August
30, 2004
Dear Nurse Nancy,
I have an ADN degree and am interested in
infection control nursing. My income and
situation is such that an RN-to-BSN program
is out of the question. Any ideas for me
to get more involved in infection control?
PS
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Dear PS,
Infection control is a fascinating section of health care, but I don’t
even think you would get a job with a BSN, let alone an associate’s degree.
This is a very complicated job, and the infection control practitioners I have
worked with have a broad background not only in nursing, but in statistics,
research, and microbiology. This requires formal education, and the infection
control nurses I know all have either a master’s in nursing or public
health.
I would encourage you to look at alternative
ways to follow your dream. So many hospitals
have tuition reimbursement packages and flexible
schedules to help busy RNs accomplish their
goals. Start slow and you will eventually
get there.
In the meanwhile, network with as many infection control practitioners as you
can. Not all are nurses; some have degrees in microbiology or other sciences.
See what they say to encourage you.
Good luck.
Nurse Nancy
August 25, 2004
Dear Nurse Nancy,
I have worked as an RN in a busy pediatric
emergency room for five years. I recently
found out that I have been paid as a new
RN in the 1-3 year category. I am really
frustrated and am seeking employment elsewhere.
Should I ask my manager why my pay scale
is so low or should I move on?
FD
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Dear FD,
There are a couple of things to think about in your situation. First of all,
this may be simply a payroll error. I would think that as a registered professional
nurse, you have some responsibility to know what your salary is and to make
sure it is correct.
I think you should bring it to the attention
of your manager, and work through this challenge;
be professional and get all the facts before
you merely leave your job. There may be circumstances
which are quite innocent that you are not
aware of. If indeed you are being held back
financially, ask for an evaluation of your
performance and for the specific goals you
have to accomplish to get there. Be sure
to get time frames for accomplishments, and
ask for all of this in writing.
Good luck.
Nurse Nancy
August 23, 2004
Dear Nurse Nancy,
I am interested in getting into forensic
nursing. I have a diverse background in nursing
including med-surg, ambulatory care, home
health, and case management. I have been
told that most forensic nurses have a background
in the ER. Do you feel this is necessary?
Would having ER experience help me with job
opportunities in forensics? Thank you.
LC
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Dear LC,
I think having ED experience is a large part of forensic nursing. There is
much to be learned from working with victims of rape, violence, and trauma.
You will get all of that from working in an emergency department. A place to
find out more information is the International Association of Forensic Nurses,
whose website is www.forensicnurse.org.
This is how they describe the work of forensic nurses:
Forensic nursing is the cutting-edge
issue in education, practice, and research
as we prepare for critical issues in health
care in the 21st century. Forensic nursing
is the application of nursing science to
public or legal proceedings; the application
of the forensic aspects of health care combined
with the bio-psycho-social education of the
registered nurse in the scientific investigation,
and treatment of trauma and/or death of victims
and perpetrators of abuse, violence, criminal
activity, and traumatic accidents.
The forensic nurse provides
direct services to individual clients, consultation
services to nursing, medical and law related
agencies, as well as providing expert court
testimony in areas dealing with trauma and/or
questioned death investigative processes,
adequacy of services delivery, and specialized
diagnoses of specific conditions as related
to nursing.
I wish you luck in your new endeavor.
Nurse Nancy
August 19, 2004
Dear Nurse Nancy,
I have been an RN for more than 10 years
and have seen things go from bad to worse
with nurses not supporting one another. It
seems that no matter which hospital I go
to, things are the same. The nurses are ready
to throw one another to the wolves even when
there’s not a reason to. I just don't
understand why we all can’t get along
and help one another with a smile on our
face — where's the teamwork?! It’s
been said that women just can’t work
together peacefully, but I have a difficult
time accepting this cop-out. Nurse Nancy,
have you any idea why nurses don’t
support each other? I’d like to know
what the root of the problem is and perhaps
try to change things.
Sincerely,
LB
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Dear LB,
I think your questions are excellent and valid. I am not sure why we see less
teamwork, but I agree it seems to be less than it used to be. My guess is that
nurses reflect societal changes, as we are a microcosm of society. I work with
nursing students, and this topic comes up a lot — why can’t we
just work together? We have different generations of nurses working together,
and perhaps some of that baby boomer vs. generation Xers contributes to this.
The news is not all bad, however. I do see
units with a lot of cohesion, working as
a team, low turnover rate despite the pressures
that we all feel. I contribute this spirit
to the nurse manager, who is generally the
person who sets the tone for the unit.
Don’t give up — I am hopeful
that if enough of our colleagues agree with
you, perhaps we can change the culture. Stranger
things have happened!
Nurse Nancy
August 18, 2004
Dear Nurse Nancy,
I have heard that Texas nurses are required to obtain
CEUs in bioterrorism for the renewal of their RN licenses.
Is this correct? When will this be effective? How many
CEUs are needed? Thank you for your help!
JA
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Dear JA,
It truly is a sign of the times that we are teaching
bioterrorism, isn't it? I have not heard (or read) of
any organization requiring this as a prerequisite. I
checked on the Texas Board of Nursing's website, and
did not see anything about it. I would suggest you contact
them directly, as they can give you the most current
information. Click here to get to their site: www.bne.state.tx.us/
Nurse Nancy
August 17, 2004
Dear Nurse Nancy,
What type of
in-service/training would you
suggest for a few nurses that I
have that have given
immunizations that were had
expired by a few days? Obviously,
they are not looking at the vial
each time or following the five
rules of medication
administration. This is
negligence and they will be
disciplined but I also want to
help them to avoid repeating
this. Would appreciate your
recommendations.
DH
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Dear DH,
I
totally agree with the approach you are taking; we need
to educate our colleagues along with the discipline
that is done. I would suggest that you take a look at
the website for the Institute for Safe Medication Practices
(www.ismp.org)
They have a great search engine, and you will likely
find what you are looking for. (Or have the nurses look
it up and present the information to the whole staff)
The ISMP also has a newsletter which I have found helpful.
I hope that will be helpful.
Nurse Nancy
August 16, 2004
Dear Nurse Nancy,
I am a male RN from Florida.
How and where can I get
certification as a nurse
educator? I got a job offer as a
staff development or nurse
educator, but I first want to
become a certified nurse
educator. Thanks for your advice.
PL
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Dear PL,
Congratulations on your new
job. A great place for you to
start is with the National
Nursing Staff Development
Organization (www.nnsdo.org)
which will be a great resource
for you. They have information on
many things that will help you in
your new job, and a great
journal, also.
The American Nurses
Credentialing Center (ANCC) is
another good place to look for
certification information. The
certification is in Nursing
Professional Development, and it
is intended for nonacademic nurse
educators. Go to the ANA website
(www.nursingworld.org)
and click on ANCC.
Good luck in your new
position!
Nurse Nancy
August 10,
2004
Dear Nurse Nancy,
I just started a new position
in a long term care facility with
experience. How long should I be
on orientation? I worked with a
nurse approximately 3 hours on
the first day, and then the next
day when I came in I had to work
a unit alone. The following day I
was given 26 patients with over
half of the medications needing
to be crushed. They are all
scheduled for 8am. I finished the
med pass at 1:30 pm. This is
definitely out of state
compliance and frustrating.
LL
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Dear LL,
This does not sound like a
sound plan to me at all. I know
there are staffing issues across
organizations, but there is more
to learn than just passing
medications. At this point, as an
experienced LTC nurse, you should
be able to find another position.
The take home message here is
to ask what exactly their
orientation plan is. Ask about
not only length, but what is
covered, how they assure
competency, and so forth. You
might also ask to speak with the
person who does the orientation.
Ask for a written copy of the
orientation plan. If they have
one, they will be happy to share
it with you. If they can’t
produce one, rethink working
there. Take your time and ask
questions – these places
need you.
Good luck.
Nurse Nancy
August 9, 2004
Dear Nurse Nancy,
Recently the charge nurse on
my floor wrote a letter to my
supervisor regarding me staying
over one hour at work to complete
charting and administering meds
which were not available to be
given at the scheduled earlier
time. We had worked short of
three nurses during my shift, and
the charge nurse left the
hospital to get her lunch despite
the need for help on the floor.
My supervisor was very
supportive when he talked with me
about this, but now he is leaving
for another position, and the
letter the charge nurse wrote is
in my personnel file. I have
asked for a copy of the letter so
that I can write a response,
which I hope will also be kept in
my file for the other supervisor
to review if there is ever a
need. What do you recommend I do
to protect myself in this
situation?
Thank you,
SF
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Dear SF,
I have always wondered who
goes and reads “those”
files. In all of my management
positions, I have never gone to
files to read old stuff. I
wouldn’t worry about it too
much, as nothing will likely
happen with it. I would also
encourage you to look in your
policy manual. Most places have a
length-of-stay policy, where they
remove disciplinary documentation
after a certain amount of time.
I have a suggestion if you are
still worried about the letter
(which I bet you still are).
Rather than write a response, ask
for a copy of the letter in
writing. Copy it to your HR
department. Be very professional
about it and resist the urge to
be defensive and accusatory. Have
someone you trust review it
before you send it, to be sure it
simply says you would appreciate
having a copy of the letter.
This way, you have put on
record that you want a copy. You
will have time to collect your
thoughts if you still want to
respond. The key here is to take
the high road. Good luck!
Nurse Nancy
August 5, 2004
I am currently working as a
school nurse in a Military
Dependent School System overseas.
We are hoping to retire next
summer. What can I do to prepare
to return to the
hospital/clinical environment, as
well as make myself marketable to
prospective employers?
BR
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Dear BR,
I am not sure what part of the
country you are moving to, but
experienced school nurses are in
demand in many areas, so if you
want to continue in your
specialty my guess is you will be
able to do so. I would imagine
your current skills would be
marketable to prospective
employers; make sure your
résumé reflects what you have
been doing. Also, be sure your
BCLS is up to date, along with
any certifications you might
have.
I imagine an ambulatory
setting would be happy to have
you also. You just have to find
your niche and you’ll figure
out what to do. Good luck!
Nurse Nancy
August 4, 2004
Dear Nurse Nancy,
I'm an RN and have not been in
the hospital for 10 years now. I
searched for a job in the
hospital to go back into my
profession and I found one
employer, but they suggest that I
should take first a refresher
course before they will hire me.
My questions are, How long will
it take for me to complete that
course? Do you have any idea of
how much it will cost (refresher
course)? What are my chances of
getting a job without taking a
refresher course? Will there be
any employer who could consider
me without any experience in the
hospital? Thanks for your time.
Sincerely,
MJ
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Dear MJ,
Welcome back to nursing. I can
tell you that things are very
different from 10 years ago, and
I think you will be much more
confident if you take a refresher
course. Most community colleges
offer them, and they are
generally one semester (some
might be longer). The cost would
be whatever the cost of the
college is.
As for employers taking you
back without the refresher;
anything is possible, but my
experience is that they require
you to have some kind of an
update. Good luck on your
re-entry. We need you!
Nurse Nancy
August 3, 2004
Dear Nurse Nancy,
Please send me information
about end-of-life issues so that
patients die comfortably and not
alone. I work as an RN for Salem
Hospital. Salem Hospital is
interested in initiating this
volunteer program.
NR
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Dear NR,
I am not sure about a
volunteer program for this, but a
great place to start to look into
end-of-life issues is Last Acts.
(www.lastacts.com)
This is a national coalition to
improve care and caring near the
end of life.
Their website has all sorts of
great information which I know
will help you.
Good luck.
Nurse Nancy
August 2, 2004
Dear Nurse Nancy,
I am an RN-associate degree
from 1980. I live in the San
Fernando Valley-Los Angeles
County. I would like to further
my education and obtain a BS and
perhaps an MS. I am interested in
patient education in the fields
of diabetes and cardiac rehab. I
am also interested in holistic
care. I would like to know the
schools in Los Angeles County
that have BS/MS programs as well
as online education
possibilities. Can you help me
with a starting point? Thanks.
DS
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Dear DS,
I think your starting point is
right where you are – at
Nurseweek.com. We have a list of
every nursing school in the
United States, and you can click
here, to find all
sorts of programs. Do some
serious investigation, as many
schools have a combined program
where you can work on both your
BS and MS at the same time.
Online education is also an
option, and perhaps that will be
the best way for you to earn your
degree.
Good luck.
Nurse Nancy
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