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July 31, 2003
Dear Nurse Nancy,
I am currently a diploma RN. I am taking classes
currently through CLEP, Dantes etc. My question is would
I be better off to then pursue my BSN or a bachelors
in administration. At my current place of employment
BSN staff nurses make the same as a non BSN RN. My goal
is to one day be in some sort of administrative position.
LF
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Dear LF,
Well, here is my bias up front and personal: get the
BSN. As a diploma graduate myself, I can tell you that
completing my BSN was one of the best things I ever
did for myself professionally. Many jobs require a BSN,
and there is a body of knowledge in nursing which is
fundamental to our profession. You will have coursework
in leadership which will help provide the framework
for your future administrative position.
Another reason to get the BSN is for the future. If
you plan to go to graduate school in nursing, most require
a BSN. Plans change over time, but with the BSN you
will be able to get into just about any graduate program.
As for the money - many places do offer a different
salary for nurses with a BSN. You are investing in yourself
in getting this education, so go for it. You earn this
degree for yourself, and I am proud of you for doing
it. Good luck!
Nurse Nancy
July 30, 2003
Dear Nurse Nancy,
I have had an RN for 10 years but have no clinical
experience. I'm 54 years old and have done some case
management for an insurance company and worked for a
drug company as a case manager assessing and educating
caregivers who were
taking a new Alzheimer's Drug. (all telephonic work)
My problem is without clinical experience I'm not marketable
but I'm so unsure of my clinical skills because I'm
out of school for so long that I'm wondering if a refresher
course will be sufficient. Can you shed some light on
what a refresher course would involve and where I can
find one.
I would appreciate any feedback.
HN
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Dear HN,
Well, first let me congratulate you on wanting to return
to nursing. I agree that you will need some clinical
updates in order to re-enter the workforce. Most community
colleges have refresher courses; I would start there
in looking for a course. The content is generally both
didactic information as well as clinical. You could
also get a current drug book and start refreshing yourself
on new drugs…..that is a good beginning.
I would also suggest volunteering in a hospital, long
term care facility or nursing home. I have seen many
nurses do this, and it helps them to see first hand
how much has changed over time. Ask to be put in a clinical
area and talk to the nursing staff. Not only will you
see first hand how much has changed, but you will also
be able to get a feel for where you might want to work
- your chance to work with potential colleagues.
I applaud your efforts, really. Many of the letters
I get are from nurses who are looking for the kind of
work you have done. Good luck, and welcome!
Nurse Nancy
July 29, 2003
Dear Nurse Nancy,
I work in a Methadone Maintenance Program and find
myself very frustrated with the way things are run.
There is little consistency, and if the staff isn’t
united, our patients pick up on this. I am also concerned
about staff safety.
I do like the job, believe it or not, but find
myself looking at the classified ads more often. How
do you think I can best bring my concerns to the attention
of a supervisor who doesn’t see these issues as
problems? Or would you suggest more time with the classifieds?
ED
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Dear ED,
I think you get a lot of credit for trying to fix this
situation. We all have had supervisors who don’t
(or won’t) see what is perceived as problems for
the staff. I think you should ask for a staff meeting
to discuss your concerns, and ask for a facilitator
who is not part of the staff to be part of the discussion.
Perhaps this person could help to assist you to get
more structure into the system.
In many studies, the number one reason people stay
or leave a position is the relationship they have with
their direct supervisor. Your situation is very typical.
If your supervisor can’t or won’t help in
this situation, I would consider finding one who can.
But I like your commitment to at least try to make it
work.
Thanks so much for your question.
Nurse Nancy
July 23, 2003
Dear Nurse Nancy,
We have several nurses in our endoscopy lab who
are real slackers. One of them hangs out in the doctor’s
lounge and watches TV, drinking coffee while she’s
walking up the and down the hallway in front of patients
who have been NPO. This has been going on for several
months. When I speak to my manager, she asks me if I
have talked to them about it! Yes, I have, and they
are furious with me. My feeling is that she is the manager,
and should be disciplining them.
There are a few of us who are hard working and
efficient. The 3 or 4 who are inefficient or just plain
lazy, make the same amount of money and nothing is done
about their inefficiency! As you can tell, I am pretty
fed up. Thanks.
LC
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Dear LC,
To the experienced nurses reading this – does
this sound all too familiar? As I read this, I had two
thoughts – one is that drinking coffee in front
of NPO patients really needs to be addressed. This is
just so unfair to your patients. I would approach your
manager again and focus on that aspect of patient care.
As for the allegation that they are inefficient and
lazy – you have choices here. Stay and do your
own job as well as you can, and feel good about it,
or leave and go to another position. No job is perfect,
so I doubt you will ever find a place with perfectly
matched employees….I have yet to find that.
My advice is to pick and choose your battles. Drinking
coffee in front of patients seems very unfair –
watching TV and hanging out in the doctor’s lounge
is also unfair, but if you have addressed it, and your
manager has not, you either do your own job or move
on. Try to take the high road and just be responsible
for you. Not easy, but it will at least make you feel
good about what YOU do. Good luck!
Nurse Nancy
July 22, 2003
Dear Nurse Nancy,
I am a 49 year old male who has been an EMT and
Paramedic for almost 20 years. I am now thinking of
becoming an RN. Is it worth it for me to begin a new
career at my age?
VM
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Dear VM,
Sometimes I feel like a broken record saying “You
are NEVER too old – age is just a number”.
Given your background, I think you have many skills
which will help you in nursing. I know many EMTs who
become Emergency Department nurses, as the transition
is natural.
I would just caution you to be clear about professional
boundaries – what you can do as an EMT and Paramedic
may not be legally allowed as a nursing student. In
honesty, I have seen some EMTs have difficulty in the
transition, and feel confined in not being able to do
things as a nursing student. I would not let that stop
you, but do understand the difference in the scope of
practice.
You will be great in many ways, though, and come to
nursing without some of the natural fears that many
students have – of emergencies, of codes, of BCLS
and ACLS.
Go for it….it is a great profession!
Nurse Nancy
July 21, 2003
Dear Nurse Nancy,
I would like to go to graduate school and stay
in the field of nursing. What types of programs/degrees
are offered?
BL
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Dear BL,
Well, it is hard to think about where to begin. Like
our profession, there are so many choices in nursing!
You can go to graduate school for education, administration,
clinical nurse specialist, nurse midwife, nurse anesthetist,
nurse practitioner, informatics, just to name a few!
There are so many choices – you need to think
about what you want to do with your degree and find
a program that works for you.
To begin, I would suggest you take a look at our list
of nursing schools, listed by state and type of degree.
You can also get a master’s degree on line –
in this case, the sky really is almost the limit! Take
a look at this link to begin your search. Good luck!
http://www.allnursingschools.com/find/index
Nurse Nancy
July 18, 2003
Dear Nurse Nancy,
After 21 years of critical care nursing, I would
like to move away from the bedside and become a consultant
to patients and their families on managing chronic medical
conditions by teaching effective coping strategies to
help prevent re-hospitalization. My credentials include
a Psy.D. in clinical psychology. Do you feel there is
a market for this type of service?
JR
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Dear JR,
What a great combination of education and clinical
experience. Yes, I certainly do think there is a market
for this service; I just wonder if people will pay for
it. Many organizations have psychiatric liaison nurses
(some are nurse practitioners) who work with staff and
families – perhaps this might be a place to start,
if you want to get a feel for the work before you branch
out on your own. This might also give you a feel for
the potential audience, your referral service.
I would take a look at the American Psychiatric Nurses
Association – www.nurseweek.com/news/weblinks.asp
. Networking is always a great way to see what is out
there, who might be willing to share their business
plan with you, (preferably in a different part of the
country, so you won’t be a competitor) and so
forth.
I think it is a wonderful idea, one that will benefit
so many patients and families. I wish the best for you.
Good luck!
Nurse Nancy
July 17, 2003
Dear Nurse Nancy,
Please advise me on the credentials for administering
a PPD, as I have been an RN for many years and before
where I worked, you needed to be an NP or PA to do this….Has
this changed, and if it has changed, do I need any additional
training since I have never done this? Thanks for your
time.
PW
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Dear PW,
Staff nurses all over the country routinely give PPDs
to patients every day. When I worked in the Indian Health
Service in the 70’s, I placed hundreds of them.
Like you, I wondered if nurses did that, since I had
only seen physicians do them in those days.
The answer is yes, this has changed, and RNs have been
doing them for years in my area. As far as training
– yes, as with any new procedure, you need to
have some education about how it is done. It is a very
small amount of medication, so it takes good eyesight
to draw up the correct amount. With some practice, you
will see how easily it is to implant the fluid into
the very top layer of the skin. You can see the fluid
bubble up, leaving a “bleb” (small bump)
which is left for 48 hours. The “bleb” is
read positive by the amount of induration on the skin.
I congratulate on learning a new skill….goes
to show we are all life long learners!
Nurse Nancy
July 16, 2003
Dear Nurse Nancy,
As a recent graduate from a BSN program (this is
my “second” career) I was hired on a CCU/Telemetry
unit at my local community hospital. The environment
is great, staffing ideal….however, it has created
a problem of sorts. There is no nursing shortage here,
in fact, recently we have been experiencing rather a
lot of down staffing.
While I love my job, it is not paying the bills.
The nurse manager has been alerted to this concern,
however he is intent on filling all RN openings “just
in case”.
I am considering taking a part time position at
another hospital, one that is in need of nurses and
will work around my community hospital weekend only
schedule. Any ideas?
DW
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Dear DW,
How wonderful for you! Great environment, ideal staffing,
no nursing shortage…..not many of us can say that.
I would think long and hard before I left that job,
as you honestly may not ever have that again.
Before you go to the other hospital, think of a few
things. It sounds like a good plan, but how are you
going to work your weekends at the community hospital?
Any part time position will have some weekend requirement…how
will you meet that obligation? Weekend only positions
generally do pay more, as they are undesirable to individuals
who want to spend weekends with family, friends, and
so forth. There is a REASON the money is better –
the work is hard, often with less people working. And
generally you get only one weekend off a year!
If the reality is you need more money, I would think
about working per diem or agency at the other hospital.
I have read so many studies on job satisfaction, and
money is never the first thing listed on why people
stay in their current positions. It is not about the
money; it is about your relationship with your manager.
Sounds like you have what so many of your colleagues
would love to have – environment, ideal staffing…..you
sure you want to leave that? Supplement your salary
in the other hospital, and see if you like it better
before you leave your ideal world. Good luck to you.
Nurse Nancy
July 15, 2003
Dear Nurse Nancy,
I am an RN who is also a Certified Hospice Palliative
Care Nurse (CHPN). I would love to also become certified
as a Pain Management Nurse. I am having trouble finding
the organization that grants such certification –
can you help?
J.W.
Dear J. W.,
What a great combination to be certified in –
hospice/palliative and pain management go hand in hand.
This is one of those good news/bad news responses. The
bad news is that there is currently no certification
for pain management nurses. The good news is that it
is on the way. The American Society of Pain Management
Nurses (ASPMN), whose web site you can find on our site
at http://nurseweek.com/news/weblinks.asp, is working
on it, and the predicted date for the first exam is
2005.
As you probably know, there is much work that has to
go into getting a certification going. A job analysis
defining the role of the specialty has to be done, a
Core Curriculum developed to outline the body of knowledge
specific to the specialty. ASPMN has been working for
many years to make this dream a reality. The Core Curriculum
for Pain Management Nursing, edited by Barbara St. Marie
and published by W.B.Saunders (2002) is out, and is
an excellent resource for studying for the exam.
So – hang in there! You soon will have your second
certification. How great for your patients!
Nurse Nancy
July 14, 2003
Dear Nurse Nancy,
Is there any proper, correct way to sign your name
or place your credentials? I was under the impression
that they should be listed in the way they were granted.
But I see it all different ways. Any clarification or
rule?
D.A.B.
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Dear D.A.B.,
Well, with all the alphabet soup we have in nursing,
it does get confusing. And yes, there is a general rule.
You place your credentials in order of permanence –
for example, if you have a BSN, MSN, RN and CCRN (certified
critical care registered nurse), you keep forever the
educational credentials – BSN, MSN. No matter
what happens to you professionally, you will always
have those credentials. Once a higher degree is achieved,
you generally drop the former degree (as it is implied
– you can’t have a MSN if you don’t
have a BSN) The RN is professional licensure, subject
to renewal based on criteria. The same way with the
CCRN.
It is almost if you look at this as what you could
“lose” – certification and license,
yes. Academic credential – never. So you would
sign your name D.A.B, MSN, RN, CCRN
Great question – thanks!
Nurse Nancy
July 11, 2003
Dear Nurse Nancy,
I am a 34 year-old male, a relatively recent RN
BSN grad., working the last 6 months in a long-term
care facility, for a total of 10 months working as a
nurse. I plan on continuing my education next spring
working part-time towards my masters in a Family Nurse
Practitioner program. My dilemma is
that I am feeling as though I am not respected for the
clinical knowledge that I have at this point in my career,
and also discovered that I am slightly underpaid according
to NurseWeek's salary wizard. I like the residents,
I like the shift 7-3 which is difficult to find starting
out in a facility. I just don't feel like the clinician
that I aspire to be. Any advice for me?
RB
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Dear RB,
I think you are so smart to be working in long-term
care. So few nurses appreciate that as a specialty,
and I see it as an important specialty as we all get
older. As for the pay, there are geographic differences,
of course. The NurseWeek.com salary
wizard does take geography into account, but not
worksites, so generally you will find hospitals pay
more than long term care facilities. And you are right,
landing a 7-3 position is not easy.
As for not feeling respected - I would say just keep
working, learning, and growing professionally. Your
idea to be a Family Nurse Practitioner is a great one
- and with your experience working in long-term care….a
great combination.
As Scarlet O'Hara said….."Fiddle dee dee"
- don't worry about what anyone else thinks of your
clinical skills. Keep moving forward, and get your satisfaction
from your residents. In the end, that is what really
counts. Good luck!
Nurse Nancy
July 8, 2003
Dear Nurse Nancy,
Why are we not allowed to wear caps and discouraged
from wearing our graduation pins?
CBC
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Dear CBC,
I am surprised to read that you are being discouraged
from wearing your graduation pin. In many cases, it
is one of the few ways patients can see that you are
an RN. Since we all wear white, or scrubs, I think your
school pin is a nice demonstration of the level of care
the patient is receiving. If someone is literally making
you NOT wear it, I would challenge that idea and ask
for an explanation.
It is in the Patient's Bill of Rights to know the title
and skill mix of the caregiver. I would think organizations
would be happy to have their RNs distinguished this
way. Wear it proudly!
As for the caps, I wore one for years (it always got
caught in the traction!) Most nurses do not want to
wear one now. The best comment I have heard about caps
is that it is not what is on TOP of your head, but what
is IN it….
Nurse Nancy
July 3, 2003
Dear Nurse Nancy,
I am an RN with a BS in Psychology and a MEd in
Counseling Psychology. I am seeking a refresher course
in Nursing so that I can return to work after a 17 year
absence. I have applied for jobs in Labor and Delivery
and Psychiatry and have been told I need at least 6
months of re-training. If you could point me in the
right direction to obtain such re-training I would be
most appreciative.
SML
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Dear SML,
Yes, despite the nursing shortage, 17 years is a long
time to be away from nursing - you will be amazed at
the changes (and the amount of paperwork!) You did not
tell me where you live, but I would suggest looking
into Community Colleges in your area. Most of them are
offering refresher courses to help you get back into
the work force.
We have a list of all of the schools of nursing on
our website, click
here. Find your state and hopefully you will find
a program near you.
Welcome back to nursing!
Nurse Nancy
P.S. Happy 4th of July, see you all next week!
July 1, 2003
Dear Nurse Nancy,
I was wondering if you knew of an online school
or courses I can take to become an LPN? I am constantly
looking to see if it offered on line.
RM
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Dear RM,
I have looked everywhere, and can not find an on line
LPN program. Generally, LPN education is one year in
length, and the requirements for licensure include clinical
hours. Since LPNs are bedside caregivers, their proficiency
is in practical clinical matters which would be difficult
to learn in an online manner.
It is the same way for RNs - you can go from RN to
BSN, or LPN to Associates. The issue here is a basic
license to improve.
Thanks for the question.
Nurse Nancy
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