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September 30, 2004

Dear Nurse Nancy,

I have been a nurse for two years. During that time, I have worked in the emergency department for six months, and the rest of the time in perioperative surgical services. I am interested in either home health or dialysis. What kind of skills and background do I need?

CC

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Dear CC,

Well, your background certainly suggests that your transition to dialysis might be a natural one, given your perioperative experience. I would caution you, however, to gain some experience where you are, as a potential employer might challenge your turn around time.

If your potential employer sees you as someone who does not stay anywhere long, you might lose out because they don’t want to train you just to see you leave for another job. You don’t have to stay in a position forever, but two jobs in two years might raise some employers’ eyebrows.

Nurse Nancy

September 29, 2004

Dear Nurse Nancy,

Would a certificate in case management be beneficial in advancing my nursing career? There are some colleges which offer this online education.

TC

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Dear TC,

Given the challenges of finances in health care, I believe case management is definitely important, as these are the folks who have set the tone for disease management, benchmark data, and generally improving the care of the patient in the hospital.

Certification will say to a potential employer that you have expertise as recognized by an organization. I think it would help you a lot.

Nurse Nancy

September 28, 2004

Dear Nurse Nancy,

I am an ICU nurse and have only worked as a staff nurse for over 20 years. I am interested in getting into utilization review work. How do I start when I don’t have any experience in these areas?

KF

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Dear KF,

You have much to offer, please know that. You not only have clinical expertise, but you also bring a maturity to a new position, which many organizations would appreciate. If you stay in your own facility, you know most of the players, especially the physicians with whom you would be communicating. (and you probably can read their writing, a real selling point!)

Good luck!

Nurse Nancy

September 27, 2004

Dear Nurse Nancy,

I just received my RN license from the state of Michigan, and am wondering which states can I transfer this license to? Thanks for your help.

DD

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Dear DD,

Congratulations on getting your RN license — a great accomplishment! Most of the states in the United States have reciprocity with other states (which means you don’t have to take the NCLEX again). We have information on this for every state. Click on this link to look at the different states:

www.nurseweek.com/career/boards.asp

Good luck!

Nurse Nancy

September 22, 2004

Dear Nurse Nancy,

I am an RN and quit my job three years ago to stay home with my son. I went from nursing school right into surgical/trauma ICU for almost two years, and then worked in perianesthesia for four years performing a variety of skills. I would like to go back to work part time/per diem, but do I need a refresher course? I am thinking of home health, but not sure if that is possible without home health experience. What do you think?

KC

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Dear KC,

I am not sure what the cutoff point is for “recent clinical experience,” but it seems to me you should discuss this with the home health care agencies you plan to look into.

Most recruiters certainly understand interruptions in working time for childrearing. That is one of the great things about nursing, that you can always come back. And there is always a need for home care nurses as out patients are sent home earlier and earlier.

I would go ahead and get your résumé together and test the waters. I wish you well. Welcome back!

Nurse Nancy

September 21, 2004

Dear Nurse Nancy,

I have been reading a lot about certified legal nurse consultants and I’m wondering if it really does sound too good to be true. I love the idea of being my own boss and working from home, but I just don’t know if the whole thing is realistic. The advertisement seems to suggest that this is the upcoming “thing.” Any information you have to pass on I would greatly appreciate.

AM

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Dear AM,

Well, I agree the advertisements certainly make clinical legal nurse consultants’ work look interesting and lucrative. There is a lot to be said about being your own boss, also. I know several people who have completed the course, and like anything else, the job is what you put into it.

Working independently can certainly be profitable, but it is a different model of business than most of us know in nursing. I know that most of these courses teach you about developing a business plan and starting your own business. Clients don’t fall out of the sky, however; you have to go out and find them. It seems to me you have to have the ability to go after clients in order to hang up your own “shingle.” And the money is not predictable as it is in traditional nursing. No benefit time, no paid vacation.

I do believe there are many successful nurses out there making a living doing this work. I would suggest you find some of the more successful ones, and ask them to share how they got there.

Nurse Nancy

September 20, 2004

Dear Nurse Nancy,

I am interested in pursuing a master’s degree in community/public health nursing. However, I work full time as a public health nurse, Monday through Friday from 8 to 5. This poses a big problem in my being able to physically attend classes. I’ve been seeking information on online MSN programs. Do you have any suggestions?

SW

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Dear SW,

Online learning is certainly a great way to get an education while working on your own schedule. It does, however, take a lot of work and perseverance to complete such programs.

My suggestion before you start any of them is to investigate them completely. See if your potential employers accept these degrees; investigate the program and ask to speak to alumni. Ask for many references, and take the time to ask what they thought the plusses and minuses of the program were.

Graduate education is a big investment in your future, so treat it like you would any large purchase. Good luck!

Nurse Nancy

September 16, 2004

Dear Nurse Nancy,

We have a hearing impaired nurse (she is a great clinician with a stethoscope that allows her to hear heart, lung, and bowel sounds). She works in the ICU. She is unable to hear the alarms on the IV pumps and cardiac monitors. Do you know of any solutions to help her, as we really would like to accommodate her needs? Thanks.

GH

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Dear GH,

How great that you and your colleagues are trying to support this nurse. This is a challenging question, as the audibility of alarms of any sort is a big patient safety issue. It is listed as one of the National Patient Safety Goals for 2004 for the Joint Commission for Healthcare Organizations (www.jcaho.org).

I wonder if your biomed department could work with you, and the company who makes the equipment, to have a visual alarm on the equipment, much like they do for telephones, doorbells, and so forth, for hearing impaired individuals. You also might consult with the agency in your area that assists hearing impaired individuals; they might have some suggestions.

Other ideas might be to have this colleague have a different assignment, where she can have the one most critical patient, perhaps, and stay in the room so she can see the monitors and trouble-shoot before they go off.

Not an easy situation, I realize. I hope you find a solution so you can keep your colleague in the ICU. Good luck!

Nurse Nancy

September 15, 2004

Dear Nurse Nancy,

Many hospitals require pretesting now before hiring staff, such as the BKAT. What exactly are these tests and how would you find information on preparation for them?

GV

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Dear GV,

The BKAT is the Basic Knowledge Assessment Tool developed by Jean Toth, RN, DNSc, at Catholic University of America. It is intended to be an assessment, to give employers and staff development staff an idea of the learning needs of each individual critical care nurse. It is not to be used for screening, hiring, or firing nurses.

It is a 100-question paper and pencil test and covers the following systems: cardiovascular, monitoring lines, pulmonary, renal, endocrinology, GI/parenteral, neurology, and others (infection control, for example). The validity and reliability has been established over the years.

To read more about this exam, click on this link:

http://nursing.cua.edu/research/toth-bkat.cfm

Good luck!

Nurse Nancy

September 14, 2004

Dear Nurse Nancy,

I am a diploma RN, certified in oncology nursing. I have worked in a variety of clinical areas (med/surg, OR, long-term care), and currently work as a research nurse for a physicians group of radiation oncologists. I am 59 years old, without health problems. My duties tend to keep me at the computer and files, with very little patient contact. I have been with the practice for 1½ years. The benefits are good; the salary is fair (not great).

My question is – am I too old to consider striking out for a more rewarding job with more patient contact and patient teaching? I don’t want to work 12 hours on an inpatient unit, but home care seems attractive. What do you think?

MK

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Dear MK,

I think you have a lot to offer, and you should definitely look for a more satisfying job. Age is just a number, benefits and salary are important, but for those who need to work with patients – no salary or benefit package can replace that professional satisfaction.

Go, look into home care opportunities. I imagine with your experience you will find a great job where you can work with your patients. Lucky patients!

Nurse Nancy

September 13, 2004

Dear Nurse Nancy,

I have an associate’s degree and have been an OB nurse for eight years now, but I would like to branch out to other areas of nursing. The areas I am most interested in are case management or screening or auditing. Most employers require a master’s degree or experience (like CPT coding or case management). Would I have to get my master’s degree first or are there other avenues I can take?

The local schools offer medical coding classes; is it wise to go to these classes or continue for a BSN/MSN?

NP

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Dear NP,

I think this might be a matter of economics. Having a master’s in nursing will, in the long run, open more professional doors for you, and be a higher-paying job. I would suggest that you go to the local school and see what the coding class is about. Ask to speak to some of the folks who have taken it, and where they are working.

My guess is that a master’s in nursing will be a better investment in the long run.

Nurse Nancy

September 10, 2004

Dear Nurse Nancy,

It was suggested that I use a nurse practitioner to supplement my doctors. Blue Cross Senior of New York does not have the designation within their net. How can this be corrected?

DM

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Dear DM,

I agree that nurse practitioners provide excellent care to patients, and we as nurses need to support our colleagues. Most nurse practitioners bring a great deal to the care of the patient, as they are usually expert nurses with a great deal of clinical experience. I have worked with NPs who covered an inpatient unit 24/7, and our discharge process was greatly improved because of their presence.

We have to lobby the companies who don’t allow NPs in their network. Make your wishes known to your HMO/insurance company. If we all did that, imagine the impact we would make.

Nurse Nancy

September 9, 2004

Dear Nurse Nancy,

The doctor’s office where I work says that nurses cannot give any injections without a physician on the premises. Is this correct? I’ve worked in other offices where the nurses could give injections. Thank you.

SS

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Dear SS,

I would caution you to refer this question to your State Board of Nursing, as each state may have different regulations related to the professional practice of nursing. As a matter of logic, it would seem to me the issue is one of physician orders; is the nurse giving the injection working on a protocol approved by the office and ordered by the physician?

We have a list of the Board of Nursing for every state; it lists the website and phone number information for each. To go there, click on this link:

www.nurseweek.com/career/boards.asp

Thanks!

Nurse Nancy

September 7, 2004

Dear Nurse Nancy,

Hi, I have been a registered nurse since 1992. I have worked in an ICU at a Level I trauma center since 1995. Since having two children, I am looking for an opportunity to work from home as an RN, but I am not sure in what capacity. What can I do, and where can I get more information? Thanks Nancy!

JES

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Dear JES,

I get this question often. There certainly are jobs out there for RNs to work at home, but you have to be creative (and persistent) to look for them. I would suggest looking at insurance companies, attorney’s offices who specialize in medical malpractice, and other opportunities.

Networking is always a great way to find a job. Get business cards with all your pertinent professional information on it, have your résumé done professionally, and attend professional meetings to get your name out there.

Good luck.

Nurse Nancy

September 3, 2004

Dear Nurse Nancy,

Every hospital in the nation is decrying the shortage of nurses. In my experience, they may be, in part, crying for what they produce. I have not done direct patient care since the end of 1992, but I have been a nurse case manager in different settings since that time. In 1999, I even took a refresher course (equivalent to 7 credits) to bring my skills up to date. Furthermore, I am fully bilingual and have a previous degree in mental health. I found myself out of work last year and contacted the local hospitals. Having been out of the hospital setting for so long, I told the recruiters that I was not able to return to the ICU, but that I would go halfway to meet them and return to the regular surgical floor if they were willing to work with me. No hospital took the opportunity. I asked one of the recruiters why they were willing to take new grads, but would not invest in having a seasoned nurse return to their floors. The answer was that the new grads were in a better position and the literature showed that RNs who returned to the floor did not do well. Is that true?

CS

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Dear CS,

You make a good point, and it does seem a shame that you want to come back to nursing, but no organization is willing to hire you. I can tell you that 12 years is a long time to be out of direct patient care, and so many things have changed over that time, even with a refresher five years ago.

It has been my experience that most of the nurses I have seen who return to the clinical area have not stayed past orientation. The differences were too diverse, the documentation staggering, and the technology very challenging. New graduates are taught in that hectic pace, so it perhaps is easier for them.

You sound determined, though, and I encourage you to continue to look for that great job. You may very well be someone who will do well in the return to work. Keep interviewing and hopefully someone will be convinced that you are able to do this. Good luck!

Nurse Nancy