August 29, 2003

Dear Nurse Nancy,

I work for a school for medically challenged children- many of them have Cerebral Palsy, and none of them are vocal. The program is fairly new---is there anywhere I can sign up to get updated information concerning these special children? I want to be sure we are meeting our standards of care, and so forth. Any thoughts?

SS

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Dear SS,

This sounds like a very challenging job, and I am sure you will be learning all sorts of new information as time goes on. I have two thoughts for you - one is a professional organization which will allow you to network with other nurses in your area, the Developmental Disabilities Nurses Association. You can reach them through our listing of all of the specialty nurses organizations, this group works with individuals with developmental disabilities of all ages, and they list networking opportunities; there is someone listed in your state.

The other group is the United Cerebral Palsy website, www.ucp.org, which has a lot of information about educational requirements for these children, laws related to access for them, and so forth. I think you will find this site helpful as there are many standards that must be met wit this population. Click on education on the home page, and you will be amazed how much information there is out there!

I wish you the best in your new career. Good luck!

Happy Labor Day Weekend!

Nurse Nancy

August 27, 2003

Dear Nurse Nancy,

I am a Nurse Midwife in Ecuador (South America) and I would like to get a license in this country to work. Since I came to this country, I have not been able to practice as a nurse midwife. Therefore, I would like your advice. I live in New York; please tell me where I can go to obtain information. Thank you.

Sincerely,
GW

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Dear GW,

Well first of all, welcome to America! We are happy to have a colleague from Ecuador, and I hope you are able to get credentialed to work here. Being bilingual is a real asset in New York, and I know you have a lot to offer our patients.

The first step for you is to go to the Commission on Graduates of Foreign Nursing Schools (CGFNS) website. CGFNS was established as a not-for-profit, immigration neutral organization with a commitment to protect the public by ensuring that nurses educated in countries other than the United States (U.S.) are eligible and qualified to meet licensure and other practice requirements in the U.S. Throughout its history, CGFNS has demonstrated its commitment to excellence and quality in the healthcare arena and to fostering equitable treatment of healthcare professionals.

The CGFNS mission is to provide leadership in healthcare education, registration and licensure to the global nursing and professional healthcare communities. CGFNS protects the public in relation to evolving healthcare policies and standards of professional practice for migrating healthcare professionals. CGFNS provides products and services that validate credentials and enhance international regulatory and educational standards for healthcare professionals.

Good luck to you!

Nurse Nancy

August 25, 2003

Dear Nurse Nancy,

This is a small rural town. One of the physicians here has an LPN who has worked for him for several years. She routinely works out of the bounds of her license by calling orders and admitting people to the hospital without his knowledge. But by far the worst thing she does is continuing to run his office while he's out of town on vacation. She continues to see the patients, prescribes meds, and calls them in. No one wants to report this because it is a small town and everyone knows everyone's business. Any suggestions???

RE

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Dear RE,

This is a very serious issue indeed. I can understand that this is a difficult situation, but I think you have a professional responsibility to report this allegation. The mission of all State Boards of Nursing is to protect the public, and LPNs are included in this. They are licensed individuals with strict practice parameters. Practicing outside of one's license is very serious, and potentially VERY dangerous.

You can find the listing of all of the State Boards of Nursing on our website. I would encourage you to call and ask to speak to the Executive Director. Ask this individual to guide you with this, and to help you with the sensitivity of the allegation. This is part of their job, and I know he or she will be able to explain to you the process for reporting this. While it is hopefully a once in a lifetime issue for you, this individual has likely had to deal with this before.

I commend you for your courage to initiate this. It isn't easy, but it is the right thing to do. Nurses are some of the most respected individuals to our patients. This nurse needs to be reported and have this investigated. Thank you for taking your professional responsibility seriously.

Nurse Nancy

August 22, 2003

Dear Nurse Nancy,

I am from Illinois and was told by a hospital that I have to take a
refresher course to work there, since I've been out of hospital nursing over five years. I have done high-tech private duty homecare for the past 18 years. (vents, lines, multitudes of equipment, chronic care, acute care, from peds to elderly; you name it, I've done it; even management). They told me this is a law in Illinois. Is that true?

MJ

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Dear MJ,

In this nursing shortage, it seems like a shame to disregard all that great clinical experience you have. I just reviewed the Nurse Practice Act for Illinois (you can find it, and the websites for all of the Boards of Nursing on our website) and did not see anything there that referred to that requirement. Possibly it is the policy of that hospital.

I honestly don't know if it is a "law" but I do have some suggestions. The INA website has a link to ask them a question - I would ask them if it is true. If those 18 years are current, I think you can ask them to review your resume (hopefully you give yourself credit for the skill set you have - see our Resume Builder or Professional Growth on our website) and have someone evaluate your practice. An experienced critical care nurse manager will be able to see what kind of experiences you have had.

I would also go to another hospital to see if they tell you the same thing. With all those years of private duty, I wonder if someone out there will give you a chance. I certainly hope so! Good luck.

Nurse Nancy

August 21, 2003

Dear Nurse Nancy,

I graduated from nursing school in 1994. About two months after
graduating and searching for a job, I began having difficulty ambulating and gripping and was eventually diagnosed with rheumatoid arthritis. I was unable to do hospital nursing, so I "moved up" in the insurance company I worked for as a nurse case manager. I feel I've lost out on experience needed to be a great RN. In 1998 when feeling much better I was actually able to work about 10 months in a nursing home before my physician told me to quit. I struggled the entire time. Currently I'm an
occupational health nurse at a factory. I'm thinking about returning to school for my BSN to further my education. Do you think this would boostmy confidence?

GV

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Dear GV,

I think it not only would boost your confidence, but it might even help you feel better! As an orthopaedic nurse who has cared for many patients with RA, I applaud all of the efforts you have made to work as a nurse. You are a good example that nursing has so many opportunities, and it sounds like you really love what you do. I imagine you have some painful days where working is especially difficult. Good for you for finding a job that allows you to keep your skills fresh.

I earned my BSN in the 70's, and it remains one of the best things I ever did for myself. Having that degree will open doors for you, introduce you to all sorts of interesting topics and content. And now you have the option of going to a traditional school "live" or taking courses on line toward your BSN. That might be easier for you with your medical history.

Either way, I encourage you to go for it! You can find out about these programs on our website.

Good luck!

Nurse Nancy

August 20, 2003

Dear Nurse Nancy,

I am interested in traveling for the summer to get away from Arizona's heat (first time traveler). I have applied to three different traveling companies. It will cost me approximately $140 to get a temporary license and am wondering if I should wait until I actually have a position offered or should I get it now (since the processing is so long)? I'd hate to spend the money if I don't get the position I am aiming for.

Heat exhausted in Arizona

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Dear Heat Exhausted,

After the challenging winter and spring we have had on the East coast, the sun of Arizona sounds great to me! But I understand that you want to have a different environment, and I have been in Arizona in the summer….that is hot!

As far as the temporary license, I would suggest you speak to the recruiter at the travel agency with which you are working. Ask about the realities of employment in your selected area. Given the current nursing shortage, it would seem to me that you have a good chance just about anywhere. I don't know what your specialty is, or where you want to go, but more and more healthcare organizations are using traveling nurses. And don't forget to keep a record of all your job seeking expenses for your tax return next year.

I wish you luck (and some shade!) in your adventure!

Nurse Nancy

August 18, 2003

Dear Nurse Nancy,

Can you guide me in how to determine patient acuity for a medsurg unit? All I can find is the flat patient/nurse ratio i.e. 6:1; 4:1 etc is there any real acuity (severity of illness) systems out there?

By the numbers

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Dear by the Numbers,

I have always been a fan of acuity systems. If done correctly (daily, with built in inter rater reliability to see if nurses agree on the assessment) they can really help. There are several systems out there - each organization generally selects the one which they think is best for their staff.

Some of the names which come to mind are CPSI, Medicus, Catalyst, ResQ, Apache (used in critical care) I would suggest you review the literature, ask colleagues in other hospitals what they use and how the staff like it.

Acuity systems project the amount of care each patient should have. I think it evens the playing field, and gives a snapshot of the activity on the unit. We have several articles on our site about acuity. Click on our home page and type in acuity in the search engine - you will find information that I bet will help you.

Good luck!

Nurse Nancy

August 5, 2003

Dear Nurse Nancy,

I was just fired from my first nursing job. The charge nurse and I
had a conflict of interest. She said I had a bad attitude and kept trying
to get me into trouble. I am not the first nurse or person to have a problem
with her and supervisors and nurse management know of this problem, yet
always side with her. What do I tell potential employers about my
discharge? Would letters of recommendation from doctors, nurses of others I
worked with me help me to get a job?

TT

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Dear TT,

I am sorry to hear of your troubles with your charge nurse, but not surprised. This happens to many of us. My advice is to be honest with your next employer - just say you did not get along; try not to be defensive or speak badly about your former colleague. Nurse recruiters and nurse managers have heard it all - they won't be surprised either.

It is difficult when it is you, but this happens all the time. I am not sure that letters of recommendation would help - some might interpret them as defensive on your part. If you feel you have done nothing wrong, chalk this up to experience and get another job. And next time - be sure to meet your new boss and be sure it is a fit from your perspective…..it is a very important relationship in your life, and you need to be sure you can work together prior to employment.

Good luck - all these experiences make us better nurses and people!

Nurse Nancy

August 4, 2003

Dear Nurse Nancy,

Hello from Middle East! I've been working since 1984 at the age of 25. I have been working here as a contract worker in a tertiary hospital. My clinical skills are good.

I would still like to work in other countries as I believe there are opportunities out there.
May I ask you if there is an age limit forcing one to retire? Thank you.

AP

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Dear AP,

Once again the Internet makes the world a little smaller; how nice to hear from a colleague in the Middle East. And if my math is correct, you certainly are still young enough to work in other countries. In your mid forties, you will bring lots of experience both clinically and culturally to any work setting.

As for retirement, that is up to the individual. Generally, nurses retire when the work gets to be too physically demanding, and this can happen at various ages - 55, 62, 65. What usually is the deciding factor is the retirement plan the nurse has, and if he or she can afford to retire.

We can help you to search for a new job on our site, from the home page you will see Career Resources on the right side menu. In there, you will find jobs listed by state and specialty, help to write a resume, job fairs, and so forth.

I wish you luck. You are correct - there are opportunities. Go for it!

Nurse Nancy

August 1, 2003

Dear Nancy,

I have begun filling my prerequisite requirements to apply to the Nursing Program for my two-year degree at a community college. There are only twenty openings and I am hearing this is a trend at most schools, that there are not enough openings for applicants. I have been reading about the nursing shortage and am wondering about educational institutions expanding their programs to meet this need. I am in my early 50's and I'm
very excited about learning and starting a new career as a NICU nurse. I know this is a ways down the road, but at my age I hope not to have to wait an extra year to be accepted into a nursing program. What are your thoughts and advice on this? Thank you so much for your time and energy.

ND

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Dear ND,

Welcome to Nursing! Good for you for starting a new career in your 50's; you will bring wonderful life experience to our profession.

As to your question, you are correct in saying this is a trend in most schools. While we are going through a severe nursing shortage, we are also experiencing a shortage of nursing faculty also. Part of the problem is that many nurses go on for advanced degrees in the latter part of their career, so their productivity is limited. Many of the professional nursing organizations (American Nurses Association, Sigma Theta Tau International) are addressing this, encouraging younger nurses to become nurse educators.

So what can you do about this? I would encourage you to study hard and do well in your prerequisite work. If there are only 20 openings, work hard to make sure your resume looks great - volunteer, join student organizations, and take on whatever leadership roles you can. This shows that you really want to be a nurse, and with only 20 openings, you need to do whatever you can to shine.

I wish you luck. Study hard!

Nancy