November 30, 2004
Dear Nurse Nancy,
I am an RN with an ADN in Nursing. I have worked in a NICU for 15 years. I am trying to find information on the fastest online route for my MSN/NNP program. There are so many options out there, I am so confused. Please help.
GZ
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Dear GZ,
Perhaps I will start with the three words in your letter that jumped out at me……”fastest online route”. Where’s the rush? You have a long haul ahead of you - you have to get that BSN first. I think online education is fine for some nurses; I have taken only one course online from the University of Iowa’s School of Nursing. It was just three credits, and I found it very challenging.
I would start with the BSN first. As you are in whatever program you are in, you will meet faculty and fellow students who know a lot about other programs. This will help you sort through what you need to know. Also, you need to know that some states do not accept degrees from online programs, so please check with your state before you start.
You have a long road ahead, but you will get there. Good luck!
Nurse Nancy November 29, 2004
Dear Nurse Nancy,
I have been a reproductive endocrinology nurse for 11 years and trained several nursing in those years. I have worked for the same doctor going on nine years and have been very loyal and go the extra mile. I recently found out our "new nurse," who is 15 years older than I and has no infertility experience, is being paid more than me and it has affected me emotionally in a serious way. Should I look for a new job even though I love my work?
HR
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Dear HR,
Your letter underscores my lifelong commitment to never speak salaries with anyone at work. Your situation only makes things uncomfortable, and served no purpose in your finding out. You don’t know the conversation, the reasons why this new nurse is making more money, or even if it is true.
This happens often in private offices where you are hired by a single physician. The choice is yours – to confront your physician colleague and ask about this, or let it go. Finding a job you love these days is rare – think long and hard before you leave over money.
Nurse Nancy
November 24,2004
Dear Nurse Nancy,
I am a 46-year-old RN. I started out many years ago working on a med/surg floor then worked on a telemetry unit. We moved away and I didn't work for awhile then worked in the clinic at my children's school as the aide for years followed by substituting for the nurses in the district after that. Now I am working in OB Ed at a hospital and teaching sibling classes for kids who are going to be big brothers/sisters and giving OB tours of the hospital to prospective patients (new moms and dads). My question is: I would like to do more in nursing, more hands-on nursing again, but feel like I don't know where to begin. Am I too far out of touch to come back to real nursing? Do I have many options?
LB
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Dear LB,
Sure you have options! If you want to go back to bedside nursing, where you are really needed, you might have to take a refresher course to get yourself updated with technology, pharmacology, and so forth. Many of these refresher courses are in community colleges; I would look in your area for them there.
Also, all those other jobs, while not direct patient care, certainly have skills involved, so don’t sell yourself short. Use them as positives, and be sure to put them on your resume.
Welcome back! Good luck.
Nurse Nancy November 23, 2004
Dear Nurse Nancy,
How can I find out if a medical school is a good one? How can I get in touch with alumni to know their experience in a particular school? The school is in Puerto Rico; there's an ad in NurseWeek and I'm very interested.
EC
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Dear EC,
There are a few ways to find out if a school is a good one. One is to ask to speak to the graduates. Any alumni office will have a list of recent graduates who went through the program. Talk to them and ask your questions. Interview several, so you get a range of responses.
There is also a website that reviews all medical schools in the country. It is www.princetonreview.com/medical. And while I know Puerto Rico is not a foreign country, I found an interesting book called A Complete Guide for Medical Schools: In Plain English. A Student Friendly Book by Nilanjan Sen (Indus Publishing Corporation, July 1997) That looks like an interesting reference, as it is written by the students in the various schools.
Good luck in your next venture.
Nurse Nancy
November 22, 2004
Dear Nurse Nancy,
Hello. I am an LVN in Texas, actively pursuing my RN degree through Excelsior College (formerly Regents) I am sure in the past you have spoken on this issue, but what do you think of this program?
JM
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Dear JM,
Congratulations for actively pursuing your RN online. And yes, I have spoken about this before, but it bears repeating. I have known many nurses who have started this program from Excelsior, but only a handful who have finished it.
I have admired those who did complete it, as it is very rigorous and challenging. When I see it on someone’s resume, I consider it a big plus. You work hard and EARN that credential.
Good luck to you in the program. Hang in there!
Nurse Nancy November 19, 2004
Dear Nurse Nancy,
I've been an RN for close to 10 years and still love my job. However, I’m finding it difficult to be optimistic in light of the shortage of nurses and the never ending paperwork, chart QA's, committees, etc... Do they really expect a nurse to take care of 5-7 patients, do daily extra paperwork, and attend committee meetings?
JE
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Dear JE,
You describe the day to day challenges of the bedside nurse very well. I often wonder how you all manage to do all that you do, without the resources you need at times.
Obviously I have no magic answer; I can only encourage you to do it as long as you can, take joy in the patient’s response to you, and take care of yourself outside of the clinical area. There are choices in nursing; if it is really overwhelming (and all those expectations are real, as the pressure comes from above) you can always do something else in nursing that is less stressful.
Thank you for all you do on an everyday basis.
Nurse Nancy November 18, 2004
Dear Nurse Nancy,
Our ICU is attempting to have our administrators and physicians permit a group of ICU nurses to insert arterial lines (after they have received education and shown competency). The Arizona State Board of Nursing has guidelines which permit this. Is this practiced elsewhere?
JR
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Dear JR,
I have not heard of it in my state ( New York) but if you have checked with the Board of Nursing, and have the proper education and competencies, it should be OK. I would also suggest that you contact the nursing organization who has more information about this – the Infusion Nurses Society which has a Standards of Practice publication that includes arterial lines in the Table of Contents. Their web site is www.ins1.org/standards.
Good luck.
Nurse Nancy November 17, 2004
Dear Nurse Nancy,
I am a HIV (+) RN I am finding difficulty securing work. If your titer for varicella, Hepatitis B, MMR are negative, what can you do? Being HIV (+) contra- indicates varicella, & MMR due to fatal health consequences. In my state, varicella & Hepatitis B are voluntary.
It's 2004 and discrimination is still alive today.
Thanks
RS
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Dear RS,
I can see your frustration, and am sorry you feel this discrimination. Have you looked into counseling of some sort, or some kind of non direct care kind of job? I don’t know what your clinical background is, but it seems that insurance companies, HMOs, etc. employ nurses who don’t do direct care.
I hope you are well, and find that right employer. Good luck!
Nurse Nancy November 16, 2004
Dear Nurse Nancy,
I am a recent nursing graduate and am interested in Endoscopy. Is it advisable for a new graduate to enter this field? I'm worried it may be overwhelming....if so, which areas may offer a relevant introduction to future career aspirations...?
Thanks.
ZR
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Dear ZR,
I don’t think there is a right or a wrong place to start your career. Endoscopy, given the right manager and preceptor, can be a fascinating place to work. You need to be able to work in a face paced environment, work with patients who are sedated, so you need to be quick with your assessments and airway management skills. There is an organization for this specialty also, the Society of Gastroenterology Nurses of America. Their web site is www.sgna.org.
s far as future career aspirations…..it is all about what you bring to the next position. Learn as much as you can wherever you go, be open to new experiences (like long term care…..a great wave of the future, I think, yet few nurses want to work there). The opportunities are there for the taking. Good luck!
Nurse Nancy November 15, 2004
Dear Nurse Nancy,
I am an LPN who has had her license reinstated this month. It was suspended
in 1999 for a total of 3 years. One of the conditions of reinstatement is I have to get 15 hours of CEU's. Prior to my suspension I was a med surg nurse at the Veterans Hospital. What course would you suggest I brush up on? I would like to work in a hospital setting again. Thanks.
DH
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Dear DH,
Well, welcome back first of all. As far as CEU’s are concerned, there is a wonderful selection you can get on our site – click on NurseWeek.com. You can choose topics that might be new to you – like the role of nursing in terrorist situations, infection control – there are dozens of topics there and you can do them on line!
Take a look on the home page.
Good luck!
Nurse Nancy November 12, 2004
Dear Nurse Nancy,
I am extra at a hospital that has adopted a policy change for CPR from annual to every 2 years. Having been in nursing over 15years and observed numerous code-blues on med-surg floors where the staff barely knew how to open the crash cart-let alone know the basics of lead placement, and ratios of breaths to compressions this action I view as unsafe nursing practice. Codes for the most part are not common occurrences and the primary placement for new graduates are being placed is on med/surg floors. Is this obviously cost-saving practice being adopted by more hospitals?
Thanks,
BS
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Dear BS,
I am not sure if this is being practiced by most hospitals, but I do know that many of the regulatory agencies do not require BCLS for staff nurses. They only look at what your hospital’s policy is and if you are meeting that requirement.
I agree that 2 years might be a cost saving. There are other ways to accomplish proficiency in codes, however. How about asking your Staff Development Department to do periodic mock codes? I have found that to be helpful, especially to new grads. That way they can practice in a safer environment.
Nurse Nancy November 11, 2004
Dear Nurse Nancy,
I am an RN with an AAS degree. I have been working in the operating room for 15 years. I am considering going back to school for a BS or possible MS. A local college offers a program call BS/MS in health care administration as opposed to the BSN/MSN. I would like to know what you think about the outlook of this degree path especially if I want to move up in my department. Thanks.
ES
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Dear ES,
Normally I am prejudiced toward degrees in nursing, but I also see the wisdom of taking advantage of the easier path. With your experience, an MS in health care administration will take you far. (I am not sure how far you will get with a BS) There are many supervisory positions in the OR and elsewhere for which you would be qualified with a graduate degree in health care administration.
If it is advancement you are looking for, aim for the MS and take it one day at a time. Before you know it, your coursework is done and you are ready for that promotion. Good luck to you!
Nurse Nancy November 10, 2004
Dear Nurse Nancy,
How about some tips on career change...
hospital RN to college classroom teaching for a nursing program...
TR
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Dear TR,
Hmm….my “tips” would be to prepare yourself on how to teach. Many nurses know the clinical situation, but have a hard time explaining it. If you don’t have the education to teach, go back to school. Along with the nursing shortage, there is a tremendous shortage of nursing faculty, so this is a great field to enter. We need good teachers to prepare the nurses of the future.
The rewards of teaching are terrific; I have taught in several universities and really enjoyed working with new nurses. Good luck!
Nurse Nancy November 9, 2004
Dear Nurse Nancy,
As a Manager-RN on the 6p to 6a shift at a rural hospital, it is a part of my duties to mix IVs for surgery patients and other Pharmacist responsibilities.
I feel this is out of my scope of practice. I have requested assistance on this matter from the Board of Nursing for the state I reside in but have not heard back from them.
m I performing duties out of my scope of practice, and if so, how I should approach my Director of Nursing about this? She assured me I am within my scope of practice when I questioned it upon hire.
NS
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Dear NS,
I had a job once as a nursing supervisor where I had to be the pharmacist at night, so I share your concern. You are correct to check with your Board of Nursing; your director’s assurance won’t help you if something is wrong. Document all of your conversations with your director. You might want to check with your state’s Board of Pharmacists also.
The principle here is one of standards of care; your patient’s deserve the same standard of care which is different if the Pharmacy does some of the patient’s IVs and you do the rest. I would suggest that you take a look at the JCAHO’s National Patient Safety Goals and use this as leverage with your Director. Medication errors are such a hot topic these days, and given your system, your organization is increasing the chances of such an error.
know it is a difficult situation given finances, but the liability is really there. I wish you the best in this challenging situation.
Nurse Nancy November 8, 2004
Dear Nurse Nancy,
I will be graduating soon and need some advice. I have a past felony conviction (DWI) and spent time in prison for this. I have been approved by the Board to take the NCLEX. My questions are how do I approach this issue on an application and in the interview? Do I tell this to the recruiter? How does the employer view this on an application? I'm very concerned that I may be limited in the choices of places I'll be able to work. I appreciate any advice that you can give me. Thank You.
RS
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Dear RS,
The most important thing is to always tell the truth; never falsify a job application as that is grounds for termination. Most job applications do ask that question. It seems to me that you have served your time, and have paid your dues to society. Hopefully that part of your life is behind you, and I think it is great that you will be an RN soon.
Nurses in general are understanding, and hopefully you will find a sympathetic nurse recruiter and manager who are willing to give you a chance. Everyone who starts a new job has a probationary period, so really everyone starts on the same page.
Good luck in your new job and your new beginnings.
Nurse Nancy November 5, 2004
Dear Nurse Nancy,
I am interested in online RN to BSN programs. Do you know of any good programs? I've taken online classes before and they work better with my schedule. Thanks!
VM
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Dear VM ,
I agree that online classes are great for earning your BSN. As an RN already, you probably won’t have clinical courses, so an online degree seems like a good way to go. As for “good” programs, I would do some homework on each of the ones in which you are interested. My experience is that these programs are very difficult, require discipline and self direction which is not in all of us.
Ask to speak with alumni of the program. Also make sure your state Board of Nursing recognizes the degree, along with your employer. Good luck!
Nurse Nancy November 4, 2004
Dear Nurse Nancy,
I have been an RN for 2 1/2 years and would like to know the different certifications I can get. I have been a case manager and clinic coordinator for the past year. Is there a certification for these?
BW
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Dear BW,
There are many certifications out there, with different educational and practice requirements. In general, you need to have two years in a specialty in order to sit for the exam, as that is the minimum time you need to move to expert status. I would suggest you take a look at this website from the American Nurses Credentialing Center:
http://nursingworld.org/ancc/certification/cert/onthemove.html
Good luck to you!
Nurse Nancy November 3, 2004
Dear Nurse Nancy,
I am an RN who is working in homecare for the past 3 years for highly respected private homecare companies. At this time my family is trying to relocate to Nevada, Las Vegas. How do I go about locating legitimate private homecare agencies that do not do fraudulent business/billing since that is a huge issue and may even affect me, down the road?
ER
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Dear ER,
I am glad to hear that you have had a good experience with your current employer. It is nice to hear that. Perhaps your current employer knows of an equally reputable place in Las Vegas. You can always check with the Better Business Bureau, or perhaps the local AARP (American Association of Retired Persons) or the Attorney General’s office. I would think one of these groups would be able to identify agencies that have complaints against them.
nother thought is to find out who accredits homecare in Nevada and ask them. Go to the Department of Health, and they can likely help you. Good luck!
Nurse Nancy November 2, 2004
Dear Nurse Nancy,
Can you please explain per diem nursing? I have been a staff nurse at the same hospital for several years and all nurses are staff nurses. I am thinking of changing job and hear/read a lot about per diem jobs. Any advice will be appreciated. Keep up the great work!
DS
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Dear DS,
Per Diem comes from the Latin for “by the day”. Per Diem nurses do not make a commitment to work full time, but chose to work periodically. They are terrific for staffing, as they fill in on shifts that are not covered, and their days are planned so that they can be included in the staffing numbers. They fill in for staffing fluctuations, but please note that the census goes both up and down, so your shift may be cancelled if the census drops.
n general, they are not assigned to any one unit, so you have to be flexible to be a perdiem nurse. You go where you are needed, not where you might like to work. In return, the nurse is able to arrange his/her schedule according to their own needs. Some nurses work full time in one hospital, and per diem in another – sometimes for a change of pace, and just to see how other places do it.
Nurse Nancy November 1, 2004
Dear Nurse Nancy ,
I am an RN BSN with 18 years of various experience including management and administration. I also have 24 graduate credits toward my MPA. Now I am ready to move forward again. My first love was always writing. I am having “brain freeze” on what to do with my career. I’d love to publish about nursing. Where do I start? Can I make a living at it?
EH
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Dear EH,
Well, you know the joke about how you get to Carnegie Hall? Practice, practice, practice. Finish your degree, and get yourself out there and publish. Most nurse editors are more than happy to discuss with you what it is that you can do to help their particular journal. All journals have an “Information for Authors” page, which tells you the length, format, style, etc. that they use.
I would encourage you to call or email the editor before you start writing. You have no idea what the editor has in the pipeline of a particular journal. Ask for a deadline and meet it.
As for making a living at it…..I suppose that depends on how good you are. There are nurses who make their living at writing, so it is definitely possible. Keep the dream alive! Good luck.
Nurse Nancy |
