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June 30, 2004
Dear Nurse Nancy,
I am a recent grad and passed boards successfully.
I want to work in OR or PACU, but each job I look at
requires at least one year of OR experience. How can
I get one year of experience when no one will hire me
fresh out of school?
MG
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Dear MG,
Congratulations on successfully passing your NCLEX.
As to working in the OR or PACU – you have to
get experience in many other areas before you will be
ready to work in those specialties. The PACU requires
quick assessment skills and critical thinking. While
some new grads are ready for this, most are not.
Life is also about paying your dues. Work in med-surg;
gain those valuable skills of assessments, time management,
priorities, and so forth. We really undervalue these
skills in nursing. Have a great attendance record, get
BCLS and ACLS (even if you have to do it on your own)
so that when a vacancy does happen, you are ready to
be interviewed.
You’ll get there. Work toward that dream. Good
luck.
Nurse Nancy
June 29, 2004
Dear Nurse Nancy,
The nursing and science faculty at our college are
having a hard time deciding whether there should be
a chemistry course requirement for nursing students.
I would appreciate knowing your thoughts on this subject,
and any references you might have on the value of the
knowledge of chemistry on nursing careers.
AM
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Dear AM,
I know this may not be the popular answer among my
colleagues, but I think all of the sciences make us
better nurses. So many things come to mind – the
Krebs cycle, acid base balance, wound healing –
all have a basis in chemistry. Things we use every day
– ABGs, for example, make more sense if you have
had chemistry.
I can’t give you any references, but would suggest
you look in the education literature to see if someone
has published on
this topic.
Nurse Nancy
June 28, 2004
Dear Nurse Nancy,
I am a new graduate nurse. I am having a hard time
trying to choose which job I want to select. Job A is
offering to relocate me and pay a sign-on bonus, but
the not-so-happy part is that I have to do a rotating
shift of a once-a-month night shift. Job B is offering
to pay my outstanding student loans and no nights. What
should I do?
Thanks for your help.
NG
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Dear NG,
Your letter underscores my concern about sign-on bonuses
– think about how those nurses who have been working
in that area feel when someone brand new gets a bonus.
That being said, I understand that it is a great recruiting
tool, which our nurse recruiters need to recruit nurses
to specialty areas.
I can’t make your decision for you, but it seems
to me you need to make a list of pros and cons for each
position. Decide what is important to you – money,
time, night shifts … it is your decision. Good
luck, and welcome to nursing!
Nurse Nancy
June 22, 2004
Dear Nurse Nancy,
I'm a new RN working for about six months now in a
small hospital in Chicago. I am not satisfied with my
salary I want to transfer to a hospital with higher
pay and excellent benefits, but I signed a three-year
contract with my current hospital. What should I do?
I hear some hospitals are willing to buy out contracts.
KF
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Dear KF,
I am not an attorney, so I can’t give an opinion
on your contract. I would suggest that you consult an
attorney about this, as it seems to me that a contract
is a binding document.
One thing you could do is read the fine point and see
if there are conditions which would allow you to break
the contract – perhaps a fine for breaking it.
Take a look. Good luck.
Nurse Nancy
June 21, 2004
Dear Nurse Nancy,
I am an RN who has an excellent work record. Recently,
a known "troublemaker” who has been ousted
from all departments entered our department. She is
friends with upper administrative personnel, which is
why she hasn't been fired thus far. After more than
two years, my co-worker and I are being "transferred"
from the department and every job we apply for "is
just not available" What can we do to save our
jobs?
MO
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Dear MO,
There is always a story behind the story, and as I
read this, I wondered what the real story is. Life is
truly all about who you know, and in this case your
new colleague has an inside track.
You can certainly ask for a review of your work record
with your human resources department. I would caution
you to leave your opinions about this nurse out of the
conversation – it will not help you to label someone
as a known troublemaker. Ask for a review, since you
have not secured a new place for transfer.
And if all else fails, if you are that unhappy, leave
this place. There are many places that would be happy
to employ you, and the great thing about nursing is
that there are opportunities all around. Good luck!
Nurse Nancy
June 18, 2004
Dear Nurse Nancy,
You have been a big help to so many people, answering
their questions, giving advice, and offering insight.
Thank you for being there.
My question is, I want to open a home health agency
but first I want to get opinions from different people.
What do you think about it? Any information you can
share will be greatly appreciated.
Respectfully,
FB
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Dear FB,
I think it is a great idea to explore opening a home
health agency. I have colleagues who have started different
programs, and the best source of advice has been people
who are in the same field but far enough away not to
be a competitor.
Aside from regulatory agencies (your Department of
Health, for example), I would encourage you to speak
to others who have started home health agencies. Go
far enough away from your area so you won’t be
considered a threat; no one wants to give away secrets
to competitors. Offer to pay them for their time, as
it is valuable. I think the best advice will be from
those who have had the experience.
Good luck in your new ventures!
Nurse Nancy
June 17, 2004
Dear Nurse Nancy,
I would like to advance my career and have been interested
in taking a class in interqual. I understand that interqual
is used among discharge planners and case managers.
Do you know where I might be able to take these courses?
I have been searching on the Internet without any luck.
Thank you.
EL
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Dear EL,
Interqual has a lot to offer, and they have their
own website … go to www.interqual.com
to get all the information you need to take the courses.
There you will find information related to certification
in both utilization review and utilization management.
Good luck!
Nurse Nancy
June 16, 2004
Dear Nurse Nancy,
I am interested in finding a chemotherapy class to
get certified in the San Diego area. Are you aware of
any? Thank you.
MP
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Dear MP,
It is always a good idea to go to the source. In this
case, it is the Oncology Nurses Society. They have listed
both web-based and live courses … see which one
works for you. Go to www.ons.org
for information.
Good luck!
Nurse Nancy
June 15, 2004
Dear Nurse Nancy,
What other options do new graduates in nursing have
besides working in hospitals? Are there any office jobs
that will hire RNs and BSNs?
CH
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Dear CH,
Not all new grads start off in hospitals. Many ambulatory
settings will take new grads. You have to go and sell
yourself a bit, as this is not the way the majority
of your colleagues will work. When you get to the interview,
present yourself in a positive, assertive manner. I
have known new grads who have done this, so I know it
can be done.
Good luck!
Nurse Nancy
June 14, 2004
Dear Nurse Nancy,
I have recently been asked to speak at the pinning
ceremony for our graduating RN students. I was honored
to have been asked and accepted the invitation. Since
this is the first time I have been asked to be a keynote
speaker, I am beginning to feel rather anxious about
what my message should be. Do you have any suggestions
for sources I can refer to for some inspirational words?
Thanks so much!
CF
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Dear CF,
Congratulations – what an honor to be asked
to speak to your students. As for inspirational words,
I would say keep this message short and meaningful –
I imagine that there will be families there, and you
don’t want to bore them to tears with a long drawn-out
speech.
Something that I have seen work (and have used myself)
is to talk about the top 10 things you have learned
in nursing. It is brief, and the audience knows how
long it will go on. As for sources – I almost
always use Florence Nightingale’s Notes on Nursing:
What It Is, and What It Is Not. It is a timeless reference,
and you will find something of importance there.
Good luck!
Nurse Nancy
June 11, 2004
Dear Nurse Nancy,
I work for a large health care system in San Diego.
I love my job as an RN. The only problem is that the
whole system has decided to put RNs in the same blue
scrubs. I have no problem about scrubs, but I do not
want to look just like everyone else. It reminds me
of fast-food workers. I believe if we want respect as
nurses, we will not get it looking like twins. I feel
that this is a step back for our profession. What do
you think?
LR
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Dear LR,
I do agree – scrubs can be comfortable, but
when everyone wears them, you sort of blend into the
background. Hopefully, your IDs have RN written on them
– encourage your colleagues to wear their IDs
so your patients know you are an RN. Also, wear your
school pin on your scrubs, as this differentiates you
from the rest.
Above all, tell your patients you are a registered
nurse, and that you will be caring for them. Sometimes,
they just need to
hear that.
Nurse Nancy
June 10, 2004
Dear Nurse Nancy,
In the clinic I work, our manager is a licensed therapist
and I noticed that he verified a medication waste with
another nurse. I feel uncomfortable with this arrangement.
What are the legalities?
PK
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Dear PK,
While each state has laws for health care professionals,
I would guess that the rule of two licensed nurses verifying
a waste is a universal rule. I would ask your manager
if he is aware of the State Board of Nursing in your
state, as he may not be aware that he is doing anything
wrong.
NurseWeek.com lists all of the State Boards of Nursing
on our site. Just type in your state and “Board
of Nursing” to contact your board directly. Good
luck!
Nurse Nancy
June 9, 2004
Dear Nurse Nancy,
I have been reading about the requirement for new
nurses to have their fingerprints taken before their
license can be issued. I have been a nurse for 20 years
and my renewal is approaching. Will I have to have myself
fingerprinted before they will reissue my license? And
a second question: is this legal? It feels like an invasion
of privacy. We are being treated as criminals. I feel
offended. Thanks.
DF
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Dear DF,
When I first sat for my state board exam over 30 years
ago, we were fingerprinted. Given the bad press the
very few bad nurses have given to our profession, I
don’t think it is such a bad idea.
I don’t see it as a privacy issue. I see it as
a patient safety issue. If we have nothing to worry
about, it should not be a big deal. If it is a mechanism
to track down bad nurses, I think it should
be used.
Nurse Nancy
June 7, 2004
Dear Nurse Nancy,
I am a RN in a rehab unit. I usually have 13 pts with
1 and a half aides.(1 is shared with another pod). We
are getting very elderly, dibilitated, confused patients
who are clearly not rehab patients. I am running for
10 hrs. a night on my feet constantly. Seems I end up
doing aide work all shift then after reporting off to
next nurse I stay over to do my paperwork. Of course
the aides always get off on time. I am about burnt out
with this situation. They could up my pay to $100 hr.
but I still can't do more than I am doing already. I
have talked to administration and they always say it
is going to get better, just hang in there awhile longer.
Turnover is great at this facility. I don't want to
leave. Do you have any miracles to give me hope?
FL
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Dear FL,
I don’t have any miracles for you, but my thoughts
are you really need to work with your colleagues on
assignments, delegation, and teamwork. You have to insure
your patient’s safety, but I would challenge you
to look at what you are doing, and try to streamline
some of your routines. Do your nursing assistants have
clearly defined assignments in writing? Perhaps how
you do report could be streamlined also – I find
lots of time is wasted there.
Nursing assistants get out on time because they don’t
have to document. If you evaluate how you do your work,
you just might find more time in your night. Good luck
in your career.
Nurse Nancy
June 2, 2004
Dear Nurse Nancy,
I am a registered nurse with BSN degree. I am concerned
that the four year degree has no difference when compared
to an associate. If this is true, why then do I find
nurses returning to school for their BS degree? Also,
if there is no difference, then what is the purpose
of having two levels? Thirdly, I know there is a difference,
but how should this be addressed in terms of experience,
education and salary. Please let me know your thoughts.
Thank You,
JV
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Dear JV,
This issue of entry to practice has been around our
profession since the 60’s, You can become a nurse
in several ways, and there is room for all of us. I
went to a diploma school first, and then earned my BSN.
I say all the time – it opened many, many doors
for me professionally. Many jobs, certifications, and
professional development opportunities require a BSN.
In the practice area, the BSN is not always rewarded
financially. Some places offer a differential, but in
fact staff nurses are treated the same, regardless of
educational background. Why do we have two levels? (actually,
three if you count the few 3 year diploma schools in
the USA)We all bring something to the patient. The emphasis
for direct patient care and the technical aspects of
nursing are taught in 2 year programs. In the 4 year
programs, the emphasis is on more complex issues of
care, patient education, leadership and management.
The real difference is that the BSN nurse receives a
more holistic education, has more opportunities for
advancement.
It is all how you look at it – nursing as a verb
or a noun. I would challenge you to do something with
your BSN – publish an article, for example.
Nurse Nancy
June 1, 2004
Dear Nurse Nancy,
I have been an RN for 24 years, the past four years
in pain management. I have recently been promoted to
director of nursing in a new ambulatory outpatient center.
I need advice on my new salary. Please help!
Thank You,
NN
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Dear NN,
Congratulations in your new position. While of course
there are regional differences, one way to get a ballpark
idea of salary is to look at our Salary Wizard on our
home page (www.nurseweek.com) and see where you fit
in. I hope this is helpful.
Good luck in your new job.
Nurse Nancy
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