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April 28, 2003
Dear Nurse Nancy,
I work in an outpatient surgical center as a registered
nurse. One of the doctors is doing pain management (epidural
injection) and asks the nurses to give Propofol IV push.
This is a short acting IV anesthetic, and I am not comfortable
doing this. Can I do this? If not, can you help me to
figure out the best way to refuse? Thanks.
LR
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Dear LR,
This issue is a hot topic for JCAHO. What we formerly
called conscious sedation is now called Sedation/Analgesia,
and the standards are based on guidelines established
by the Anesthesia Society of America. There are now
four stages of sedation, from reducing anxiety to general
anesthesia. In the interest of patient safety, in order
to administer these drugs, both credentialing and documentation
are required. The intent of the standard is to provide
the same level of care for the patient, regardless of
the practice setting.
And speaking of practice, you might check your nurse
practice act to see if this is addressed. We list all
of the state boards of nursing on our website under
Professional
Growth.
.
Nurse Nancy
April 24, 2003
Dear Nurse Nancy,
I was recently fired from my job. Do I have to tell
this to my new employer, or is there anyway he can find
out? No harm was done to a patient, nor was there a
medication error.
CD
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Dear CD,
It may sound like a cliché, but honesty is the
best policy. The world of nursing is very small, and
my guess is that yes, your new boss will find out the
truth. This happens all the time in nursing - and in
life, for that matter. I would think your new potential
employer would be impressed with your honesty (I would
be!) and would be willing to give you a second chance.
The worst case scenario would be if he found out from
someone else…and there is a good possibility of
that happening.
There are always two sides to every story. I would
be honest about this, not defensive. Hopefully there
is a lesson to learn here. Good luck in your new position
and if you are still looking visit our Career
Resources seciton for current job listings, resume
builders and other professional growth information.
Have a great holiday weekend!
Nurse Nancy
April 17, 2003
Dear Nurse Nancy.
I have just relocated back to the USA after almost
twenty years abroad. I was (and still am) an RN. I am
having trouble finding out how to go about getting my
RN status reinstated in the States. Do you have any
suggestions? Thanks very much.
HP
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Dear HP,
Well, welcome home! I am sure you will find many differences
in nursing since you were here 20 years ago. Click the
NurseWeek.com link which lists all of the State
Boards of Nursing; this will direct you to the licensing
organization in your state. Also check out our other
helpful Career
Resources to help you effectively re-enter the US
nursing workforce.
Good luck!
Nurse Nancy
April 16, 2003
Dear Nurse Nancy,
I find in every clinical job I have that I am beaten
down by the negativity of the other staff: backstabbing,
gossip, complaints about other workers, etc. I made
a vow to stay out of the politics and nay saying when
I took this job, but the negativity starts from the
minute I walk through the door. It is like that everywhere
I work. How do I stay in nursing and stay out of the
negativity?
AT
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Dear AT,
Yours is a way too familiar complaint. I can only say
to the experienced staff out there…READ these words.
New nurses need comforting and nurturing……not
negativity and disrespect.
We all have an obligation to speak well of the profession,
to encourage and help our new colleagues. It makes working
so difficult when the environment is negative…just
think how quickly you can turn that around and make
it positive! It is up to each one of us to do this.
Sincerely,
Nurse Nancy
April 11, 2003
Dear Nurse Nancy,
I am an RN with a BSN and 28 years of experience.
I want to go to graduate school to point my direction
to higher positions. I float among MedSurg, OB-GYN,
Nursery, Telemetry, Adult Medical ICU and SNF. I have
certification in Med Surg from ANCC.
I want a position where I can utilize my experience
the most. What is the most suitable degree I should
focus on?
JM
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Dear JM,
What a great resume you already have! You must be very
flexible to float to all those specialties. The type
of degree you get depends on which direction you want
to take - management, education, clinical specialist,
or perhaps nurse practitioner.
My advice would be to go speak to a recruiter (office
of admission, cousellors, or other they may not use
recruiters check that) in a School of Nursing that offers
a variety of master's degrees. Recruiters have a talent
of matching the individual with the right career path.
And for many of the degrees, the core courses are the
same, with tracks for the different specialties. This
allows you to take some time and see what else is out
there, and to talk to students and faculty who can help
you along the way in your decision.
For information on Nursing Schools visit our comprehensive
school search.
Whatever you do, you have a great background, and I
know you will be very marketable. Good luck!
Have a good weekend,
Nurse Nancy
April 9, 2003
Dear Nurse Nancy,
I am an RN and I work on a med/surg unit. I just
recently graduated from school in May 2002. On this
unit, they are asking staff nurses to mark the surgical
sites on our patients before they go to surgery. I don't
feel comfortable marking these sites. Shouldn't the
OR nurses and the surgeon have to do this?
RC
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Dear RC,
The OR nurses and the surgeon are most likely also
asking the patient this prior to surgery. There is a
great deal of concern about being sure that the surgeon
operates on the correct knee, eye, hand, and so forth.
There have been errors made, which make the patient
have needless surgery, go through all the stress of
anesthesia, surgery, etc.
Regulatory agencies, such as the Joint
Commission for Accreditation of Healthcare Organizations
(JCAHO) require hospitals and ambulatory surgical
centers to have a process in place to prevent errors
such as wrong-site surgery. Also check our Web site's
listings of other
health care regulatory sites. It appears that in
your institution, they have added another step for safety
by asking staff nurses to participate. This is good
thing. Be happy to participate in this.
Sincerely,
Nurse Nancy
April 8, 2003
Dear Nurse Nancy,
I am an Ortho/Neuro nurse with 17 years experience.
I would like to change my work setting from the hospital
to informatics nursing. Do you know what the future
is for this kind of job? What is the educational preparation?
I am willing to go back to school.
BS
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Dear BS,
I feel that the future of nursing informatics is excellent.
As the technology we use grows, there will always be
a place for nurses, as our role is critical in the design
and operation of computers.
As for educational preparation, I would encourage you
to speak to other nurses working in this field. All
of the nurses I know who do this have a master's degree,
which prepares you for the role in terms of writing
skills, presentation skills, working with groups, etc.
Many schools of nursing offer a masters in nursing informatics,
so you might want to look for that.
Networking is always the best way to get started. There
is an organization for nurses interested in informatics,
ANIA
(American Nursing Informatics Association). You can
find out about this specialty in nursing along with
other associations, state boards of nursing, healthcare
sites, and patient referral service on our Web site,
click
here.
Thanks for your question,
Nurse Nancy
April 7, 2003
Dear Nurse Nancy,
I work in a busy L & D unit. Last week one of
the nurses on our unit was found to be under the influence
of drugs. She was removed from the floor and taken to
the ED. Supposedly they found drugs in her locker, and
that they were taken from the floor. What happens to
her from here? What could we have done as her coworkers
if we had suspected but not known for sure?
LN
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Dear LN,
Diversion of narcotics is unfortunately something that
happens in nursing. Substance abuse is in our society,
and as nurses we are not exempt. Your hospital did the
right thing when this is discovered - remove her from
the clinical setting, get her immediate help, and hopefully
work with her to get into a rehab program.
Your question is excellent in that you are asking for
the warning signs….and they are there. In a busy
unit, you probably have to waste narcotics often. I
have seen nurses say to a colleague…"I just
wasted this, will you sign as a witness?" This
is a red flag to me. No matter how busy you are….get
a witness and have someone WATCH you waste the drug.
Most nurses don't realize this is a federal law and
we as professionals need to respect that. While some
see counting at the change of shift (if you don't have
a computerized system for narcotics) as a chore, you
should vary who counts; an impaired nurse will have
an opportunity to "cover up" if he or she
counts all the time.
Another sign is keeping the keys. Nurses who divert
drugs often volunteer to be in charge and keep the keys.
And they generally have excellent attendance, since
you have to be at work to divert the drugs.
What happens next depends on due process. Is this the
first time? Multiple times? It must be reported to the
Board of Nursing, and often nurses volunteer to surrender
their license until such time that they can go back.
Sometimes they can't. Your colleague is lucky to have
such a caring coworker on her side.
Thanks,
Nurse Nancy
April 4, 2003
Dear Nurse Nancy,
I am currently going through a BSN program through
night and weekend college. While scouting the job market,
I see that graduate nurses are not making very much
money. In my town, LPNs are making $21.00 an hour with
one year of experience, but BSN's are making only $15.00
- 16.00 an hour. I find it very odd that BSN's are not
making so much less than a one year LPN. Any thoughts
on this?
SB
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Dear SB,
You didn't tell me where you are from, so I can't comment
on the salary disparity for your area. I do agree, however,
that it does not make sense. In terms of educational
preparation, scope of practice and responsibilities,
BSNs certainly should get paid more. And in fact, they
do in every place I know of.
According to the Department of Labor (www.dol.gov)
here are the statistics on salaries for LPNs and RNs
nation wide….
LPN Median Salary $35,028
Salary Range $33,523 - $38, 145
RN Median Salary $45,066
Salary Range $44,949 - $48,047
These are base salaries, so one would add experience
differential, education level, etc. to this. I would
go and speak to a Nurse Recruiter in your area to see
your potential salary range or take a look at the NurseWeek.com
Salary Wizard…….and good luck finishing
school!
Have a good weekend,
Nurse Nancy
April 3, 2003
Dear Nurse Nancy,
I am a new graduate on a busy medical unit. My assignment
is heavy, and I have up to 10 patients under my care
daily. I have to give so many medications that I am
afraid I am going to make a medication error. I know
the 5 Rights and try to respect them, but I am terrified
I will make a mistake. Do you ever get used to giving
these many medications?
PW
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Dear PW,
The transition from a nursing student to a new nurse
is a tough one. And yes, giving all those medications
can be overwhelming. I have some practical advice for
you; I hope it helps. This is really about common sense.
Most errors are made when you are in a hurry or tired.
Here is a short list to help you:
1. Get enough sleep before your shift.
2. ALWAYS check the patient's armband.
3. Ask the patient to tell you his name - never say
"Are you Mrs. Jones"?
4. Bring the med cart to the patient's room and open
the meds right before you give them.
5. Never do things in a hurry. When you are in a hurry
is when you will take shortcuts and make a mistake.
6. Take a break. No matter how busy you are, you need
a little down time to clear your head. It is time well
spent.
I wish you well in your new career. I promise - it
gets easier.
Sincerely,
Nurse Nancy
April 2, 2003
Dear Nurse Nancy,
I am an RN with an associate's degree, and am thinking
about going to Medical School. What do I need to do?
Are there schools that consider RNs as non traditional
entrants?
MM
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Dear MM,
Medical education is very different from nursing education.
It is much more standard, in that you have to not only
have a minimal of a Baccalaureate degree, but you also
have to have certain sciences completed, more than nursing
requires.
What you would have to do is complete a Bachelor's
degree program, take as many sciences as you can, and
do really well to get into medical school. You also
have to score high on a standardized test, the M-CATS,
which every potential medical student has to take. Being
a nurse will help once you get there, as you will be
familiar with many of the classes required (Anatomy,
Physiology, etc.) but I believe the competition is still
challenging to get in.
Click
here to see our Nursing School listings.
But if this is what you want - go for it. Happy Studying!
Sincerely,
Nurse Nancy
April 1, 2003
Dear Nurse Nancy,
I have worked in a critical care unit for many years,
and have thought about transferring to the Emergency
Department. I keep reading about Violence in the Workplace,
and have some concern about my personal safety. I don't
live in an urban city area, but I am still worried.
Is it safe to work in the ED?
MB
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