one of them, and they do not administer it.
Nurse Nancy
March 2, 2004
Dear Nurse Nancy,
I am an RN working for five years now I have a history
of committing a med error. I lost a part-time job last
year because of a med error. It haunts me wherever I
go.
Just last week on a very busy night with an assignment
of seven patients on a surgery floor where I work on
probation I made an error again, and I was very scared
to tell anyone (I might lose my job) No harm happened
to my patient, but I feel guilty. I feel like not going
back to work; I am scared to lose my license if my practice
is like this. Please help me.
MK
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Dear MK,
You sound very worried. Let me start by telling you
we all make mistakes, and the most important thing is
to report the mistake, whether or not anything happens
to your patient. We have a professional responsibility
as nurses to “do the right thing” and it
is important to report medication errors.
This is what performance improvement is all about.
We make medication errors for a variety of reasons—we
are in a hurry, we are tired, we do this every day so
we cut corners. While medication errors are expected
in any health care organization, we of course want to
minimize them, and never harm the patient. Most of the
regulatory organizations, like JCAHO, promote open communication
and a no-fault atmosphere, so that the error is not
punitive or the nurse punished. This promotes honesty
among us.
Get yourself into good habits. Check the order, check
the patient’s armband EVERY time you give the
med, even if you know the patient. You will gain confidence
over time. Don’t let anyone pressure you to cut
corners; this is when mistakes happen.
Deep breath. You care a lot, and sound like a good
nurse. That is a good thing.
Nurse Nancy
March 1, 2004
Dear Nurse Nancy,
Do you have any good ideas on finding jobs in research
nursing? I have just finished a two-year trauma study
with Johns Hopkins University and cannot seem to find
another position in research.
Thanks.
JA
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Dear JA,
What an interesting specialty for you. I would encourage
you to look at academic medical centers, as those are
the places who do research. Send your résumé
to nurse recruiters, and specify that you are interested
in research positions. In one job that I had, I hired
research nurses and found them hard to find.
I would also encourage you to network with the other
research nurses in Johns Hopkins. Just keep looking,
I know you will find a great job.
Good luck!
Nurse Nancy
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