October 29, 2004
Dear Nurse Nancy ,
In the office that I'm currently employed with, says that nurses cannot give any injections without an M.D. on the premises. Does this sound right to you? In other M.D.'s offices nurses do give injections without an M.D. there. Thank you
SH
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Dear SH,
I have not heard of this practice. It would seem to me that the issue is protocols and orders; obviously nurses can not give injections without an order. I would question this practice and ask the rationale; it may just be the practice of the office. I also wonder which drugs you are giving IM. If the rationale has to do with anaphylaxis, that can happen with PO meds also.
When you think about it, we teach patients and families how to do injections all the time; insulin, for example.
Nurse Nancy
October 28, 2004
Dear Nurse Nancy,
I am looking into returning to the workforce after being home for the last 2 years due to a move to another state. I would like to find a PRN/ part-time position. I fear that since I have not used my nursing skills for this time, I will not be prepared to return to a nursing position. Do you have any suggestions on ways to update my skills before applying for a job.
NS
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Dear NS,
As the nursing shortage increases, my prediction is that there will be more and more refresher courses available to assist nurses who want to return to the bedside. Take a look at community colleges in your area; they are likely the ones to have a refresher course.
Also, be sure to explore orientation plans before taking a job. Ask to speak to a new nurse in the organization to see if what the organization promised is what was obtained. Go prepared with questions for the nurse recruiter (who also may know of good refresher courses).
Good luck.
Nurse Nancy October 27, 2004
Dear Nurse Nancy,
I am in a dilemma, I have been an RN for 17 yrs. and worked in many different hospitals. I recently signed a contract for 2 years, ($5000 if I break it) to work in the OR. I am 44 years old, and I feel this particular OR staff is treating me as if I have NEVER been a nurse, I have never taken call, and I am very quiet, in cases I don't get involved in the small chatter, eat in the cafeteria where the light can bee seen due to windows. I want out of this contract. What can I do???? HELP!!
OP
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Dear OP,
Your letter makes me think once again – be careful what you sign! If a place is having such difficulty getting OR nurses, that they have to offer a recruitment bonus,that should tell you there is something wrong. If things are good, employees want to work in those areas.
I doubt that there is much you can do at this point. Read the fine print, and if indeed you signed a document that said you would pay back $5000 for breaking the contract, you have to live with that. Hopefully it will be an important lesson to you (and to other colleagues reading this)
Nurse Nancy October 26, 2004
Dear Nurse Nancy,
We have recently begun working 12 hour shifts at my hospital, and I am contracted to work from 0700 - 1930. Often though, I do not get to work my full shift. I will work from 07 - 1530 (we have the 1/2 hour non-paid lunch) and then be put on call for the remainder of the shift.
But when I check my timecard, I receive my 8 hour of straight pay and only 3.5 hours call time for a total of 11.5 paid time.
I have questioned payroll and HR about this and the answer I have received is that they only pay call time on the hour, not the 1/2 hour. Can they do this legally?
RK
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Dear RK,
First let me remind you that I am not an attorney, so I never comment on legal issues. I do know that the labor laws require that you have a 15 minute break after working 4 hours.
Everywhere I have seen where nurses work 12 hours, they are paid for 11.5 hours. (With breaks and meal times) If your payroll department and HR say it is there policy, then it seems that is the way it is.
I hope that is helpful.
Nurse Nancy October 22, 2004
Dear Nurse Nancy,
We are looking at changing our clinical ladder. Do you have any suggestions? Thank you in advance.
JK
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Dear JK,
Sounds like a progressive move to me, good for you! I would suggest a few things to make this successful:
1. Get a group together of both staff and management to look at your present criteria. This is a great idea for a performance improvement program which is useful, and sets the stage for collaboration.
2. I assume you will be doing a literature review on clinical ladders. You might want to look at the criteria the ANCC has for Magnet Status. While your hospital may not be making an application, it is good to see what the best practices are in hospitals where nursing is excellent.
3. Have a “Certification Day” and have nurses from the specialty organizations distribute information to your staff on each of the specialties. Just about any specialty has certifications now, and this of course would be a part of your clinical ladder.
I wish you the best. Good luck!
Nurse Nancy October 21, 2004
Dear Nurse Nancy,
Why is nursing so racist? I am a traveler who is an RN, but whenever I go to a new place, I am asked if I am an LPN or a CNA. I am certified as a mental health nurse, but that does not matter either.
get the heavier loads and more chronic clients who no one else wants to deal with. It really hurts when I want to be an active team member and give good nursing care.
BD
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Dear BD,
There are two issues in your letter. The first is about assumption of your role. I am not sure why calling you an LPN or CNA seems racist to you, but I would ask you to take a look at how you present yourself. Do you look and dress professionally? Introduce yourself as an RN before someone asks who you are.
s for your assignment, this is unfortunately all too familiar in nursing. I do understand that units that have to use travelers are under a lot of stress (and likely overtime) and staff perhaps don’t warm up to you right away, as you are there to help, but at some point you will leave, also. Try to make the best of your assignments.
Nurse Nancy October 20, 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.
f 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 October 19, 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 October 18, 2004
Dear Nurse Nancy,
I am an ICU nurse and have worked as a staff nurse for more than 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 with. And you probably can read their writing, a real selling point!
Get your résumé ready, emphasizing your clinical expertise. Make an appointment to speak to the person in charge of utilization, and let him or her know your interest. Networking is always important, so start now by letting your wishes known. Good luck!
Nurse Nancy October 15, 2004
Dear Nurse Nancy,
I am a senior R.N. who is ready willing and able to volunteer several hours a week to help out where it is needed. I have an active current license and would like to get active in my new community as a volunteer Registered Nurse. How can I best do this?
JE
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Dear JE,
Good for you for wanting to help! There are likely many community groups who would love to have your services. I would check with your local Red Cross stations, church groups, and even local departments of health. Many have health fairs where volunteers are needed to do blood pressures, blood glucose testing, PPDs or flu shots.
Also, Volunteer Departments in hospitals are happy to have retired nurses. There are opportunities out there; once you start you will have endless possibilities.
Good luck,
Nurse Nancy October 14, 2004
Dear Nurse Nancy,
I am a senior R.N. who is ready willing and able to volunteer several hours a week to help out where it is needed. I have an active current license and would like to get active in my new community as a volunteer Registered Nurse. How can I best do this?
JE
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Dear JE,
Good for you for wanting to help! There are likely many community groups who would love to have your services. I would check with your local Red Cross stations, church groups, and even local departments of health. Many have health fairs where volunteers are needed to do blood pressures, blood glucose testing, PPDs or flu shots.
Also, Volunteer Departments in hospitals are happy to have retired nurses. There are opportunities out there; once you start you will have endless possibilities.
Good luck,
Nurse Nancy October 13, 2004
Dear Nurse Nancy,
I am currently in a BSN program and have 1 more year remaining until I graduate. My main goal is to become a certified registered nurse anesthetist. I know that most graduate programs require at least 1 to 2 years of work experience in critical care. Would it matter if it is full time or part time experience?
PC
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Dear PC,
I would check with the schools to which you might be applying, but I would imagine it is 1-2 years full time. In that time, you will learn time management, how to prioritize, sharpen your critical thinking skills, and have enough experience to have both the knowledge as well as technical skills to be able to take the important step to becoming a CRNA.
In my experience, those programs are competitive, as there are not many. Work on your professional resume to make yours stand out; i.e. joining professional organizations. Good luck to you!
Nurse Nancy October 12, 2004
Dear Nurse Nancy,
I am an RN with my BSN. I am interested in the field of case management. However, the jobs posted in this field require experience and/or certification which I do not have. My work history includes surgical charge nurse and staff nurse in day surgery. Do you have any suggestions?
Thank you,
PF
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Dear PF,
Sometimes employers list qualifications for the “ideal” candidate. I would suggest that you get your resume updated, and be sure to give yourself credit for your charge nurse experience. This suggests leadership skills, and a potential employer will like that. Also, read what you can about case management; there are several text books and journals devoted to the topic of case management. Learn the language.
Apply anyway, and ask the interviewer what he or she thinks you can do to prepare yourself for a case management position. We all start somewhere, so the interviewer might have some helpful hints for you.
Good luck!
Nurse Nancy October 11, 2004
Dear Nurse Nancy,
I have been an RN for 21 years; the last 10 years with the same company. I started as an endoscopy nurse. After endoscopy I did research coordination for the GI docs. Then last year I was told my job had been eliminated, so I took the only open position which was Electronic Medical Record RN. In June I was offered and accepted the position of Risk Manager which has now been eliminated. I really don't know whether to stay at this clinic. Any suggestions?
MM
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Dear MM,
It sounds to me that you have fallen into all these positions over the past 10 years. I think you should take the time to go out and interview elsewhere, and see what else is out there. It is always better to interview when you have a position than when you don’t.
You have a good clinical background, and I think you should make sure your resume reflects the variety of positions you have had with your current employer. You have many skills employers would be interested in; be sure to give yourself the credit!
Good luck.
Nurse Nancy October 8, 2004
Dear Nurse Nancy,
I returned to school and am working toward my RN degree. I graduate in May, but I have been an LVN for the past 17 years. This is a new step in assuming the RN role. Please give me some advice on a new role in nursing.
HH
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Dear HH,
Congratulations! How great for you to be completing school in May. I know you have worked hard to get to this point; I am happy for you that the end is in sight.
My advice is to start over fresh somewhere; resist the urge to work on your same unit where you are comfortable. You will be under a microscope of sorts, and your colleagues may be critical of you. Starting over on a new unit will help you set up your professional identity.
I would also say just do the best you can do, remember why you became a nurse, and ask questions. Make a single goal for yourself each day and keep a journal of your progress. The words to live by are the ones all nurses do: Do No Harm.
elcome to your new role in nursing!
Nurse Nancy October 7, 2004
Dear Nurse Nancy,
I have a three year diploma as an RN and have been working since 1976 as an RN. I also have a BA in Psychology and had attended 1 full year of college for my BSN until my children started coming. What kind of monetary help is available for a 54 year old RN who would dearly love to teach but has no money to get a Masters Degree? Or, are there other opportunities that are available to experienced RNs without a degree in nursing but with a degree in another field? Help please!
DE
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Dear DE,
You sound like you really want to teach RNs, and I hope you reach that goal one day. One thing I thought of as I read your letter is to look at teaching other members of the health care team – LPNs or Nursing Assistants. I have taught in these programs, and it is quite rewarding. Many of these men and women are eager to learn, and bring much life experience and caring to their positions. They need good role models like you to teach them not only the science but the art of nursing.
Good luck. I wish you the best.
Nurse Nancy October 6, 2004
Dear Nurse Nancy,
I have nearly 10 years experience in emergency nursing as an RN. I have been unemployed (by choice) taking care of my family for the last 18 months. I would now like to begin a career change to full-time travel nursing. Can you give me some idea as to which specialties are the most in demand (and therefore would offer the most opportunity for flexibility and available openings throughout the country)? I have asked this question of several travel nursing firms and been given very vague answers. Since I will need to work again locally for at least a year in order to be considered qualified in any specialty (including emergency nursing) and able to "hit the ground running" I am more than willing to consider changing specialties to ICU, step-down, etc. if there is a significant difference in availability of assignments between those areas and emergency nursing. Thanks.
DL
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Dear DL,
I believe that while critical care and emergency department nurses share some skills, there is a difference in the specialties. When I was a Director of Nursing, we were always looking for critical care nurses; I have no data to support that, but that is my experience. I imagine with 10 years of emergency nursing, working in critical care would increase your marketability.
I imagine the recruiters at the travel firms are vague because the needs change. It makes sense to me, though, to have both skill sets so you can have choices. Ask to speak to current and former employees of these agencies and get it directly from them.
Good luck! I hope you love travel nursing.
Nurse Nancy October 5, 2004
Dear Nurse Nancy,
They say that there is a shortage of nurses in the U.S. I believe there is a shortage because they don't hire us. I don't believe places want to take time and train great nurses. I have been a nurse for a year now and I have been searching for employment for the last 6 weeks and no new prospects have arrived. What is that about? Why aren't places hiring us when they say they need us?
DN
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Dear DN,
I don’t know where you live, but I sure feel the nursing shortage in New York City. I believe there are jobs out there, but perhaps not the shifts or clinical service that you prefer. For example, we have a large vacancy rate in our Emergency Department where I work, due to an expansion of that area. While there are nurses out there who want to work there, not everyone can.
I know the shortage in long term care is also critical, and there is a whole other area for exploration. Keep looking; I hope you will be open to new opportunities in your search.
Good luck!
Nurse Nancy October 4, 2004
Dear Nurse Nancy,
How do you feel about online Family Nurse Practitioner programs? Most of these programs require the student to set up his/her own clinicals.
Do you think the education is just as good as the traditional brick and mortar approach? I have three children under the age of five, and a full time job. Thanks for your help.
MC
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Dear MC,
My father used to say that if you wanted to get something done, ask a busy person to do it. You certainly fit that bill! Sounds like you are a busy person!
I certainly think there are courses that can be done on line; I took one on pain management from the University of Iowa and was impressed with the process. I just wonder how the quality is measured, though, when you do the entire program on line. There is so much to be said about interacting with faculty and students; the learning is not just what you read and study.
I would check into the program carefully, and ask to speak to alumni of the program. Were they able to get a job after finishing the program? Does your State Board of Nursing accept the program; this would be an important issue to clarify.
Of course, I can’t make up your mind for you. Check carefully before you sign up for the program. Good luck.
Nurse Nancy October 1, 2004
Dear Nurse Nancy,
Why is nursing so racist? I am a traveler who is an RN, but whenever I go to a new place, I am asked if I am an LPN or a CNA. I am certified as a mental health nurse, but that does not matter either.
I get the heavier loads and more chronic clients who no one else wants to deal with. It really hurts when I want to be an active team member and give good nursing care.
BD
• • • • • • • • • •
Dear BD,
There are two issues in your letter. The first is about assumption of your role. I am not sure why calling you an LPN or CNA seems racist to you, but I would ask you to take a look at how you present yourself. Do you look and dress professionally? Introduce yourself as an RN before someone asks who you are.
As for your assignment, this is unfortunately all too familiar in nursing. I do understand that units that have to use travelers are under a lot of stress (and likely overtime) and staff perhaps don’t warm up to you right away, as you are there to help, but at some point you will leave, also. Try to make the best of your assignments.
Nurse Nancy
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