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March 31, 2005

Dear Nurse Nancy,

I will be graduating in May with my ADN. I am interested in working in an Emergency Room or critical care area but I know that it is hard to get into these jobs right out of school. My instructor also told me that it is very difficult to get clinical rotations for students in these areas. Any suggestions for me to get my "foot in the door?" Thanks!

TF

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Dear TF,

Congratulations on your upcoming graduation. As with many new graduates, you seem very eager. You are correct; it is difficult in some places to start in these areas. There are several reasons why it is difficult to start there – while you think you are ready, you have no professional skill sets needed to care for complex patients. Spending some time in a med/surg area will teach you valuable lessons of time management, prioritization, critical thinking. You will bring something to that critical care position.

In addition, some states require one year experience prior to working in the Emergency Department ( New York is one).

My suggestion to you is to be an excellent staff nurse in med/surg, work toward your BSN while you are working, and make yourself marketable to a nurse manager. This includes positive evaluations, an excellent attendance record, and so forth. You’ll get there. Good luck!

Nurse Nancy

March 30, 2005

Dear Nurse Nancy,

I am an endoscopy nurse looking to update my resume. Where could I find a sample resume describing this area of nursing?

NC

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Dear NC,

Well, of course you can come to NurseWeek.com to find all sorts of professional resources. We have assistance from you at http://www.nurseweek.com/resume_builder/form_login.asp. Here you will find samples of different kinds of resumes. And if you want to add the official endoscopy lingo, take a look at the Society for Gastroenterology Nurses and Associates at www.sgna.org. They can help with the scope of practice language, and so forth.

Good luck.

Nurse Nancy

March 29, 2005

Dear Nurse Nancy,

I have been offered a contract position as a consultant. I am certainly capable of fulfilling the job requirements and expectations. I just am not sure what pay I should be expecting. What pay range do RN consultants get paid in Texas?

RD

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Dear RD,

Consulting generally commands an hourly rate. Depending on your level of expertise, I think the range is around $100-$200/hour. You can certainly ask the person who is hiring you for their range. (some pay by the day, or the project completion – be sure you know what it is before you start).

Nurse Nancy

March 28, 2005

Dear Nurse Nancy,

I recently started working in a long term care facility in Northern WI, as a Registered Nurse. During a conversation at our facility between a social worker and a nurse, the nurse stated "Part of my job is to advocate for these residents" The social worker replied, "No it's not, it's not in your job description". This statement has me deeply troubled. It has been my understanding and belief that nurses do advocate for their patients. Does it have to be in writing, in a job description, for nurses to advocate for resident's rights?

AS

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Dear AS,

Relax – take a deep breath! Of course nurses advocate for their patients, whether it is written in a job description or not. So do social workers, therapists, nutritionists, nursing assistants, physicians, physician assistants, pharmacists, chaplains…..I don’t see it as any one profession’s domain.

How much better for our patients that we ALL advocate for them; they need all the help they can get.

Nurse Nancy

March 25, 2005

Dear Nurse Nancy,

I am a BSN, RN, with a Labor and Delivery specialty. I have taken the last 9 years off raising my children and I am thinking of returning to work. I have kept my license current with the required CEs, but the special certifications such as NRP and ACLS I have not renewed while not working. My question is this: Will a prospective employer hire me and provide the necessary courses or should I have them completed before job searching? Thank you.

JM

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Dear JM,

Welcome back to nursing. I hope you plan to take a refresher course as well, as 9 years is a long time to be away from the bedside. I would think a potential employer would be impressed if you had a current ACLS and NRP (neonatal resuscitation) card. It would strengthen your resume, and make you look more serious about returning to the workforce.

Nurse Nancy

March 24, 2005

Dear Nurse Nancy,

I am looking into furthering my education as a wound, ostomy continence nurse. I am wondering what you know about availability of jobs in this field and an estimate of salary.

MM

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Dear MM,

Check the website of the Wound, Ostomy and Continence Nurses www.wocn.org, where you can get all the information about becoming a WOC nurse. I think this is a great job, as you learn so many things, and prevention of pressure ulcers is a great part of care in any healthcare setting. As far as the job market, I see wound centers opening around the country, and it seems to be a growing industry.

For salary information, have you seen our Salary Wizard at NurseWeek.com? It will tell you the ranges of salaries for your geographic area – it is fun to use! Click on this link – http://www.nurseweek.com/salary.

March 23, 2005

Dear Nurse Nancy,

I hope you can assist me. I am looking for samples of specific competencies for Public Health Nurse(s). We are in the process of updating our competencies and are seeking outside resources and information. Any referrals would be appreciated.

NJ

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Dear NJ,

I am a big believer in networking and professional organizations. Being on several listservs, I have found it quite easy to find information from colleagues across the country. I would suggest that you look at the American Public Health Association, in the Nursing Section. The link is http://www.csuchico.edu/~horst/
about/competencies.html.

I know you will find great resources in that group, as they are public health nurses from across the country. If you are not a member, consider joining just for the networking opportunities.

Nurse Nancy

March 22, 2005

Dear Nurse Nancy,

I am looking for a position after not working for the past 18 or so months (for personal reasons). I've only had two interviews--neither employer offered me the position. Here's my problem: I did, in an exit interview from one job, tell them the truth about why I was leaving (yes..."burning bridges" might apply here). It was only when the interview was concluded that I was told the (taped) interview would be shared with supervisors. Of note is the fact that I participated in collective bargaining and was treated to a bit of "pay-back" afterward.

My last position was as a traveler. My mother died while I was on assignment. The nursing supervisor told me to "go do what you need to do; you may finish out the assignment when everything's taken care of." The next day, while packing to leave, my agency called and said the hospital didn't want me to return because I'd refused pain medication to a patient, allegedly stating, "I'm not giving morphine to a drug-addict." I said no such thing.

I'm afraid that these two experiences are coming home to roost. The first was an error in judgment; the second was just plain wrong. I have been open with interviewers about why and how I left these positions. I do so dispassionately, thinking the "best-offense-is-a-good-defense" approach might help to show I have nothing to hide.

JG

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Dear JG,

You have learned a valuable lesson here, and I hope our readers will learn from your mistake. While you should have not been taped without your permission, never badmouth your current place of employment, even when you leave it. No matter how bad it is, take the high road and be professional. The world of nursing is very small, and in your case, you have paid the price for your error.

Nurse Nancy

March 21, 2005

Dear Nurse Nancy,

I work in the recovery room in a small hospital. I had a patient who came in to have carpal tunnel surgery. Fourteen minutes after this man came out of surgery, the anesthesiologist came out and told me to discharge now. Before I had a chance to explain that the patient wasn't ready for discharge (he didn't have a ride home and wanted to speak to the surgeon) and that I had not had anything charted on him, the anesthesiologist became argumentative and threatening. He told me he didn't care if my paperwork wasn't completed and that I was to discharge the patient now. Because I refused, he kept saying "I am warning you and you better watch it". He also yelled at me in front of all the patients and their family members. This happens a lot and no one ever does anything about it. This doctor is contracted through an outside organization and does not technically work for my hospital. Can his influence actually get me fired for not doing what he says or am I worrying about nothing.

HV

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Dear HV,

This is verbal abuse, and you should not have to put up with it. Good for you for refusing. You are correct to advocate for your patient and “do the right thing”. Safety first, regardless of the anesthesiologist’s orders.

This is a potentially dangerous situation, regardless of to whom this individual reports. Keep a paper trail privately – include the patient’s name, medical record number, diagnosis, etc. Keep this factual and not emotional – just write down the quotes. Share this with your supervisor, the chairman of anesthesia and risk management – sounds like this physician needs to be talked to by someone above you. Even though he is contracted outside of your hospital, if he is working there, the chairman of anesthesia is responsible.

Nurse Nancy

March 18, 2005

Dear Nurse Nancy,

I am a 60 year old nurse planning to retire from School Nursing in approximately 3 yrs. Do you know where I might look to find part-time employment to supplement retirement in nursing, or use my nursing experience in the business world? My experience has included hospital, physician's office, Director of Nursing at retirement facility, as well as Public Health. I attended a three year diploma school and got a BES undergraduate degree (mostly sociology and psychology) and a Masters in Education with emphasis in School Counseling. Where would you suggest I start?

GK

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Dear GK,

You have quite a variety of experiences, and I bet you will be able to find something part time when the time is right. I would start by getting your resume together, to highlight your many strengths. I can think of several part time positions for which you are qualified – many hospitals look for seasoned nurses to be part time supervisors to cover evenings, nights, and weekends. You also might look into teaching – many schools of nursing look for nurses to do clinical rotations with nursing students.

The other thing I can think of, given your Public Health background, is to look for opportunities for health screenings, immunizations, flu shots, and so forth. This is episodic, but if you connect with the Health Department in your area, there might be part time work there also. Good luck.

Nurse Nancy

March 15, 2005

Dear Nurse Nancy,

You had mentioned a couple of times in your reply that some state boards do not recognize online degrees. Can you specifically name some, if not all, of these states? I am planning to pursue my MSN online within the next few months & planning to transfer to another state, if not this year, by next year. Thanks for the info!

HI

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Dear HI,

I think I was referring to entry level degrees. I would encourage you to look at our website; we list all of the Boards of Nursing for every state. The link is http://www.nurseweek.com/
career/boards.asp.

Another way to check is to ask the places that offer the on line degree. Ask where their graduates work, and if their degree is accepted. I think the Internet is an excellent way to do some of your graduate work, and I bet we will see more nurses taking advantage of this method of education.

Nurse Nancy

March 14, 2005

Dear Nurse Nancy,

I am a psychiatric nurse for 30 years, and I would like to do Case Management. What is the best way to break into that field, as all the jobs I see in NurseWeek, etc. require experience?

JW

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Dear JW,

Most positions look for the “ideal” candidate. I would not let that stop you, as employers can not always find candidates with ideal experience. Spruce up your resume and keep applying; you have lots of experience that I imagine someone will want.

Nurse Nancy

March 11, 2005

Dear Nurse Nancy,

Please help me. Are there any jobs for nurses that cannot be on their feet due to disabilities? It is not fair that someone with a brain and talent cannot work because they cannot walk anymore. It is also not fair that someone in my position cannot qualify for disability. There are doctors that still work in wheelchairs but I have never seen a nurse working in a wheelchair. When I was injured there was no disability act. After the disability act hospitals changed their job description of nurses to get around this by requiring a nurse to be able to work in all areas of the hospital if needed unless they need to be floated.

LL

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Dear LL,

I am always sorry to read this kind of a letter (and I see it frequently) as there is no magic bullet or quick answer I have for you. What I can tell you is that there are positions where you can use your talents as a nurse and not have to work physically in the hospital. You just have to keep trying, keep searching, and hopefully you will find something. Chart reviews, working with attorneys, giving flu shots and PPDs…..it may not be your ideal job, but it is something.

I wish you the best. Just keep looking and try to keep positive.

Nurse Nancy

March 10, 2005

Dear Nurse Nancy,

At present, I am an RN at a correctional facility, working in a clinic. I am trying to seek a career change within nursing. What website can I search to assist me in making a decision? I do have an interest in Forensic Nursing.

I have an AA in nursing. I worked ten years at an acute care hospital (orthopaedics) as well as a float nurse. I also have clinical experience in clinical psychiatry, and some with medical billing. Thanks for your help.

LA

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Dear LA,

You’ve had quite an interesting career so far. In terms of choices, there are so many! We list all of the nursing specialty organizations on our website. Click on this link http://www.nurseweek.com/special/resources.asp. There you will see a variety of specialties.

There are several on line courses to become a forensic nurse, but I really can’t endorse any, since I have no experience with them. One place I would suggest you look is the International Association of Forensic Nurses. Through networking with this organization, you can likely find the better programs, have resources and literature about this interesting kind of nursing.

Nurse Nancy

March 9, 2005

Dear Nurse Nancy,

I am a male nurse and I have always been interested in Maternal & Child Nursing but I don’t think I have much chance to work in this area because I'm a male nurse. But if given the chance I would gladly accept it and I am planning to enhance my skills on this field and get certifications so that I would be more qualified to work on this field. Please give me some advice. Thanks.

LD

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Dear LD,

While I must say I have never seen a male nurse work in Maternity, I can think of several colleagues who have worked in pediatrics. I would be surprised if any nurse manager would not want a man in pediatric.and what a great role model you can be to young people to become nurses.

I admire your eagerness to become certified in a specialty, but please know you have to work in that specialty for at least two years in order to take the exam.

Good luck.

Nurse Nancy

March 8, 2005

Dear Nurse Nancy,

I have worked in a large oncology practice for the past 2 1/2 years and I love my job. We recently have gone to an electronic medical record and there are some practices going on that I have serious misgivings about. When we had paper charts, I had several suspicions that a particular physician was destroying documentation I had placed in the chart. (I am the telephone triage nurse and my documentation was on a special form) Now that we've gone to the EMR, I have come across 30+ patient records that have nursing documentation errored out. Because it is an EMR and there is no paper to throw away, there is just a small box that tells when that particular documentation was last revised and who did it. My first problem is that our EMR system allows "just anyone" to error out documentation entered by me. My second problem is that the documentation that is being errored is important stuff. Signs and symptoms when patients are having problems and actions taken to assist with problems as well as documented adverse reactions to treatment and in one instance the events leading up to a patient being transported by ambulance to the hospital.

I have started keeping a log of all the charts I happen upon that have entries that have been errored. So far they have all been done by the same physician and are not limited to my documentation. I have taken my log and my concerns to my supervisor and so far there has been no real action. I am still finding altered charts and the dates of the alteration are within this past week.

I'm really not sure what I need to do or where I should go from here? Although my gut tells me this is very wrong and bad medical practice, I'm not sure what exactly the offense is or what could be done about it. Any insight would be greatly appreciated.

Sincerely,

IT

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Dear IT,

This is a very serious allegation, and you are smart to keep a log of the charts you are concerned about. I do know that many physician practices are followed discreetly by peers, and there is no discussion or gossip about it.

In your case, if the practice continues, I would go up the chain of command. If you have told your supervisor and it continues, ask to speak to the next person in the chain. I would put all this in writing, and keep copies of the correspondence. This is a dangerous practice, and it needs to be addressed.

If no one changes the practice of this physician, you have to decide if you can work under those conditions. Sounds pretty risky to me.

Nurse Nancy

March 7, 2005

Dear Nurse Nancy,

I am an RN with a BSN. I worked part time for two years in med/surg orthopedic/neurology. Then, I quit to have a family. It has been four years since I worked and I'm concerned about staying current. My children are 6, 4, 2 and 6 months old. My husband's job will be very flexible in the next year and I am considering returning to work part time for a while to keep my license up. My children still need me at home a lot. What would you recommend I do to prepare to return to the work place? Do I need a refresher course after only four years? What kind of nursing would be good to do at this point? (ie hospital, home health, office, etc.) I also would like to know how much I should work to stay current in nursing. My ultimate goal is a master's degree in 15-20 years (when my children are older), but now my children are my priority. Thank you for your time!

LF

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Dear LF,

Most places suggest that you take a refresher course if you have been out for more than five years. Coming back part time might be challenging, because it will take you awhile to get into the rhythm of working again.

As far as what kind of work - I would encourage you to interview around and see what is a good fit for you. Given your busy household, you will want to find a manager who understands about your schedule. Pick your manager wisely; it is a very important relationship in your life.

Good luck.

Nurse Nancy

March 4, 2005

Dear Nurse Nancy,

I am a new grad doing my internship in the ED. I love the dynamics of the ED and hope to make a career out of it. However, I feel like my preceptor keeps putting me down for everything. Saying things like "you should have learned that in school" or scolding me in front of other colleagues. She is deemed the best nurse in the department so I feel I cannot approach anybody with my frustrations. Recently, I have been suffering from insomnia because I am so scared of not knowing/ remembering something the following day at work. I have just completed 2 months of internship and have a long ways to go. What can I do?

CG

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Dear CG,

I am sorry to read this, as this preceptor has much to learn about supporting our new colleagues. There are a couple of ideas I had when I read this. It might be easier if you speak to your manager, and ask his/her advice on how to handle this; my thought is you are not the first orientee who has worked with this nurse.

Of course, the most direct way to handle this is to speak to the nurse directly, but I can understand that that might be difficult to do. Your manager can help you to work this out. Education is different now; that is a fact. She needs to know it and work with it.

Nurse Nancy

March 3, 2005

Dear Nurse Nancy,

I just passed the NCLEX-RN but I don’t think there’s much opportunity in my area. What do you suggest that I do first before I start working?  Do you think the hospital will allow me to volunteer before being hired?  What is the hospital protocol with new nurses?  Do I need to have one year experience prior to applying?

CW

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Dear CW,

You need to get your resume in order, and go speak to a nurse recruiter. I can’t imagine there are many places in the country where new graduates are not welcomed. Specialty areas, such as Obstetrics, Critical Care, and so forth, may not hire new graduates due to inexperience. But if you are willing to work in med/surg…..I am sure you will find a position.

As for protocol with new nurses…..as a licensed professional RN, you will have an orientation period where you will work with a preceptor. You will be expected to build on your skills, and eventually you will have your own assignment.

Nurse Nancy

March 2, 2005

Dear Nurse Nancy,

I am currently on probation with my board of registered nursing.  I am allowed to work but it has been hard for me to get the joy back into my career.  Before I was in this situation, I loved the profession.  Now I am mostly depressed and have anxiety going into work.  I applied to some nursing jobs and was offered the position.  Unfortunately, the offers were withdrawn and I still am feeling bummed about this.  Being on probation feels like having a criminal record to me.  I feel trapped because I feel that I can't go to another employer for the reason of being rejected again.  Please help!!!

GH

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Dear GH,

Keep looking. I personally have hired a nurse in a similar situation, and I told her she would be on probation as all new hires are. Just keep applying, be honest, and I am sure someone will give you that chance. Your situation is not as isolated as you might think.

I am sure this is a difficult time for you, but try to be grateful that you have the chance to start over. Many of our colleagues do not get that chance. Find a support group and share your situation with others.

Nurse Nancy

March 1 , 2005

Dear Nurse Nancy,

I have worked as an RN for almost 25 years now in a variety of clinical areas. I was fired from my last two jobs due to frequent absences, tardiness, and time management problems. Now my confidence as a nurse is badly shaken. I am having great difficulty believing in myself and my abilities as a competent nurse. Do you have any advice?

ND

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Dear ND,

It seems to me you may need professional help with this. Find yourself a class in time management, determine the cause of your absences and tardiness and make a change. Perhaps some short term therapy will help you to identify the cause of these issues, and you can work on improving them.

While it may seem overwhelming at the time, you can improve your work record if you find out the cause and improve it. Absences, tardiness and time management can be fixed. But only you can do the work to get there. No employer will tolerate these issues, so I encourage you to work on them. Good luck.

Nurse Nancy