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April 30, 2004
Dear Nurse Nancy,
I am frustrated. I am an RN who "retired"
to raise my family. Nearly 20 years later, I am curious
about what I can still do as a nurse. I read about the
acute shortage, but when I inquire about skill-building
classes, I am either asked to sign up for a $3,000 refresher
class (cash upfront) or offered a job (great orientation,
can you start tonight?)
I was a PACU nurse who spent a few years in ICU before
going to the recovery room. Obviously, I cannot jump
into a unit, but there should still be somewhere that
a rusty but well-educated nurse can still be useful.
Any ideas would be appreciated. Several friends who
are in the same boat are talking about applying as phlebotomists
at the local hospital. I considered it also. It seems
sad that a PACU and labor and delivery nurse/midwife
cannot find a better re- entry than phlebotomy.
KO
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Dear KO,
Well, welcome back to nursing. I hope you are aware
of how different things are in nursing than they were
20 years ago. That is a long time.
I think you definitely need a refresher course for
several reasons – it is a whole different world
out there. You certainly bring much experience to the
workplace, but my experience is you need that refresher
course. And one of the major differences you will see
in health care is that it is now a business. A fee of
$3,000 sounds reasonable to me; you have instructor
time here, preparation of classes, and so forth. Someone
has to pay for that.
Most hospitals would not employ an RN who has not been
at the bedside for 20 years. You have some skills to
refresh. I hope you will reconsider this fee and realize
how much it will benefit you in the long run. Good luck.
Nurse Nancy
April 29, 2004
Dear Nurse Nancy,
I am trying to get information on school bus safety
and the use of seatbelts. I work in the emergency department
at a level II trauma center.
CM
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Dear CM,
The National Safety Council has much information about
this important topic. Go to their website, www.nsc.org/airbag.htm
and you will find all sorts of information, listed by
state and by age, and so forth.
It is an important topic. Good luck!
Nurse Nancy
April 28, 2004
Dear Nurse Nancy,
Do you know of any school or college in Northern California
that offers ostomy/wound education leading to certification?
PC
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Dear PC,
There are not many schools that offer the accredited
program for wound, ostomy, and continence. The best
place to look is on the website for the Wound, Ostomy,
and Continence Nurses Society – www.wocn.org/education/wocet/programs.
They list the five programs across the country that
they accredit. Perhaps they might know of others closer
to your geographic area.
Good luck!
April 27, 2004
Dear Nurse Nancy,
About a year ago, I took a job as a pool nurse in
a nearby community hospital. I had worked for five years
in a big city hospital, and this was quite a change
for me. Some of the LPNs have been working there for
20+ years, and they take verbal orders from the MDs
who have known them for 20+ years.
I don’t feel safe since this is out of their
scope of practice. When I confront them, they tell me
it is OK since they know how Dr. So and So does things.
I really enjoy working there. What do I do without causing
a lot of waves at work? Management all know about this,
and turn their heads. Advice?
UR
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Dear UR,
Go grab your life jacket…those waves are coming
toward you! You are 100% right, and I believe you have
a professional responsibility to make a little noise
about this. I would keep a record of how often this
happens (photocopy the verbal order if the LPN is putting
it in the medical record) or gather the patient’s
information so that someone could easily go back to
the record and see if an LPN wrote the verbal order.
I imagine your policy says LPNs can not take verbal
orders – it is an accident waiting to happen.
I would speak to your manager first, and then to your
risk management department. But allowing those LPNs
to intentionally go against your policy is a mistake
or potentially a sentinel event waiting to happen.
Good for you, you are doing the right thing.
Nurse Nancy
April 26, 2004
Dear Nurse Nancy,
I am an RN/Paramedic in a very busy inner-city ER
whose hospital administration has bonded with the idea
of 100% "customer satisfaction".
While I agree with this idea, the reality is they are
going about this at the expense of the most experienced,
compassionate, seasoned, cream-of-the-crop. This frustration
seems to fall on deaf ears since the winds of change
are on customer service, customer family happy and not
customer keep alive and healthy anymore.
How do we soften the blow for our nightly 12 hour shifts,
for not only ourselves, but for our underlings who look
up to us while we try to explain that we still "first
do no harm" and "save lives" at the same
time attempt to accomplish the unrealistic goal of cappuccino
and pedicures for the administrative goals?
MB
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Dear MB,
While your comment on cappuccino and pedicures is
amusing, I know you are not far from the truth there.
Hospitals are doing all sorts of things to recruit new
patients. Money is the name of the game, like it or
not. But certainly the ABC’s have not changed,
so you need to first and foremost take care of your
patients.
And sometimes the customer service stuff is not all
that difficult. Smile. Explain what you are doing to
patients and their families. This will all help those
customer service scores, and everyone will be happy.
Good luck.
Nurse Nancy
April 23, 2004
Dear Nurse Nancy,
I recently failed my OB postpartum clinicals in nursing
school, partly due to having a terrible cold and taking
cold meds the week of that clinical, and partly due
to my lack of a medical background. I previously failed
clinicals in med/surg I and repeated that course successfully.
Since this is my second failure, I will have to go before
a progression committee to try to reenter the program.
I will be questioned as to what I would do differently
to succeed. Do you have any suggestions? I would like
to work as an extern in the local hospitals but would
be unable to apply unless I am actually in the nursing
program.
Some of the instructors are excellent in guiding students
while others penalize you for asking for guidance. Any
advice for handling this?
AA
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Dear AA,
You have two strikes against you academically. You
need to really buckle down and study. Also, take care
of yourself. This means eating properly, exercising,
getting enough sleep. When you go before the committee,
I would say just that. Don’t give them a pile
of excuses – they have heard them all, I am sure.
Own the problem and fix it.
Also, find a faculty member who you describe as excellent
in guiding students. Avoid the ones who penalize you.
Good luck.
Nurse Nancy
April 22, 2004
Dear Nurse Nancy,
I work for a private long-term care facility; we’re
not skilled care. We have a resident who was having
chest pain that was not alleviated with Nitroglyceine.
We received an order to send the resident to the emergency
room from the doctor. The only RN on duty at 3 AM phoned
the resident’s son to inform him and he said absolutely
not. The resident is unable to make decision either
way. What is our responsibility in this situation? I’m
concerned that if she were to expire, we have no proof
of what the son had said and could be sued. The resident
does not have a DNR order but even if she did have one
I feel that if we can't alleviate the pain (which we
couldn't at the time) she should be sent to the ER for
diagnosis and treatment of the pain at least.
What’s your opinion?
NM
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Dear NM,
Well, this is a great case for me to get on my soapbox
about advance directives. My heart goes out to that
solo RN at 3 AM with a patient with unrelieved chest
pain. If the patient is not able to make decisions for
herself, she needs to have a health care proxy who can
make them for her, based on her wishes. If I were the
nurse, I would send the patient to the ER – if
something else had to be done, let them call the son,
and let him yell. In the absence of anything in writing,
it seems to me to be prudent to err on the side of taking
care of the patient.
This is a tough situation, and one that could be so
easily fixed if we all had our own advance directives.
And all of you nurses out there reading this –
do you have an advance directive? Does your family know
what your wishes are, and do you know theirs? Think
about it.
Nurse Nancy
April 21, 2004
Dear Nurse Nancy,
I am finishing my RN-to-BSN this May. I would
like to become a medical writer. I am a member of the
American Medical Writers Association (AMWA). My question
to you is, how can I get education and experience in
this field? The workshops offered at AMWA are scattered
throughout the country. I am considering getting a writing
certificate from my university as a start. I am not
interested in nursing informatics, per say, I am interested
in writing up research grants, pharmaceutical pamphlets,
and some marketing. Do you have any advice?
I appreciate your time and response in advance.
DS
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Dear DS,
I would suggest that you build your résumé
with publications. If you want to write for a living,
you need to have a publication history. Be sure you
publish in refereed journals, so that potential employers
know that the work is yours, and not some republished
work that a producer wrote.
Take whatever writing courses you can. And as always,
network, network, network!
Nurse Nancy
April 20, 2004
Dear Nurse Nancy,
I am interested in lecturing at national/local
seminars and conventions. I have a BSN. How can I accomplish
this?
CV
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Dear CV,
Your question reminds me of that old joke …
how do I get to Carnegie Hall? Practice, practice, practice
… if you want to be on the circuit, you have to
get out there and build your reputation. Speak wherever
you can – volunteer to speak for different nursing
groups, civic groups, and so forth, just for the experience
and for resume building.
If your topic is generic (humor, for example), it is
very transferable to many groups. I would also encourage
you to gain the experience of groups such as Dale Carnegie
or Toastmasters, where you really learn platform skills.
At any rate, start now by getting business cards made,
and go to as many professional meetings that you can.
Good luck to you!
Nurse Nancy
April 19, 2004
Dear Nurse Nancy,
What do you think about acquiring a BSN through the
Internet vs. the traditional college network?
PI
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Dear PI,
I think the Internet BSN is a great tool for busy
nurses who are disciplined enough to work at this in
their own time. I would caution, you, though, that not
all states recognize this degree, so do your homework
and really explore the Internet sites you are interested
in. The programs need to be accredited not only by the
NLN, but also your state Board of Nursing.
Good luck!
Nurse Nancy
April 16, 2004
Dear Nurse Nancy,
I work in long-term care/skilled nursing facility
on the Medicare unit. We received an admission from
a hospital with Jackson Pratt drains and an order to
flush them. No one had ever heard of it much less knew
how and we received no instructions from the hospital
on how to do this. I have spent hours on the net trying
to find out how and no luck. Can you help? Thanks.
JM
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Dear JM,
I have asked many colleagues about this practice,
since I also never heard of flushing a Jackson Pratt
tube either. They were first invented for neurosurgical
drains, and then moved on to general surgery. The principle
behind them is to create a drainage system that is sterile.
Flushing the tubes sets up all sorts of potential problems
– infection being the most obvious.
Your question brings up a bigger point – if something
is ordered with which you are not familiar (or in this
case have a hunch is wrong) question it. Perhaps whoever
wrote the order was thinking the drains were something
else. We all have a responsibility to check on each
other, so that our patients receive safe care.
Nurse Nancy
April 15, 2004
Dear Nurse Nancy,
I am done with my prerequisites for the nursing program
at my school, but what I have found is a no-win situation.
The “approximate” wait to get into the program
is one to two years. I have also found this to be true
at other schools around the country. Why is it that
there is such a nursing shortage, but yet the wait to
get into these programs is so long? It is
very frustrating!
HC
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Dear HC,
I agree that the wait is frustrating. Just as we have
a nursing shortage, our profession is also experiencing
a shortage of qualified nursing faculty to teach. What
I tell students who are frustrated with this (which
is totally understandable) is to do well in school,
so that when the list opens up, you will have a good
chance of getting in.
Hang in there. We need you, and the time will go by
quickly. Welcome to nursing!
Nurse Nancy
April 14, 2004
Dear Nurse Nancy,
I have been an RN for 10 years, but have only worked
in doctors offices, and have no hospital experience.
How do I pursue any other fields with no experience?
Are there courses I can take or are there any hospitals
willing to work with me. Thanks!
CT
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Dear CT,
I would suggest you take a refresher course prior
to seeing if hospitals will work with you. Refresher
courses are generally given in community colleges; take
a look at any near your home.
Also, you have skills that would be beneficial in an
ambulatory setting. Try to update your resume highlighting
what you have done in those 10 years (skills, customer
service, and so forth).
Good luck.
Nurse Nancy
April 13, 2004
Dear Nurse Nancy,
I received my RN in September of 2003 but I have been
running into roadblocks with my current job not wanting
to transfer me from an LVN in status to RN because I
have no experience as an RN. I work for the VA and have
been with them for more than 12 years. I love my job
and caring for the veterans. Any advice would be much
appreciated. Oh, by the way, my hospital is trying to
get Magnet status. Thanks for listening.
RT
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Dear RT,
If I understand your question, you want “credit”
within your organization as an RN because you worked
there as an LPN for 12 years? LPNs and RNs are very
different roles, as they both represent positions in
nursing which are different. Technically, your employer
is right in saying you have no experience as an RN.
Your time may be similar, but it won’t count
as time as an RN. I wish you well as you begin your
career as an RN. Good luck!
Nurse Nancy
April 12, 2004
Dear Nurse Nancy,
Nursing became a second and much dreamed about career
for me seven years ago. I have worked for the past five
years in the ED, and will be finishing my MSN in education
this fall. After much thought, I decided that I really
do not want to trade in my clinical nursing skills for
the classroom and have been considering applying to
nurse anesthesia school after I complete my degree.
How difficult would it be to get into such as school
in California? Could you possibly tell me how I can
best prepare for applying to a school? I'm in my early
50s, which doesn't bother me because I've always been
highly motivated, and I don't have ICU experience.
PAB
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Dear PAB,
Sounds like you are really enjoying your life as a
nurse; how great for you. And your letter demonstrates
all the wonderful choices and options you can have as
a nurse. And we at NurseWeek.com are here to help you
with all those nursing issues you are trying to figure
out. To find out where the schools are that offer a
nurse anesthesia program, click on “Education/CE”
on our homepage. There you will see a “Find a
School” wizard to help you find the kind of school
you are looking for, in the area you are hoping to see
it.
California has two schools that prepare CNRAs. One
is in Oakland and the other at USC in Los Angeles. Hopefully
you live near one of those areas.
As for the critical care experience, it may be required,
as you will need to be comfortable in caring for patients
with ventilators. Perhaps you have done this in the
ED where you have worked. I would ask the specific schools
what their admission criteria is and go from there.
I wish you the best. Happy graduation!
Nurse Nancy
April 9, 2004
Dear Nurse Nancy,
I am interested in epidemiology and wonder if there
exist any positions for nurses in this field?
MO
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Dear MO,
Yes, there certainly is a place for nurses in epidemiology.
There are so many opportunities, as the spread of disease
and the drug resistance that is around us seems to increase
each year. And there is also the important issue of
prevention. I would suggest you take a look at the website
of APIC, the Association of Professionals in Infection
Control (www.apic.org) which is an interdisciplinary
group of health professionals.
Generally, nurses who work in infection control have
an interest and a master’s in public health. That
is a place to start. APIC can help you learn more about
the specialty and how to get started.
As always, it’s all about networking! Good luck.
Nurse Nancy
April 8, 2004
Dear Nurse Nancy,
My question is if there is any difference between
taking my ANP certification from ANCC or AANP? Are the
tests and certification similar enough that it would
matter which one I took in June?
KO
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Dear KO,
Congratulations on completing your nurse practitioner
course! This is a great professional credential. As
to the ANCC or AANP certification, that depends on the
state in which you live. I would encourage you to check
with your individual state to be sure you take the correct
certification exam. Good luck!
Nurse Nancy
April 7, 2004
Dear Nurse Nancy,
I am taking a one year early retirement to pursue
my dream of being my own boss for once, before it’s
over. I want to become an elder care consultant, specializing
in end-of-life issues. I have 44 years of experience
in many areas, including 22 years in ICU/CCU, education,
and most recently, in marketing and admissions for hospice.
How do you suggest I begin?
I graduated in 1960 from an excellent diploma program,
have taken courses toward my BSN, but life has intersected
with education goals.
Please give me an idea of directions I should take.
I'm willing to return to school, if necessary, or certification
programs, if any exist. I'm computer literate, and don't
really need to work for money more than one shift a
week. I'm creative and smart and have lots of passion
for this area, have every reason to believe I'd be successful,
if I can get started on the right track. Thanks for
any help you can give to help me make my dream come
true.
JMG
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Dear JMG,
Sounds like a great plan! You sound so eager to do
this, I imagine you will carve out a place for yourself.
As for where to begin, I would suggest you get the usual
professional materials gathered – business cards
that “sell” you, and a professional résumé.
If you have been working in marketing, you likely know
how to put a brochure together informing individuals
and families on what you do.
I had a friend who had a similar dream, and she just
tried hard to market herself. She had a brochure made
(her issue was bereavement for families), mailed it
to everyone in her phone book, to funeral homes, to
houses of worship, community groups – she set
the net out wide, and just never looked back. She made
many contacts, agreed to do some of her work as a volunteer,
established her reputation, and voilà …
started her own business.
There are resources for small business owners, and
women’s groups. Look around you and utilize them.
I think the most important part is what you have already
– the energy and drive to make this work. Good
luck!
Nurse Nancy
April 6, 2004
Dear Nurse Nancy,
I am currently a pediatric nurse who floats to PICU
and NICU. I also have med/surg experience, home health,
and geriatric experience. At this time, my desire is
to go into some kind of management position. I do not
have any management experience at this time. Do you
have any suggestions on how I can change the direction
of my career?
JD
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Dear JD,
I think this is a great choice, as management can
be very rewarding (and challenging). You have prepared
yourself more than you know, as you have a great deal
of different kinds of clinical experience. Selling points
are your flexibility and your ability to see the whole
patient continuum, given your home health experience.
I would suggest that you update your résumé,
and go talk to a manager in your organization who you
respect. Ask him or her for advice on where the management
openings exist, and what they think your next steps
should be. If you have an opportunity to be in charge,
take that as a great experience also.
All managers start somewhere with their first management
position. Be sure you have a supportive supervisor who
will help you as you go along. Good luck in your transition!
Nurse Nancy
April 5, 2004
Dear Nurse Nancy,
I moved to the United States in December 2002 from
the United Kingdom, where I worked as a nurse for three
years as an RN. I have now completed my CFGNS and NCLEX
successfully and have a Pennsylvania RN license. I am
now searching for a job, but have had difficulty making
my experiences and education match job description requirements.
How can I get a job in the United States? Any guidance
would be appreciated.
DR
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Dear DR,
I know many nurses who were trained in the UK, and
have practiced on a different level there. For example,
the regulations for midwives are different in the United
States and the UK. Here, you have to have a whole separate
education to do midwifery.
I think if you got a job as a med/surg nurse, you will
establish your U.S. experience. It may not be what you
want to do right now, but the demand is out there, and
you will be able to get a proverbial foot in the door.
And you don’t have to stay forever; just a few
years to establish your experience.
Good luck to you.
Nurse Nancy
April 2, 2004
Dear Nurse Nancy,
I am interested in becoming a cruise ship nurse on
a part-time basis. Where do I start?
VL
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Dear VL,
Well, that sounds like an interesting job, doesn’t
it? I would imagine it is an interesting job, and one
where no two days are the same. I would prepare for
this by completing BCLS and ACLS if you don’t
have them yet, and to learn about first aid.
I have a friend who did this for years (and loved it)
and she advises that you contact the different cruise
companies and let them know of your interest. In her
experience, the turnover was minimal, as she and her
colleagues really loved the travel.
It sounds like a wonderful experience to me. Good luck!
Nurse Nancy
April 1, 2004
Dear Nurse Nancy,
I have worked on my medical unit for five years, and
now have a chance to transfer to the ICU. I feel badly
about leaving my colleagues, and guilty about asking
my head nurse for a transfer. Any thoughts on this?
PC
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Dear PC,
Your feelings are understandable, as I imagine you
have a great unit and head nurse. But nursing is all
about opportunity and professional growth, and it sounds
like you have a great chance here.
Your head nurse is likely not in her/his first job.
And if they are good managers, they will be happy for
you and feel a sense of pride in contributing to your
professional growth. It is important that they hear
this from you, not someone else. Go and negotiate a
transfer date —you don’t want to leave too
early and leave your colleagues with a vacancy.
As for your colleagues—they will still be there.
You can visit any time, and hopefully they will be happy
for your new opportunity. Best of luck to you!
Nurse Nancy
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