May 31, 2005
Dear Nurse Nancy,
Why would a nurse want to become a SANE nurse?
AM
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Dear AM,
SANE nurses (SANE stands for Sexual Assault Nurse Examiner) provide a wonderful service. They work in hospital Emergency Departments, District Attorney offices, Rape Crisis Centers. They are educated in handling evidence, collecting specimens needed for court, and even going to court themselves with the victims of rape. There are two organizations you can go to find out more information about SANE certification. One is the American Forensic Nurses; the other is the International Association of Forensic Nurses.
Generally, nurses have some Emergency Department experience and develop an interest in these patients. They provide a great service.
Nurse Nancy May 27, 2005
Dear Nurse Nancy,
As a nurse, what is the correct way to document pain?
MM
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Dear MM,
Documentation of pain should record the patient’s assessment of his pain, what was done about it, and a reassessment of what the patient feels after an intervention. There are many scales out there, but for adults, we generally use the 0-10 scale (0 is no pain, 10 is the worst pain you’ve ever experienced). We also use the Wong-Baker Faces scale, which is a series of faces from a happy face to a tearful one. This is used for children, for elderly patients, for people for whom English is not their first language, for developmentally delayed individuals, and aphasic individuals. Both are valid and reliable tools to use. With younger children and babies, there are other scales – the FLACC, the CRIES, the Oucher.
The other issue to document is the patient’s establishment of a pain goal. Some cancer patients are comfortable at 2 or 3, as they are used to having so much more pain.
Nurse Nancy May 26, 2005
Dear Nurse Nancy,
I am applying for a shift manager position on a 43 bed floor at an acute care hospital. Do you have any idea what kinds of questions they may ask at the interview which will be in front of administrators?
NN
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Dear NN,
I would imagine they are interested in your management style, may ask for examples of such things as how you handled a crisis, what your experience is with difficult employees, and so forth. For example, they might ask you what you would do if an employee came to work and was clearly impaired from alcohol. (Always think of the patient’s safety. You would take the employee out of the clinical setting, get him help in your ED, and not allow him to work that day) They might also ask you about quality issues, how you could reduce the length of stay on that unit, and so forth.
If you don’t know an answer, say so – don’t try to make it up. And go prepared with some questions yourself. And you know the drill – dress professionally, follow up with a thank you to the person in charge, never badmouth a former employee in an interview. Good luck!
Nurse Nancy May 25, 2005
Dear Nurse Nancy,
How does one find out what universities, colleges and nursing schools pass rates are for the NCLEX?
HK
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Dear HK,
Most schools publish their NCLEX passing grade as a matter of marketing. If you have any specific school of nursing in mind, call them up and ask to speak to the recruiter about this. They may not publish on the website if not 100%, but they will know the number.
Nurse Nancy May 24, 2005
Dear Nurse Nancy,
I graduated from a registered nursing program in Canada in 1990. I worked for 4 and a half years. I then had a head on collision accident resulting in long term chronic pain (Fibromyalgia) It is now 2005 and I am currently in Florida. I would like to take a reentry program while I am residing here. I really miss nursing.
I came to Florida because of the climate and the positive affects on my condition. I would really like to get back into nursing even if it is on part time basis. I am wondering if they hire nurses in a Dr's office setting. Any response would be appreciated. Thank-you in advance.
EI
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Dear EI,
I am glad the warm Florida sunshine is helping your fibromyalgia. Physicians’ offices may hire nurses; you just have to look at several of them, as many are hiring medical assistants to do some of the work registered nurses used to do. You will have to be licensed with the Florida State Board of Nursing. To go there, click on the State Boards of Nursing.
Once you get to that site, they likely will know facilities in Florida offering refresher courses. Generally, the community colleges offer this; I would look there first.
Good luck in your new (warm) life!
Nurse Nancy May 23, 2005
Dear Nurse Nancy,
We work in the Emergency Department of a small specialty hospital. We have occasions where we do not have patients in the department at shift change. Management is now asking that we clock out 30 minutes early, once the new shift has arrived, when we do not have any patients in the department. That can add up to 3 hours in a two week pay period! Can they do that?
KR
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Dear KR,
It seems to me that the purpose of the 30 minute overlap is for report. If you have nothing to report, should you be paid to do nothing? Perhaps you can offer Management an alternative to that time – staff meetings, quality improvement projects, some educational offerings – self directed learning. I know in New York City, the ED nurses need 50 hours of continuing education to maintain the 911 status. Perhaps you can think of things that might benefit the staff and ultimately your patients.
Nurse Nancy May 20, 2005
Dear Nurse Nancy,
I have been called in by the State Board related to a complaint against my “nursing practice." Do I need an attorney before talking to them? The complaint was from a former employer, for a medication error.
MS
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Dear MS,
While I am not an attorney, nor do I give legal advice, I think it would be in your best interest to speak to an attorney who specializes in this area for advice. You can find them in the newsletters of State Nurses Associations or specialty organizations. Many are RNs themselves, so they know both sides of the issues. Good luck!
Nurse Nancy May 19, 2005
Dear Nurse Nancy,
I work for a urology clinic. I have a supervisor who is an X-ray tech only and thinks she is a nurse. She has no problems telling the doctors that I work for we can do anything they suggest, even if it might conflict with what the state says I can do. I like my job but I worked hard for my license. Any suggestions?
CC
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Dear CC,
This is troublesome, since X-Ray Techs are a different kind of professional, and do not know about professional nursing practice. If speaking to her about this issue has not been helpful, I would ask to speak to the chief nurse in charge of the organization who is responsible for nursing practice. Even if that person does not work with you, he or she will know the regulations and be able to discuss it with the X-ray tech. In the meantime, if you know something is wrong, just politely refuse to do it. Keep a record of what you are being asked to do, and by whom, so you will have the data to support your concern. Good luck!
Nurse Nancy
May 13, 2005
Dear Nurse Nancy,
Work is insisting that we all wear our name tags visibly. I sometimes don’t want my patients to know my first and last name. Why do we have to wear them?
EG
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Dear EG,
It is a patient’s right to know your name. If you are doing your job, you have nothing to worry about. I also think it is important for your patients to know that you are a registered professional nurse. Given that so many people are wearing scrubs and look alike, it is important for nurses to identify themselves.
Be proud to be an RN, and wear your ID so that your patients know you are an RN.
Nurse Nancy May 12, 2005
Dear Nurse Nancy,
I work in a cardiac cath lab, and one of the nurses who worked as a staff nurse for years was recently promoted to head nurse. She is bossing us around like crazy, and making demands which are not achievable. How can we remind her to remember what it was like to be staff?
DK
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Dear DK,
The transition to management is often a difficult one. If you have had a good relationship with this nurse, pull her aside and tell her privately and tell her how you feel. Hopefully she will listen and learn from your conversation.
Nurse Nancy May 11, 2005
Dear Nurse Nancy,
What do you think of nurses speaking out about the Terry Schiavo case? Don’t you think the public should be worried about nurses who “care and tell”?
MJ
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Dear MJ,
I think it is so unfortunate that the Terry Schiavo case was so public. We have sound bites and media related accounts of this very special woman. My only opinion is that we don’t have all the truth of this case, it is a private family matter and I am sorry for all involved – especially the other patients and families in the Hospice she was in.
The one good thing that I am hopeful that will come out of this is that the general public will consider filling out their own health care proxies. As a nurse – do you and your family have one? Please do complete them.
Nurse Nancy May 10, 2005
Dear Nurse Nancy,
I have been called to a deposition as a witness for something that happened to a patient many years ago. I don’t remember most of what happened. Please help – I am scared!
MMc
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Dear MMc,
I know being called to a deposition can be frightening. I have been deposed a few times. Your attorney will be with you, and he or she will coach you before you actually go to the deposition. The rules are fairly simple. Try not to get rattled. Tell the truth. If you don’t remember, say so. Answer the question, but don’t offer any other information. The other attorney will try to rattle you, but don’t let him/her. You need to be neutral, calm and confident. If you need a break, tell your attorney. They are there to help you, so follow their instructions.
While we are talking about depositions, it reminds me to tell our readers please remember that your notes are a legal document. Are yours clear, non judgmental and direct? Go take a look.
Nurse Nancy May 9, 2005
Dear Nurse Nancy,
I work as a Nursing Supervisor in a Primary Care setting. My clinics are in counties surrounding our main healthcare facility. As the facility continues to grow and evolve, we look at our staffing mix. At the present time, our clinics have providers (physicians and nurse practitioners) RNs, LPNs, and clerical positions.
What is the advantage of an RN in Primary Care Clinic?
CN
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Dear CN,
I know there must be pressure in your area to hire LPNs instead of RNs. While LPNs certainly are an important part of the health care team, they have not been taught the skills RNs have in terms of assessment, education, and planning care for patients in any setting.
I would suggest you look to the professional organization that represents ambulatory nursing, the American Academy of Ambulatory Care Nursing. I know you will find great information you might need to document the value of RNs in an ambulatory setting. There is also a certification in this specialty, and that of course adds value to your RN staff, as it represents national expertise from an outside agency, and speaks volumes to your patients.
Nurse Nancy May 6, 2005
Dear Nurse Nancy,
My nurse manager never makes a decision about giving us time off. If we ask for vacation or days off, he waits until the last minute to decide. We work in a clinic, and he has to arrange coverage, but even when we give him lots of lead time, he makes us wait. This is difficult with planning for us. What can we do?
AM
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Dear AM,
I can understand how tough this is when you want to plan time off. One solution I can think of is to ask him if you can do self scheduling on a monthly basis, with his approval as the final approval. Put together a plan in writing, with specific dates for each step (initial request, revisions, final approval to manager) and perhaps that would help the situation. Write down deadlines and hold all accountable – including your manager.
He might even be glad you initiated this, as time schedules are not the favorite task of most managers. I hope this helps.
Nurse Nancy May 5, 2005
Dear Nurse Nancy,
How do you become a cyber nurse, writing on the Internet? I have a lot of experience with Maternal Child Health and would love to do that.
CG
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Dear CG,
I would encourage you to publish and get your name out there in the literature. I think any organization looking for someone to write on the Internet would want someone who has a strong publication history. Also, networking always helps – become active in local MCH organizations and talk to people. I can tell you that is how I got this job with NurseWeek (and I love it!)
Given your MCH background, you might also look into parenting websites who might utilize your background and talent. Good luck!
Nurse Nancy May 4, 2005
Dear Nurse Nancy,
I have applied for many jobs online, and have heard nothing back from them. No contact, no follow up. This is annoying, as a few of them I was really interested in. Why is there no follow up?
TR
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Dear TR,
I agree with you that no follow up is annoying. I have found that even when you apply in person, interview with someone there is often still no follow up. I wonder sometimes if people are just too busy, have too many qualified applicants, and just simply don’t have the time for follow up. It doesn’t seem right, but it seems to be the practice.
Just keep plugging away. You’ll find that right job one of these days. Good luck!
Nurse Nancy May 3, 2005
Dear Nurse Nancy,
I have been called to jury duty, and asked my supervisor to write me a letter to be excused. She refused, saying I should go. Don’t you think nurses who take care of patients every day should be excused? I am too busy to go to jury duty. What do you think?
CA
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Dear CA,
I am with your supervisor on this one. I have been asked many times to write such a letter, but have never done it, as I think nurses are citizens and have a civic responsibility to participate in this process.
As Americans, we are privileged to have a jury of our peers. We should respect this right, and embrace it. I went last year and found it very interesting.
Nurse Nancy May 2, 2005
Dear Nurse Nancy,
I was recently searching the Internet and came across Nursing Informatics. I asked around and was told that they help out with the nursing documentation computer programs. What else do they do? Where would they work? Thanks.
MC
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Dear MC,
There are many opportunities for nurses with an informatics background. They not only work in documentation programs, but also work for companies who install computer systems for health care – staffing and scheduling, pharmacy interfaces, and project work to name a few.
There is an organization for nurses interested in this work. It is the American Nurses Informatics Association, and their web site is www.ania.org. Take a look at all of the opportunities for this specialty in nursing. Good luck.
Nurse Nancy
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