April 29, 2005
Dear Nurse Nancy,
I work in a small nursing department for Radiology. I have a male co-worker who refuses to do some procedures with children and females such as follow-up calls in the Breast Care Center which causes a lot more work on the two female nurses. What is the scope of practice for male nurses? Is it different than females, because I know I don't have a choice when I have a male patient who needs care in sensitive areas. I thought all nurses worked in a professional manner. Could you please help. Thanks
DK
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Dear DK,
Of course there is not a separate scope of practice for our male colleagues. I agree with you that if there are 3 nurses working there, all of you should do all of the procedures, unless a patient is uncomfortable with him as her nurse. (This has not been my experience at all, actually).
Perhaps you should have a meeting with all of your colleagues, including your supervisor, and discuss this issue. His role needs to be clarified, and if he needs some education to deal with the issues with which he is uncomfortable, that needs to be done. I agree it is unfair for the work to be divided by gender.
Nurse Nancy April 28, 2005
Dear Nurse Nancy,
I'm a new nurse and work in a private clinic. There is a "nurse" who has worked for the clinic for over 20 years. She identifies herself as a nurse. Everyone in the clinic calls her Dr. S’s "nurse" I was talking to her about how nursing school has changed from when she attended to now. During the conversation she stated that she never took the NCLEX. I had brought this to the nurse manager’s attention and since then, the "nurse" has started writing GVN behind her name. I don't believe this is correct and fraudulent. Is this "nurse" correct by addressing herself as "nurse" or is GVN acceptable after graduating nursing school over 18 years ago?
EF
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Dear EF,
You can check with your State Board of Nursing if this is correct, but it seems to me if she completed school, she is a graduate nurse and the title is not fraudulent. My concern would be where and what she is documenting, and if your state requires a co-signature.
I agree with you that there are many people out there who call themselves “nurses”, many of whom have no nursing education. This is where it is important for all of us clarify who we are, introduce ourselves as a Registered Nurse, and wear your school pin and your ID which informs your patients of your title. Be sure to tell your patients your title, RN, LPN, LVN, and so forth.
Nurse Nancy April 27, 2005
Dear Nurse Nancy,
I am a RN with 10 years experience in long term care on the sub acute units, both as a staff nurse and as a manager. I am interested in returning to hospital nursing. Are my job prospects harmed by the last 10 years in long-term care? Do hospitals acknowledge LTC experience?
TAS
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Dear TAS,
Like everything in nursing, I imagine that some hospitals do acknowledge it, and some don’t. I think it is a great asset, as you have many transferable skills that you would bring to a hospital position, and I would approach your transition as a positive one.
As our population grows older, and we have more and more elderly patients in hospitals, I think you bring much to a hospital position. Good luck to you.
Nurse Nancy April 26, 2005
Dear Nurse Nancy,
I am an RN working in a long-term care facility. I was recently called to a resident’s room who was having some pain in his left arm. There was a physician present. The nurse in the room told me that the resident had these symptoms before, and that he needed a nitroglycerin sub lingual.
I went and got the nitro, and gave it to the patient. I was later terminated because there was no order for the nitroglycerin. Can my license be revoked because I followed another nurse’s request?
WS
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Dear WS,
I am sorry that your position was terminated for a medication error. I think that is the wrong message to nurses – in my opinion it leads to less reporting of errors based on the nurses’ fear. We all make errors and it is very important to document them, not only for patient safety, but also for organizations to track practice issues and see what improvements can be made.
The lesson here for all nurses reading this is to follow those 5 R’s you learned in nursing school – right patient, time, route, medication and dose. This is a major emphasis of the Joint Commission of Healthcare Organizations, as part of the National Patient Safety Goals.
Even in an emergency, you need to check. As for having your license revoked, I can not imagine any agency doing that over a medication error. I know you learned a valuable lesson here, and I thank you for sharing it.
Nurse Nancy April 25, 2005
Dear Nurse Nancy,
I will be finishing nursing school with an ADN in May 2005. I am really looking forward to it. For the past two years I've work in a local clinic that is run by a CRNP and I really love my job. I do not hold a degree of any kind right now but I get to do a number of things like labs, wound care and vital signs. But my heart is set on the ER. My problem is that I don't want to leave the job I'm at but I don’t know if they will be able to pay what I feel my degree is worth. I would really like to go on and become a CRNP myself someday. Should I stay where I am or go to work at a hospital? The NP I work with has been a great teacher and has been really good to me. I've really learned a lot. I thought about working two days a week at a hospital then three at the clinic but I'm worried about doing to much and causing early burn out. So what should I do? Follow my dream of the ER or stay where I already feel at home?
CJ
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Dear CJ
Staying in your comfort zone won’t help you get to that goal. You need to learn how to practice as an RN, time management and critical thinking. By working on a med surg unit, you will be gaining experience in all of those things, as well as emergencies, codes, and so forth. ER nurses have to know so much, and quickly – the pace is incredibly fast, as you well know. You will get there….and good luck with your dream.
Nurse Nancy
April 22, 2005
Dear Nurse Nancy,
I am a RN, BSN since 1996. Due to family situations, I had left the hospital setting in 1999. Then I worked in a clinic setting for less than two years. And for the past two years, I stayed at home full time to care for my son with a medical problem. I am looking to going back to work. How do I find a good refresher course? Also, I am interested in Case management, but I don't have any experience in this area at all. What do I need to do in order to get my foot in the door? Is there any way to get into this area with no experience?
Thank you very much for your time.
LM
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Dear LM,
First of all, welcome back to nursing. I would encourage you to look into local community colleges, or the web page of your State Nurses Association for refresher courses in your area. Also nurse recruiters in your area will know good refresher courses, as they hire nurses who have been through them. As for case management, most have recent clinical and home care experience. In your situation, your home care experience is first hand, so I would highlight that in your resume. I imagine you have experience navigating the health care system as a parent.
Have someone review you resume so that you emphasize your strengths. Good luck!
Nurse Nancy
April 21, 2005
Dear Nurse Nancy,
I graduated from nursing school last summer and have been working for 6 months. I am somewhat disappointed so far. I don't feel like a nurse. I feel like I need to go back to school for time management lessons. I used to think that being a nurse was about taking care of people. I'm seeing now, that we don't have time to "take care" of people. When we go into work there are certain things that need to be done in a certain amount of time regardless to what ever else is going on ... including having a regular patient load, then a discharge, then an admission, this one needs blood, this one is going to surgery, that one's family is upset about something, a doctor wants you to assist a procedure, etc, etc...and don't forget to chart all of that! All the while hoping that nobody will ask a question to slow me down further.
t's just not like I thought it was going to be. I don't feel like I'm doing anyone any good. I feel like I could do just as well in a factory on an assembly line. How do I get past this feeling? Is this normal? And if so what can I do about it?
Thanks,
JC
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Dear JC,
I think what you are describing is very normal, and that you are overwhelmed. It is difficult to work as a staff nurse, and time management is critical to your success. I believe this passes with time. The more admissions, discharges, etc. you do, the better you will be at managing your time and multitasking. All you can do is your best effort. I hope you still don’t feel like you work on an assembly line; your work is important and I hope your patients bring you some professional satisfaction and joy. Good luck!
Nurse Nancy April 20, 2005
Dear Nurse Nancy,
I am an LPN who works in substance abuse treatment and would like to know where I can get certified in addictions. Thanks.
GM
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Dear GM,
This is a growing field, and I am glad that you are interested in obtaining certification in this specialty. There are several levels of certifications, and you can read about them on the website of the National Association for Addictions – their website is www.naadac.org. Good luck!
Nurse Nancy April 14, 2005
Dear Nurse Nancy,
I work in an oncology unit 7pm-7am .We usually get 8 patients. Several times the patient & family will complain about their needs not being met immediately. Our patients are so sick & require close care. Is this assignment too heavy?
DG
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Dear DG,
I know oncology nursing is stressful, and that you work hard to make people comfortable while they are in your care. I am not sure if 8 patients are too many; many things go into that decision. I wonder about resources, do you have what you need, or do you need to spend valuable time going to the pharmacy, other places, etc.? How helpful are your nursing assistants? Do you use an acuity system to measure patient acuity?
In many cases, as you well know, families are frantic as they feel hopeless to help their loved ones, and sometimes take it out on the staff. I think if they know you are doing your best, and try to utilize others who can help your patients and their families – volunteers, chaplains, and so forth – it may help. Also, acknowledging to the families how difficult this is might reduce their demands. Work as a team with the patient and family; let them see you are doing your level best, which is all you can do.
And thank you for all the kindnesses I know you show to your patients.
Nurse Nancy April 13, 2005
Dear Nurse Nancy,
I am an associate degree nurse having worked full time for 20 years in adult and neonatal ICU when I decided to go back to school for a B.S. in community health; working part-time for doctor's offices. It has been close to 5 years and still have 6 courses to complete which would take a full two years since they are offered only every other year.
I feel I made a mistake in choosing the institute I did. The format of the program has changed twice since I first interviewed the program director. I am no longer interested in completing the program. I realized during this time that my passion is still in neonatal ICU and would like to return to the hospital setting. How can I make the best of this situation? What should I say in my cover letters and interviews? I am taking an RN refresher course in two months.
MM
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Dear MM,
Having earned my BSN over 5 ½ years, I know the struggle you are going through in trying to finish. It is difficult, but if you are looking for the “best of the situation”, I would suggest you try to finish school (it is always my bias) as two years is not that long, and will go by quickly, I promise. Just bite the proverbial bullet and get it over with – you will be happy with yourself when you are done.
Can you work part time while you are taking courses? This will give you a chance to get back into the workforce, and experienced critical care nurses are in demand just about everywhere.
I hope you can manage both. The time does fly by, even though you think it is forever. I wish you the best. Good luck!
Nurse Nancy
April 12, 2005
Dear Nurse Nancy,
I have been a pediatric ICU nurse for 2 1/2 years and work for a very large & reputable hospital. I have never been called into my nurse manager's office nor have I ever been disciplined for anything. So you can imagine my shock when I was called into her office last week and told that I was immediately terminated for "falsifying my timecard." She stated that she had been told that I had been exceptionally late one day, and had put a different time on my timecard. I told her that was absolutely not true, and that I could prove it.
After listening to my explanation she stated that she had already started the termination process, and that she would have to call Human Resources to reverse it. How can I protect myself from these false allegations? Shouldn't she have called me in prior to taking action and given me a chance to explain? Or asked the day nurse that I was relieving what time I had arrived? After our meeting they called the day nurse in and she confirmed that I had arrived on time. This action was all done on hear say. I believe it was the job of a new over zealous Charge Nurse on our unit. I have three witnesses confirming that I was there on time. What can I do?
NC
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Dear NC,
What a story! Your manager needs to go back to People Skills 101, and spend some time with her Human Resources professionals…..you really can’t treat staff that way. Even if you had been late, this is a great example of how not to handle a problem.
I am hopeful that by the time you read this, this situation is all settled. I have learned over the years to work with Human Resources, and never do anything as drastic as terminating an employee in isolation. They know about labor laws, regulations we may not know about….we need to work together on issues such as this.
Your manager has a lot to learn, and I hope that she not only apologized to you for mishandling this situation, but also learned from it.
Nurse Nancy April 11, 2005
Dear Nurse Nancy,
Do you know what’s in the future of nursing educators?
MK
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Dear MK,
Well I don’t have a crystal ball, but I would say it is a great time for nursing educators, as programs are springing up with the nursing shortage. All the creative ways to get second degree people into nursing have a way of needing faculty, and hopefully we will be seeing more programs to prepare nurses interested in teaching.
Nurse Nancy April 8, 2005
Dear Nurse Nancy,
Our unit is experiencing difficulties with a nurse manager who plays favorites, a "tattle-tale" environment with one of our co-workers (a personal pet), unresponsive to concerns of staff members, talking about staff health issues without asking permission first, it goes on and on. Morale is at the lowest point in three years. HELP! What can we do?
TP
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Dear TP,
The most serious of your allegations in that list is the nurse manager is talking about staff health issues without their permission. I would talk to him/her directly about this, as this is a HIPPA violation and needs to stop right now. (and if it doesn’t, I would seriously call your Corporate Compliance Officer, as the organization could be seriously fined for this manager’s indiscretions)
As for the other issues, I wonder if you as a group could meet with the manager and share your concerns. It can’t be fun to work in a place like that, and I would encourage you to tell him/her before everyone leaves at once. Give him/her a chance to make some improvements, and then if it does not change, speak with her supervisor. Try to have objective examples, and facts, not emotions about the unit. (avoid terms like “tattle-tale” and “pet”…..give examples in a calm, professional manner).
If all else fails, I suggest you think seriously about another unit, as this manager has a lot to learn.
Nurse Nancy April 7, 2005
Dear Nurse Nancy,
I've been a NICU nurse for 6 1/2 years. I love it, but I need a change. I'm thinking about doing something non-hospital for a while. How do I make the transition with only my NICU experience?
KW
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Dear KW,
This is interesting to me, as so many nurses are trying to get into NICU’s! And here you want out. That is the way it is in nursing. I think you are smart to leave and do something else; hopefully you can always go back.
As to the transition, I think you should be able to sell yourself easily. Your skills will transfer into an ambulatory setting, or a physician’s office. See what is out there. People will understand that you want to do something different. Look around, see what’s out there. Good luck!
Nurse Nancy April 6, 2005
Dear Nurse Nancy,
I work on a on a Step-down unit and have recently cared for a patient whose family members are overly controlling of her care. They have gone so far as to write a list of nurses that they approve to care for their loved one, and gave this list to the Nursing Director. The hospital administration has approved that list, and I am the only nurse from my shift who is on the list. I've never refused a patient assignment before, but I am very uncomfortable and feel like this family is just looking for a reason to sue. I also feel like the hospital administration has put me in a very compromised situation and has no faith in them to back up the nursing staff. It also appears that the patient could be here for a very long time, so the problem isn't going away. What actions can I take, other than speaking to my superiors who have been less than helpful? Any advice would be greatly appreciated.
KM
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Dear KM,
This is a difficult situation, and it all revolves around trust, it seems to me. The family is hyper vigilant because they don’t trust the staff, and in attempt to appease them, your administration is giving in to their demands. I have seen similar situations, and what has been helpful has been a family meeting, including the key players to see how you can work this out. A skilled social worker or chaplain might be able to facilitate the meeting so that both the staff and the family are comfortable.
Perhaps a list of the patient’s routines, likes and dislikes, posted in the patient’s room might help. Anything you can think of that can help dissipate some the anxiety should help.
I know this is easier said than done, but I bet if you do this, you will slowly win them over. I wish you the best.
Nurse Nancy April 5, 2005
Dear Nurse Nancy,
I have read so much in regards to the nursing shortage, but there seems to be few refresher courses to take for reentry into nursing. I am frustrated and needing some advice. Where should I start if I choose hands on nursing again? I feel insecure. I live in Illinois. Should I be given the chance to have a hands-on experience? I will be forth right in stating I will need updates, this should help, if I am given a chance. Thanks for listening.
ND
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Dear ND,
If you have been reading about the nursing shortage, then you are aware that there is also a shortage of nursing faculty. Many community colleges have started to offer refresher courses, and I imagine as the shortage gets worse this will increase. Look in your local area and if they don’t have one, call them to see if they know who does.
You are correct to be concerned that you need a refresher. Welcome back!
Nurse Nancy April 4, 2005
Dear Nurse Nancy,
I would like some guidance, please!
I have been in nursing management for the past 7 years. I will be going through In Vitro Fertilization and I have just moved to another state. Would it be a poor career move to go back to staff nursing on a part time basis or look for a part time supervisory position?
SW
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Dear SW,
I think your plan is excellent. The great thing about nursing is that it allows you to make so many changes and tend to your personal situation. Anyone reviewing your resume would understand this is a good choice, as doing something part time will allow you to have the time to go through the IFV.
Good luck in both areas…
Nurse Nancy April 1, 2005
Dear Nurse Nancy,
I graduated in 1985 with a BSN and worked for 7 years in Labor & Delivery. I am trying to re-enter the field without much success. I looked up refresher courses but still not much success in finding employment without recent experience. Any suggestions for those of us who took a break to take care of our own families?
CF
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Dear CF,
I think as the nursing shortage increases, we will see more courses offered for returning nurses such as you. I would suggest that you look at your state Board of Nursing, as they approve refresher courses. Of course, we have that list of Boards of Nursing all ready for you at NurseWeek.com – click on this link: http://www.nurseweek.com/career/boards.asp, and you can find out your state’s email address and phone number.
Keep looking, as I see more and more of these programs being offered. Nursing is a mobile profession, and taking time off to raise one’s family is certainly a norm among many of our colleagues. I wish you well in your search, and welcome back!
Nurse Nancy
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