September 30, 2003

Dear Nurse Nancy,

I recently graduated with an Associates Degree in General Studies. I am forty-two years old and strongly desire to become a nurse. There are three universities in my city that offer a two-year nursing program. But, I wonder if I should just go ahead into a bachelors program? Would that be the best?

AK

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Dear AK,

My bias is always for the BSN programs. I would advise you to get the catalogs of every nursing program near you. Carefully study what the pre-requisites are, and go and speak to the recruiter for the school to see which program offers you the best option. Many schools have different paths, including ones for individuals who may have another degree. Generally it is for those with a Bachelors in something else, but I would really look into the options.

If you click on our home page and click on Education/CE, we have a listing of every school of nursing by state listed. Hopefully there will be something there to assist you.

Welcome to nursing! We are happy to have you.

Nurse Nancy

September 25, 2003

Dear Nurse Nancy,

I start my first semester at nursing school. I have all my pre-requisites done along with my general Ed courses. I used to feel motivated, but I became discouraged after so many students tell me I am "so old". I'm only around students who are 18-29 years old. I'm the only middle age student at 39 years. Do you know the stats of people coming in to nursing at older ages? Will I be accepted in the field? Thanks for your thoughts.

DC

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Dear DC,

Thirty nine is "old"? My word……don't let those students discourage you! I am surprised that your class has such young students - the average age for nursing students these days is around 37, as many people are coming to nursing as a second career.

You will be fine. "Seasoned" (never old!) students bring life experience with them that most employers appreciate - work ethic, good judgment, and responsibility. And colleagues who came into nursing as you did tell me that most people assume you know what you are doing because of your age, and that it is actually an asset for your self-confidence.

So I say BOO-HISS to those who say you are old. Nonsense! Welcome to nursing - we are happy to have you!

Nurse Nancy

September 24, 2003

Dear Nurse Nancy,

What do you think of employers that do not allow their nurses breaks or lunches? This is everyday! and the shifts are anywhere from 6.5 hours to 8 hours.

WI

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Dear WI,

I think employers who do not allow nurses to take breaks or lunches are breaking the law. I am wondering, though, if these employers are overtly saying that, or is that the culture of your workplace?

There is obviously a reason for breaks and lunch. We need to take a few minutes to relax, clear our minds and refuel for the rest of the day. If you are working in an environment where you never get a break, I would suggest you rethink your priorities. I know you can't abandon your patients, but in most situations, a 15 minute break can be managed. (I have worked in places where nurses complained about this to me for at least 15 minutes - they could have had a break instead of whining about this!) If you can't manage it, I would collect data for a few weeks and present this to your manager. (This stuff is so emotional - I would encourage you to do this calmly and professionally)

If that does not work, I would suggest you present it to your Human Resources Department. They can assist in compliance with the Labor Laws. I do hope you can resolve this on a local level, though.

Good luck to you.

Nurse Nancy

September 19, 2003

Dear Nurse Nancy,

I am getting tired of hospital nursing, but I do not want to work in an office. I have wanted for some time to work for a medical supply company in education and or demonstrating the product. I have been a nurse for 36 years and have a lot of experience with equipment. How would I go about finding a position of this kind? I never get an answer on e-mail. I have particularly been interested in Pyxis and other machines used in patient care.

TN

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Dear TN,

Sounds like a great job transition for you, and you bring a wealth of experience to this adventure. I say adventure, because you will have to do some exploring to find a job like this. There are a few things I think you can do to increase your chances. Emailing resumes is one way, but you never know who receives them, and if the company has a policy that they do not open attachments (some do). Consider doing this:

• Have a very professional BRIEF resume and cover page done, "selling" yourself to the companies you are interested in - select as many as you can, and send it to all of them. This is your first impression, so be very clear about your request, your experience, and your willingness to travel (a must for most of this kind of job)
• I send my resume via overnight mail to places that are big and I wonder if the right person is getting it. If you request a signature on the package, you can follow up on it, as well as call in a few days knowing that (hopefully) the right person has seen it. Remember to keep a record of all the money you spend in job seeking - keep it for your income tax form.
• Network, network, network. Talk to every sales rep you know. Ask about vacancies, how he/she got involved in this business, etc. Who you know is often the key.
• Have business cards with your pertinent information on it (including email) Keep them EVERYWHERE - in every purse, pocket, jacket and coat. You never know where you might meet someone who can help - in the most unlikely places, like the dentist's office, church, and so forth.

This is just a matter of right place, right time I think. I wish you well. Good luck!

Nurse Nancy

September 16, 2003

Dear Nancy Nurse,

I am a RN with an ASN degree. After 10 years in the nursing field I find that I am very interested in Massage Therapy or Reflexology. Do you know what the future holds for the Nurse Massage Therapist or Nurse Reflexologist?

Thanks, TV

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Dear TV,

Well, I certainly don't have a crystal ball, but I do think there is a future in both massage therapy and reflexology. We have moved from the words "alternative medicine" to "complimentary medicine"; I believe that is a small but important difference.

I would refer you to the website of the American Holistic Nursing Association, whose mission is to unite nurses in healing (www.ahna.org)

There are so many modalities out there - Therapeutic Touch, Reiki therapy, massage therapy, aromatherapy. All are intended to assist our patients. I think it is a terrific area to explore.

Good luck to you.

Nurse Nancy

September 15, 2003

Dear Nurse Nancy,

I was involved in a sentinel event involving a medication error. The doctor ordered 300mg of plavix now. The order had been approved and noted. I did not catch that the patient was already on this med because it was listed under both the generic and brand names on the MAR for each order. (75mg Copidrogel and 300mg Plavix). At this time I was three months into my nursing career. The patient died following a cardiac catheterization the day following the error. The family did not want an autopsy so no real cause of death was established. Now I have been asked to speak at an in service regarding my personal experience and what a root cause analysis is. This has brought back many uneasy and guilty feelings. Do you know of any sites that could help me cope and prepare for this speech?

DE

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Dear DE,

I know this is a terrible thing to re-live, but I think it is good for you to share this experience with your colleagues. Many nurses do not know what a sentinel event is, or a root cause analysis. The Joint Commission of Accreditation of Healthcare Organizations (www.jcaho.org) defines a sentinel event as follows:

An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase "or risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called "sentinel" because they signal the need for immediate investigation and response.

A root cause analysis is a process for identifying the basic or causal factor(s) that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event.

I would suggest that you do an interdisciplinary in service, including the physician and pharmacist, as this is a shared responsibility. Medication safety is critical in healthcare, and as you review the error, there are several people and systems involved. The intent is to educate each other, not to blame. We can only learn from this situation, and go forward. We have double checks in place, but at times they fail, as this one did.

As for coping, I hope this in service might make you feel better, as you will be educating others. The JCAHO website has much information to share with your colleagues. Good luck in the presentation.

Nurse Nancy

September 11, 2003

Dear Nurse Nancy,

Could you tell me what the policy & procedure is for MRSA patients within the Behavioral units of acute care settings? I am doing research to upgrade our hospitals policy. Thank You

LB

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Dear LB,

MRSA (Methicillin Resistant Staphylococcus Aureus) is certainly a difficult issue for those of us in healthcare, regardless of type of patients. I would suggest you look on the Center for Disease Control and Prevention's website. They are one of the authorities on this topic, and have a fact sheet on the topic - I imagine in Behavioral Health the notion of prevention of spread of this would be of interest. Obviously, they advocate good hand washing with soap and water, but there is also more information for your hospital policy.

Go to www.cdc.gov, and on the left side of the page, click on Health Topics A- Z. Click on M and it will take you to MRSA.

Thanks for your question.

Nurse Nancy

September 10, 2003

Dear Nurse Nancy,

I worked in personnel for 20 years before becoming an RN. In those days when one applied for employment it was customary to send out a letter to the prospective employee to let them know if they were being considered for the position or being rejected. MY HOW THINGS HAVE CHANGED! I love applying for jobs over the Internet. I am so thrilled when I am contacted by a Clinical Manager who would like to interview me, but disappointed about what DOESN'T happen if the job is given to another candidate. No letters are mailed, no phone calls, and no email notification are sent to let me know the status of my application. This practice is not limited to the Internet. I have personally gone into a healthcare establishment, completed an application, and never heard from them again. When calling to check on the status of the application I never get a straight answer.....only that someone will return my call. And that never happens. Nancy, can you help me understand and get around this situation?

RL

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Dear RL,

I totally agree. This has been my experience also. I suppose it is a new world out there, but it is frustrating not to have closure or acknowledgement of an application. I know that nurse recruiters have a tough job these days in this shortage, along with budget cuts. I can only hope that our colleagues will read this and take your words to heart.

This of course is not the case with all nurse recruiters or organizations, but some just never get back to applicants. This does not speak well of the organization, and in this day and age of competition, I hope your letter will be of interest to those who don't send even a form letter with a response.

Thanks so much for saying it so well!

Nurse Nancy

September 9, 2003

Dear Nurse Nancy,

I am preparing for the NCLEX exam. I have a question about the first 15 experimental questions. I heard that those 15 questions will not count. I am thinking that if I give the correct response to those questions, the computer may catch my strong areas and weak areas. Should I respond to those experimental questions correctly? Or make some mistakes knowingly?? What is your opinion?

SS

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Dear SS,

I hope you get to read my response before you take the exam, or have asked one of your teachers about this. PLEASE do not even think about answering a question incorrectly if you know the answer. You won't know where the experimental questions are, so to answer any question other than correctly defeats the whole purpose of taking the test.

There is a reason for the experimental questions in any exam. Educators use them to see if the question is clearly written, and understood by the majority of test takers. They also want to see if the distracters (answers) are written clearly also. For example, if 90 percent of the test takers select the answer "B" and the correct answer is "C", there is something wrong with the question. If no one gets the right answer, it is likely too difficult. Experimental questions provide necessary data to those individuals who write the exams.

You know the drill - go to bed early before the exam, eat breakfast, leave plenty of time to get to where you need to be. Try to relax, and answer all the questions correctly. Good luck!

Nurse Nancy

September 5, 2003

Dear Nurse Nancy,

Recently, we accepted a patient transfer from another facility who was a Gypsy. She had exceptional cultural needs and her family was extremely difficult to manage. One of the nurses documented in her notes all of the difficulties she encountered with this family. I documented only issues that pertained to the patient's immediate care and her responses to my interventions. I feel that the other nurse set herself up for legal liability. Should she have documented this in the nurses' narrative notes?

MM

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Dear MM,

I agree with you. While I understand how challenging this situation can be, the medical record is never the place to document arguments, "he said-she said" kind of information. It is difficult to resist documenting all the difficulty, but you are correct in documenting just the facts.

Families coming together (in alarmingly large numbers) at the time of illness is one of the strongest values in gypsy culture. It doesn't help any that they sometimes camp on hospital grounds, disregard visiting rules and create chaos in the hospital. All in all, though, you have a job to do and you have to care for a group of patients.

While it doesn't make the situation any easier, sometimes knowing why people do what they do may help. I would encourage any nurse who wants to know more about the Gypsy culture, their beliefs and values, what they think of healthcare, and other interesting facts, to go to this website. An appreciation of other cultures is important.

Read here, Patin, Cross-culture Medicine a Decade Later, by Anne Sutherland. She talks about Gypsy's and their culture.

Nurse Nancy

September 3, 2003

Dear Nurse Nancy,

I am interested in knowing if there are nurse practitioners who work in the home health field. I am currently working as an RN in home health. I am also a newly certified adult nurse practitioner. I would like to stay in home health but in the advanced practice role. To do that, I need to develop a package that I could submit to my employer. I would like to know available resources for finding information on APN in home health to assist me in this task. Thank you.

JY

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Dear JY,

Congratulations on becoming a certified adult nurse practitioner - a great professional accomplishment for you. I can easily see a need for adult nurse practitioners in the home health arena, especially as our population ages. Hospice and palliative care are two opportunities that come to mind immediately, and your experience as a home health care nurse combined with your NP make you very marketable.

As for resources, a great resource is the American Academy of Nurse Practitioners. Their web site, www.anp.org, has an excellent section on home health care listed in the Legislative Section (just type in home health care). In it, they list issues, updates, fact sheets, current regulations, and information about Medicare reimbursement - a great beginning for your investigation. And I am sure you can network with some of the nurse practitioners who work in home health who can share job descriptions, responsibilities, billing information, and so forth.

Good luck in your new career!

Nurse Nancy

September 2, 2003

Dear Nurse Nancy,

Our Labor and Delivery unit is going from written documentation to PC documentation! Yippee, but...we have not received any formal training and will be going "live" soon! I am wondering, is this acceptable practice? It seems to me since obstetrics is such a hot bed for litigation these days, and our documentation is such an important issue, should we not be expecting better instruction?

Thanks for your help!

LN

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Dear LN,

Well, congratulations on going toward computerization. Yes, that is good news! I am equally surprised that you don't know about any education around this process. My guess is that there is a plan, but perhaps you just don't know about it yet. I would ask your nurse manager, or your staff development department.

Aside from the litigation in OB, this is a basic safety issue for all of you - and especially your patients. Speak up - you have a right to this information, and I honestly can not think of one organization that hasn't provided some kind of education in the transition.

Good luck!

Nurse Nancy