December 30, 2004
Dear Nurse Nancy,
I am wondering how you feel about unionization of nurses. Our hospital does not have a union and we currently are being approached to become organized. We are getting almost daily letters from management and the union trying to persuade us one way or the other. We have lots of staffing and pay issues and it seems to never change. What do you think?
LD
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Dear LD,
I have worked in a collective bargaining environment, both as a member and a manager. As a member of our professional union, I had many benefits – tuition reimbursement, job security, predictable salary increases, and so forth. I have experienced both collegial and adversarial relationships with collective bargaining.
One thing I do feel strongly about is that if you indeed do go with a collective bargaining unit, I hope it will be a nursing organization. There are many unions representing nurses who really don’t know our profession. That would be a concern for me.
It really is a personal choice and somewhat emotional for some nurses. Do your homework and make sure you know what you are getting into, so there are no surprises. Good luck!
Nurse Nancy December 29, 2004
Dear Nurse Nancy,
I am a new grad RN/BSN. I have a limited experience {to be exact a one month experience} as a nurse. I want to be a nurse practitioner. How will I go about this? Whom to contact? Can I do it thru online schooling? Do I need to have my masters first before getting my NP certificate? Please help me. Thanks.
LC
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Dear LC,
One month experience and you are already ready to go back to school! Wow! I would suggest that you work for at least a few years, so that you have some solid experience and confidence when you move into an advanced practice role .You will have much more credibility with your colleagues and your patients.
As for the education piece, you can do courses online; I would caution you to check with your Board of Nursing to see if they accept online degrees (some states don’t). And most programs have a combined Masters and NP certificate program; once you start looking at different schools and plans you will see that. I would start by looking at the website of all of the universities near you (they all have websites) and see what you think fits for your lifestyle. Also, talk to nurses in your hospital who are Nurse Practitioners and ask their advice; most will be happy to help. Good luck!
Nurse Nancy December 28, 2004
Dear Nurse Nancy,
My son is a junior in high school and he has taken 2 tests so far that indicate that healthcare would be closely matched with his studies and interests so far. As a RN myself, I would like to encourage him to consider Nursing as a profession. He however thinks that nursing is for “girls” not “guys”. Do you have any suggestions how I could find him a male nurse who might mentor him?
WM
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Dear WM,
I think we all long for the day when nursing is gender free, and we no longer think of our male colleagues as “male nurses”. I would encourage you to take a look at a great organization; The American Assembly for Men in Nursing founded by Luther Christman, PhD, RN in 1974. Along with some excellent role models, your son might benefit from their discussion room and perhaps even find a mentor there.
I hope he will reconsider. We need him!
Nurse Nancy December 27, 2004
Dear Nurse Nancy,
I graduated in 1997 with a RN associate degree. I got married directly after college. I had a baby and stayed at home with him his first 5 years. I want to pursue my degree as a nurse but am having trouble. I thought with the nursing shortage I would be welcomed with open arms. This has not been the case. One hospital suggested an RN refresher course at my expense. I think I can be a good nurse if they would just give me a chance. Shouldn’t they be making it easier for nurses to return to work?
BG
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Dear BG,
I am glad you are willing to join the workforce, but I think you are a bit unrealistic about how much has changed in the five years you have been at home. You have a minimum of educational experience, and no clinical experience. Any new graduate would have difficulty; that is why we have orientation programs.
As for paying for a refresher course; obviously there are costs related to this. My experience has been that the nurses who take the courses and go back to the bedside do not stay very long; it really is a tough transition.
I think you need to be a bit more realistic and realize there are costs involved with returning to work. I think you will also gain great confidence in sharpening your skills. Good luck!
Nurse Nancy December 23, 2004
Dear Nurse Nancy,
I am scheduled for an interview for a clinical supervisor position. I am to meet first with the director and then spend time on the ambulatory unit. My question is – do I dress for the interview in a suit or do I wear scrubs for the floor?
JV
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Dear JV,
Great question. Since you are on an interview, by all means dress professionally. When you do go to the ambulatory unit, you are there as a visitor, not an employee. You don’t have the job yet, so be respectful of patient’s confidentiality and behave as a guest. This is not the time to “prove” your clinical skills.
Good luck in the interview.
Nurse Nancy December 22, 2004
Dear Nurse Nancy,
Do you know an organization or website for Neurosurgery Nursing? Thanks
DD
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Dear DD,
Just about every specialty you can think of has an organization. The American Association of Neuroscience Nurses (http://www.aann.org) will meet your needs. They are celebrating their 37th annual meeting in April 2005 in Washington, DC. I hope you get a chance to join the organization and network with colleagues who share your interest and expertise in neuro nursing.
Nurse Nancy December 17, 2004
Dear Nurse Nancy,
I have been out of practice as an RN for five years for personal reasons. My background included a BSN degree and 10 years of med-surg and rehabilitation. I am planning to return to the RN field, but prefer to work in a less physically demanding environment, such as a clinic setting or office practice. What should I do to prepare myself in the competitive job market and what other opportunities are out there? Are RN re-entry programs and RN refresher courses the same?
HD
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Dear HD,
Welcome back! To prepare yourself, I think a good refresher or re-entry program (and yes, they are the same) would be very beneficial. I also think that it will increase your marketability having been through the course.
To prepare yourself, I would suggest you read nursing journals, update yourself on what is new in the profession, and network with other nurses who can perhaps help you find a job. Be sure to update your résumé, and be positive about your 10 years of practice, not the five you did not work. I wish you luck as you look for a new job.
Nurse Nancy December 16, 2004
Dear Nurse Nancy,
I have a question about certification. Is it limited to certain hours in a facility for renewal, or can this be done through private care?
DR
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Dear DR,
Different specialties have different requirements for certification, so I suggest you go to the certifying agency (most have a website) and see what the requirements are. I don’t know of any who acknowledge private care, so I would look into this if this is how you are hoping to recertify yourself. Good luck.
Nurse Nancy December 15, 2004
Dear Nurse Nancy,
I work for a not-for-profit hospice which has integrity and takes pride in the work we do. Upon discharging a patient from our hospice due to no longer meeting the hospice criteria, we learned that within a few days, a for-profit hospice has admitted this same patient to their hospice. Isn’t this unethical?
ME
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Dear ME,
Well, it does not sound right to me, but I am, of course, not aware of all of the particulars of the patient. I wonder if the family was more comfortable with this arrangement, and if they have the finances to cover it; perhaps they were doing this for the patient. End-of-life care is difficult for most of us, and given the wonderful work you in hospice care do, perhaps this is easier for the patient and the family.
Nurse Nancy December 14, 2004
Dear Nurse Nancy,
After 31 years in emergency nursing and 14 years in public elementary education, I realize that I have a number of years left to devote to the workforce. The logical end to a productive career would be to teach nursing. This would satisfy both of my loves and is something that excites me. Our local program offers an 18 month program after which I could exit with an MSN and MED. However, the finances are prohibitive. The grants that I have located are only for undergraduate and minorities. Is there any help for postgraduate work?
HI
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Dear HI,
Sounds like you have much experience to share with students. We have a shortage of faculty, which would require you to get a master’s level. I can see how getting this advanced degree could be costly. Have you thought about teaching nursing assistants or EMTs, or maybe LPNs? You may not need a master’s to do that, and you would still have the teaching piece. These groups would benefit from your experience, and I imagine you would enjoy teaching them, also.
I hope that is helpful. Good luck.
Nurse Nancy December 13, 2004
Dear Nurse Nancy,
I have been a staff nurse for over 10 years, and I love my patients! However, I am considering trying to transition into management because I am so frustrated that managers with whom I have worked seem to forget why we are in health care – for the patients. Do you have any suggestions? Thanks.
JL
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Dear JL,
Go for it! All managers were at one time staff nurses, so this is a natural progression. I would suggest you update your résumé to reflect any leadership positions you might hold – even in community or church groups. Find a good mentor who will help you get to your goal. This is likely a good manager with whom you worked somewhere. Most are happy to help coach you with this transition. My advice is to carefully select a job where your immediate supervisor will be supportive and help you with the new challenges you will face. Those colleagues are out there; I hope you find one to help you! Good luck.
Nurse Nancy December 10, 2004
Dear Nurse Nancy,
I am interested in finding out what the rule is regarding pre-writing sections of a clinical note. I work as a consultant in home care, and have noticed this practice on several occasions. Nurses pre-write notes prior to the visit. I come from the “old school” way of thinking where this practice is totally unacceptable. I have been given some challenging arguments in favor of this practice. I haven’t been able to find out any specific ruling and would like your comments.
LM
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Dear LM,
Thanks for your question. My comments are just that, as I am not speaking as an attorney. I guess you and I come from that same “old school” as it seems to me that pre-writing orders – regardless of where care is given – lends itself to potential litigation. Isn’t the whole point of providing a registered nurse in the home to give a professional assessment of the patient? If you pre-write your notes, what happens if your findings are totally different?
I think you question is valid, and would encourage you to discuss it with Risk Management, or the agency’s attorney. It doesn’t seem right to me, either. Good luck.
Nurse Nancy December 9, 2004
Dear Nurse Nancy,
I am trying to get into forensic nursing and specializing in death investigation. I am looking for some direction. I am not sure whether I should get a death investigation certificate through a local college or to take forensic nursing classes over the Internet. I am not really sure which way would provide me with more opportunities. Any help would be appreciated.
LP
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Dear LP,
I would encourage you to look at the professional organization in forensic nursing – the International Association of Forensic Nurses. I have found throughout my career that networking with people who do what I wanted to do is the best way to get started. Most nurses who go into forensic nursing have a background working in the emergency department, and have the credential of a sexual assault nurse examiner (SANE). If you don’t have that, I would start there.
If possible, I would encourage you to network with other forensic nurses. Join IAFN and I am sure you will find a mentor who will help you. While I am not sure about the choices of a death investigation certificate vs. online education, I do know some states do not accept online classes, so check this out with your Board of Nursing before you start.
It sounds very interesting. Good luck!
Nurse Nancy December 8, 2004
Dear Nurse Nancy,
Are there any good sites or information to help explain occupational health issues, legalities of occupational health, and injury management in the workplace?
SP
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Dear SP,
There are two organizations that I know will be of assistance to you. One is OSHA, the Occupational Safety and Health Administration, part of the U.S. Department of Labor. This site provides education, training programs, outreach, and legislative issues related to the workplace. Another is the Association for Professionals in Infection Control and Epidemiology. This is a multidisciplinary group which promotes work-related safety also. I encourage you to explore both of these sites – there is so much out there!
Nurse Nancy December 7, 2004
Dear Nurse Nancy,
I have been in school part time for over six years. I have my associate of arts and am working on my bachelor’s in psychology. I have three children and have enjoyed being able to be with them, as they need me. I am 40 years old and was in banking for over 13 years, so this will be my second career. I keep going back and forth between nursing and counseling. Counseling will take me another five years and even when I am done, I don't feel I will have the flexibility that nursing offers. I am thinking of nursing in the psychiatric field; however, I understand that when I go through school I may enjoy another aspect as there are so many different fields. I suppose my question to you would be is if you see a correlation between helping people as a counselor versus nursing. I want to help people, have a flexible schedule, and earn a decent living before it is time for me to retire. Any advice?
KLC
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Dear KLC,
Nursing meets all of the criteria you list. There is a great opportunity to not only help people, but to get great satisfaction in doing it. The schedules are flexible, and you can certainly earn a decent living as a nurse. You are right in wondering if you might find another clinical area that interests you. …. the possibilities are endless. The work is hard, but the rewards are terrific. Good luck!
Nurse Nancy December 6, 2004
Dear Nurse Nancy,
I work for Hospital X. They have instituted a policy that allows the ER to fax report (that is usually incomplete). This is very frustrating as, patients often arrive unannounced and unexpected. What should we do?
CFJ
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Dear CFJ,
Many hospitals fax report from the ED; I have seen it work well. I would suggest you collect some data on this, and then ask for a meeting with the ED so you can show them how this impacts on patient care.
Keep a log for a few weeks. Copy the actual ED report (take off the patient, nurse, and physician names and any other identifying information to be HIPPA compliant) and keep a record of two things – what time the fax came in, and what time the patient arrived. I have found that people can’t argue when you have data.
Meet with the stakeholders (representatives from your staff and the ED) and show them the data. Maintain a professional demeanor, and try not to show your frustration. Emphasize that this is about patient safety (which it is) and you are trying to improve the care. Have someone take minutes, share the minutes and meet again to see if it gets better. Thank the ED staff for their time, and see if this approach doesn’t work. I bet it does.
Good luck!
Nurse Nancy December 3, 2004
Dear Nurse Nancy,
I am an RN BSN and am going to try a position as a clinical instructor for first year students in LTC. I have worked in cardiac settings for 14 years. Any advice as to how to handle or what to instruct students would be helpful. I will be having a day of orientation with the instructor from the local college and will pursue questions also. I plan to go over assessments, insulin, floor orientation, time management, personal goals, and what I expect from the students. I just would like some guidance from someone who's been there. The first time is always a little scary. Thank You.
JS
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Dear JS,
I think it is great that you are going into education; we need more clinical instructors who have clinical experience. My suggestion is to keep an open mind. Your students, if young, are in a different generation and learn differently. I work with students in my job, and I find myself having to remind them to NOT bring their cell phones into clinical, to dress professionally, and so forth.
You are a very skilled clinician, I am sure.Make your expectations reasonable, equal to what these students need to know. They are likely scared and have little clinical experience. You are right to give them goals and set out your expectations; everyone likes to know the rules. Another tip I will give you is to include the CNA’s in the long term care facility you will be in. They know the patient’s really well, and your students (and you) will likely learn a lot from them.
Good luck. Have fun!
Nurse Nancy December 2, 2004
Dear Nurse Nancy,
After taking a break for some time now, I am looking for a new job as an RN. Three times now, I have had excellent interviews and was told that they intended to make me an offer. Within a couple of days however, I learned that they were no longer interested. What could be happening?
WR
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Dear WR,
I guess I am surprised that they would make you an offer in the interview; generally there are more layers of people involved in hiring someone. To have it happen three times is disturbing, however. Many times internal candidates are offered priority, or there could be someone whose credentials match better than yours.
Another thing you might think about is your reference check. Sometimes you are offered a job, pending references, and the references turn out negative. Be sure you have the right people speaking for you. That may be the reason you are not getting the job.
Nurse Nancy December 1, 2004
Dear Nurse Nancy,
I'm interested in learning more about being a PICC line insertion nurse. Can you please tell me where I can get started in finding out the requirements?
TS
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Dear TS,
I would start with the Infusion Nurses Society (www.ins1.org).They have several publications on the topic of PICC lines, and are the specialty who know all about intravenous lines and infusion devices. Most of these organizations also have a government relations committee, or some kind of legislative agenda which could help you with the requirements for your state.
Good luck.
Nurse Nancy |
