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June 30, 2003
Dear Nurse Nancy,
My state's Nurse Practice Act and our Medical Staff
Bylaws make it clear that only an RN or LPN can take
telephone and verbal orders, but I cannot find evidence
of laws stating from whom we can take them. We have
doctor's offices that have their medical assistants
or various other personnel call in orders to the inpatient
units, and we wish to only take these orders from physicians
and other licensed personnel. What do you think?
HA
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Dear HA,
I agree with you. I am reminded of the time years ago
when I went to a renowned ophthalmologist who told me
"his nurse" would give me a prescription for
glasses. When I went out to the desk, I asked "his
nurse," who was wearing a white uniform, where
she went to nursing school. She laughed as she wrote
out my prescription, signed his name, and told me she
was the receptionist, that it made the patients "feel"
better to think she was a nurse. I ripped up the prescription,
went back to his office, and made him write it again,
and told him what I thought of this illegal action.
We have to take a stand. I completely agree - only licensed
prescribers can call in a prescription.
If you don't take the order, the practice will stop.
I would invite the council of your Risk Management Department
in this issue. Wrong is wrong, and given the attention
the regulatory agencies are giving to medication errors,
this is a practice waiting for errors. This may not
be the popular answer, but you know it is right. Our
job is to do the right thing by the patient, bottom
line. I wish you courage!
Nurse Nancy
P.S. I switched ophthalmologists after that visit.
Vote with your feet!
June 25, 2003
Dear Nurse Nancy,
I work for an organization that told me when I was
hired that only 10-hour shifts were available. I work
four days a week. Whenever there is a holiday, we are
only paid for eight hours and are required to use two
hours personal or vacation time or work two additional
hours another day during the week. Two hours without
pay is not an option.
Additionally, we lose pay for the holiday, because we
are not paid shift differential. What is your opinion
of this practice?
CY
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Dear CY,
This is the practice of every organization I have ever
worked for that has 8-, 10- and 12-hour shifts. The
bookkeeping becomes unwieldy if you have to do holidays
in three levels. In addition, most nurses I know would
be very upset if you didn't pay them - or provide a
mechanism to pay them - for those two hours.
The shift differential is generally paid when you work
the holiday, not when you don't.
Hope you find this helpful.
Nurse Nancy
June 24, 2003
Dear Nurse Nancy,
I am a BSN with 28 years of experience
in OB/GYN, Pediatrics, Public Health and Community Nursing.
I would like to utilize my degree for health education
for young adults and the community. I am interested
in motivational speaking with an emphasis on wellness,
using humor and real life stories.
I will be graduating with my master's in counseling
in 2005. I plan to incorporate this knowledge with my
nursing background to be an excellent speaker and writer.
Do you think I am qualified to teach in college?
ECB
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Dear ECB,
I think you have a great background, with lots of experience,
and that many organizations would love to have you to
be part of them. If you want to be a motivational speaker,
prepare yourself: Get business cards, and carry them
everywhere, advertising what you can speak about. You
might need to volunteer at first, at church groups,
youth groups, high schools, job fairs. This is a great
beginning as you hone your craft as a speaker.
Also, develop a brochure advertising what you can speak
on. Send it with a cover letter to any group that you
think might benefit from your great experience. Publishing
is not as difficult as you might think. Think of topics
you are experienced in, send a letter to the editor
of journals, youth groups, and faith based groups, and
so forth; offer to share what you know. You are selling
yourself, so go for it. This all builds your resume,
and by the time you complete your master's, I think
you just might be ready to teach.
I love your entrepreneurial spirit and support you.
Good luck!
Nurse Nancy
June 20, 2003
Dear Nurse Nancy,
I am looking for greener pastures in terms of learning
opportunities, better benefits and pay, and a nice working
environment. Do you have any idea where I might find
that in a hospital in southern California?
MX
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Dear MX,
Wow - what a job environment! We at NurseWeek.com aim
to be your resource in looking for a new position and
a great career. We have a link on our website that allows
you to look at many great hospitals, state by state.
Here is the place to start to find your greener pastures
is at the NurseWeek.com Facility
& Agency Profiles Page. I hope you find what
you are looking for! Best of luck to you.
Nurse Nancy
June 19, 2003
Dear Nurse Nancy,
I am being forced to precept a graduate nurse who
worked with me while she was a student nurse. From my
experiences with her, I do not think this person is
safe. I have been told that I cannot be held responsible
for any errors the GN makes, but I am extremely uncomfortable
with this situation. Help!
PA
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Dear PA,
As I read your letter, I was thinking, "Gee, we
are all new at some point and need the guidance of our
seasoned colleagues." I would think that all new
graduate nurses need our help and assistance. As far
as "unsafe" - document what your colleague
is doing. Be objective, be fair. Are you asking too
much of her? All I ask is that you give her a chance.
Keep careful notes on what your new GN is doing; what
you think is unsafe may not be exactly that.
Remember, we are all new at one point. How many of
us graduate and hit the ground running? If she is unsafe,
of course you have a responsibility to do no harm to
your patients. Give her a chance. If indeed she is unsafe,
have the data to support that, tell your nurse manager,
and let him or her worry about that.
I thank you and all others who precept new grads. I
know it makes extra work for you, but in the end, you
have a competent colleague who can help you. Let's not
"eat our young"; let's help them learn.
Nurse Nancy
June 18, 2003
Dear Nurse Nancy,
What can be done to educate nurses at conferences
and job fairs to stop taking all the freebies and listen
to the vendors? I find it so embarrassing to go to some
of these, as so many nurses just take the free stuff
and don't even stop for a minute to listen to the person.
I mean, how many pens do we all need?
AJ
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Dear AJ,
Amen to AJ! I agree with you 100%; I am often embarrassed
at the behavior of some of our colleagues at professional
meetings and job fairs. I once had a poster that was
a game, with pieces on a game board, and I had to run
down the aisle reminding my colleagues that they were
not freebies, but part of my poster! After doing this
five or six times, I just glued the pieces to the board.
I suppose it is human nature to get something for nothing,
but I agree - how many pens and Post-it ® notes
can we all use? Some organizations discourage vendors
from giving away these freebies and to just put that
money toward nursing education.
The bottom line to me is to thank those vendors and
recruiters for coming to your meeting/job fair. They
represent companies that support nursing, and deserve
your polite attention for at least a few minutes. We
all need to do this.
Nurse Nancy
June 17, 2003
Dear Nurse Nancy,
Is there a general principle/policy or "rule
of thumb" about removal of jewelry before surgery?
It is more prevalent now because of body piercing and
such. Patients are reluctant to do so. Thanks for your
help.
BK
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Dear BK,
Well, there is never a dull moment in nursing, is there?
Our patients who have body piercings need to know why
the metal has to be removed. The issue is safety, of
course. We need to explain to our patients how the electro
surgical units that are used on patients can potentially
burn them if metal is on a person's body.
And of course, we at NurseWeek.com have the link for
you to see what our colleagues at AORN
(Association of PeriOperative Registered Nurses)
have to say about this. They are the experts in caring
for patients pre- and intraoperatively.
Listed in their FAQ's (Frequently Asked Questions)
is a link
for members of the public, informing them why the
metal has to be removed, including such practical advice
as contacting a local body-piercing store to find out
how some metal can be removed.
Sometimes it just requires explaining to patients why
things are done. Thanks so much for your question.
Nurse Nancy
June 16, 2003
Dear Nurse Nancy,
I have been a nurse for many years, and I recently
worked for a company as a pool nurse. When I gave my
two-weeks notice, my supervisor begged me not to quit
and told me I could come back anytime. Recently I found
out that on a reference check on me from another employer
that when they asked if I would be eligible for rehire,
the answer was "No comment". I always had
a good evaluation at this company and was never in trouble.
The answer "No comment" makes me sound bad.
Is there anything I can do about this?
JB
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Dear JB,
It has been my experience that many organizations have
as policy that they just give dates of employment. The
"No comment" remark may just be something
that this company writes on everyone's reference. I
have a few ideas for you:
1. Stop worrying. If you know you are a good nurse
and have not been in trouble, relax.
2. If you can, give the name of the supervisor who
asked you to stay as a reference. That will make you
feel better, although if the policy is employment dates,
he or she will merely write them in.
3. Keep copies of your performance appraisals and have
them with you when you interview. Don't take them out
until the references are an issue. If it becomes an
issue, hand the interviewer a copy of your performance
appraisal and tell him or her to read what your employer
said about you.
I wish you well in your new position. Good luck!
Nurse Nancy
June 13, 2003
Dear Nurse Nancy,
What are the unique roles of nurses in bioethical
decision making?
DG
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Dear DG,
A great question, as we as nurses bring much to the
table when it comes to bioethical decision making. I
always see the role of nurses to be, first, an advocate
for the patient, which is defined as informing patients
of the options and supporting their decisions. Imagine
how frightening it must be to be a patient these days
- so many decisions and choices. In every organization
that I have worked in, there has been an Ethics Committee,
and anyone can initiate an ethics consult. In just about
all of them, nurses initiate the consult. Who better
knows the issues, the patient, the family, and the dilemmas
families face? Our uniqueness is our continued presence,
our caring, and our wanting to do the right thing for
the patient. While all providers certainly care and
want to do the right thing for the patient, we are the
only professional who is there 24/7.
The
American Nurses Association has long advocated the
role of nurses in ethics. Our Code of Ethics was updated
in 2000, with 11 provisions and interpretive statements.
Briefly, the areas covered in this document are:
- Protecting Patients
- Ensuring Competence and Taking Responsibility
- Ensuring Continued Learning
- Workplace Rights and Protection
- Advancing Nursing Action and Social Advocacy
- Preparing for the Future
To read the document in its entirety, click
here.
Great question. Thanks!
Nurse Nancy
June 10, 2003
Dear Nurse Nancy,
If you felt that a skilled patient shouldn't be
discharged home due to inappropriate home health care,
how can you document your concerns without setting yourself
or anyone else up for a lawsuit? This is a Skilled Extended
Care Facility.
KM
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Dear KM,
You are wise to ask what you can do proactively. Documentation
is not the place for arguments and battles, although
I know we all see providers who write silly - and sometimes
stupid - things in the medical record. "Inappropriate"
home care is a dubious term - inappropriate by whose
definition?
I would suggest two things:
1. Document your objective data. Be specific about
your observations; record the facts as they are. Resist
all opinions, name-calling, and negative charting. If
you are teaching a client, and the client is unable
to return the demonstration, say so objectively. For
example, 'Client instructed in blood glucose testing.
Reviewed 3 times with client, unable to return demonstration.'
2. If you have a major concern about the client, this
needs to be articulated to the attending physician,
social worker, or home health care nurse. Ask for a
meeting and give them the data on the client. Again,
try to give the facts as they are. Share your concerns
verbally, but be careful what you document.
We all know that medical records are legal documents
and should be treated as such. It is often difficult
to resist negative charting, but it is never the place
to "fight."
Thanks for your question.
Nurse Nancy
June 9, 2003
Dear Nurse Nancy,
I work in an intermediate care nursing home full-time,
and work as a contingent staff nurse on a hospital med/surg/telemetry
floor. I have over 10 years of experience, including
OB, ICU, Med/Surg, Home Health, etc.
Over the weekend, I received a new patient at the
Long Term Care facility who came from out-of-state.
The patient has a new split ash catheter for hemodialysis
and a P.D. cath that could not be removed. Both of these
sites had dressings that were coming off. My concern
was risk of infection, and I wanted to re-dress these
areas using sterile technique. My superior suggested
that I only reinforce with the tape, as the dialysis
nurse for our community would be in servicing us next
week.
Was I being too aggressive in my care, although
I've gleaned a lot of experience throughout my career?
GON
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Dear GON,
As I read your letter, I was reminded of a situation
I was in once, similar to what you described, where
I thought I could "fix" something, and wound
up actually cutting a catheter in half. We are all well
intentioned, and none of us means to cause any harm
to our patients.
In this case, I think you and your supervisor were
only trying to help your patient. Who knows what harm
you possibly could do by taking down the dressing? Perhaps
none, but it could happen. I would suggest as a compromise
to both you and your supervisor that you call the dialysis
unit where the patient comes from and speak to one of
those nurses. Certainly with your experience, you could
figure this out, but I think the reassurance of what
is under that dressing might help both you and your
supervisor have a level of confidence in the dressing
change.
Thanks for caring so much about your patient.
Have a great weekend!
Nurse Nancy
June 5, 2003
Dear Nurse Nancy,
I am a new graduate working on a floor where many
of our patients die. How do you as a nurse cope with
death?
SCH
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Dear SCH,
My clinical background is in orthopaedics, where most
of our patients come in with pain, have surgery, and
go home in better condition than they came in. I have,
however, been with many patients who have died, and
have always considered it a privilege to be there at
the time someone dies. If it is a planned, peaceful
death, and you have had the opportunity to get to know
the family members, it is a relief for them to have
you there.
How do nurses cope? Nurses who work in areas where
patients die often - like in burn units, ICUs and oncology
units - often schedule memorials to remember the patients
they have cared for. Some facilities encourage nurses
to attend the funerals of their long-time patients;
we spend so much time with them that we are like part
of the family. I worked in a hospital once where the
pediatric unit kept a book of "angels" - a
memory book for each child who had died. It was filled
with pictures, happy memories, and the addresses of
the parents so the staff could keep in touch.
We all grieve, and grieving is an important part of
life. Nurses are human, and we need to honor our feelings.
Nurse Nancy
June 4, 2003
Dear Nurse Nancy,
I have a BSN and am interested in infection control.
What further education do I need to be qualified for
a position in this field?
EB
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Dear EB,
Certainly, a master's in a related field — nursing,
health administration, or public health — would
help you in the transition. Courses such as statitistics,
epidemiology, and so forth would help you see the big
picture.
Networking would also help. I would speak to the Infection
Control nurse in your facility and ask for his/her advice
on what you should do to proceed. So many jobs are obtained
based on who you know, so use your contacts and go for
it! Infection control is an important job, and most
organizations employ several infection control nurses.
Good luck to you!
Nurse Nancy
June 3, 2003
Dear Nurse Nancy,
Can a hospital post a document stating that no male
nurses can be assigned to take care of one particular
doctor's patients?
TI
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Dear TI,
Unfortunately, a hospital can post any such ridiculous
document. I have seen many in my day.
However, this physician needs to know that gender plays
no role in assigning patients. We need to be sensitive
to patients who take issue with such an assignment,
perhaps based on religious beliefs - but that is rare
these days, as patients just want to be cared for by
a professional, regardless of gender.
This physician needs some education about the nursing
shortage and how we all need to behave as professionals.
How incredibly insulting to our male colleagues! And
ask him: Does he let female physicians see his patients?
He needs help. Go to it!
Sincerely,
Nurse Nancy
June 2, 2003
Dear Nurse Nancy,
Can a hospital post a document stating that no male
nurses can be assigned to take care of one particular
doctor's patients?
TI
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Dear TI,
Unfortunately, a hospital can post any such ridiculous
document. I have seen many in my day.
However, this physician needs to know that gender plays
no role in assigning patients. We need to be sensitive
to patients who take issue with such an assignment,
perhaps based on religious beliefs - but that is rare
these days, as patients just want to be cared for by
a professional, regardless of gender.
This physician needs some education about the nursing
shortage and how we all need to behave as professionals.
How incredibly insulting to our male colleagues! And
ask him: Does he let female physicians see his patients?
He needs help. Go to it!
Sincerely,
Nurse Nancy
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