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October 31, 2003
Dear Nurse Nancy,
I am a registered nurse in San Francisco, California.
I have as ASN degree but planning to return to school.
Which would you say offers more job security........CNS
or FNP? I am undecided on which road to take.
JK
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Dear JK,
Great question. Of course, both of these advanced practice
roles have viability, but with different paths. Clinical
Nurse Specialists generally work with staff and patients,
role model behavior and work to make the time the patient
spends in the hospital a more productive and educational
experience. They are considered advanced practice nurses
by the American Nurses Association, along with nurse
midwives, nurse anesthetists, and nurse practitioners.
Nurse Practitioners generally work more independently,
and work with patients directly. They have been around
for many years, and I believe are here to stay. One
reason is that they have defended their role in health
care, and provide a great service to many patients.
Clinical Nurse Specialists provide a great service
also, in that they are experts in their specialties,
and serve as role models to staff, along with providing
care to patients and their families.
Both are good, both are viable. I encourage you to
do whatever it is you want to do. You need a Masters
degree for both, and I would encourage you to develop
your professional life - publish, speak professionally,
participate in specialty organizations.
Either way….go for it, and good luck!
Nurse Nancy
October 29, 2003
Dear Nurse Nancy,
My hospital had just opened new positions of Clinical
Nurse Specialists as educators for each patient care
area. I am contemplating applying for a position. Do
you think this is a wave of the future or will it fizzle?
JAE
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Dear JAE,
Well, I don't know that I can predict the future, but
I do think this is a wonderful opportunity for you to
make a difference in the care of your patients. I would
encourage you to discuss this with whoever you will
be reporting to; I think it is a fair question.
One thing that comes to mind immediately is to work
with your Performance Improvement Department and start
collecting data right away. A sure way for this to be
successful is for you to PROVE your contribution - in
data. I would collect all sorts of baseline information
- quality indicators like what the rate of infection
is, what the average length of stay is, how your unit
does with pressure ulcers, pain management, and so forth.
What will definitely get the attention of your administration
is if by adding your position, you are maintaining quality
AND meeting deadlines of the patient's targeted length
of stay.
You have to get this into a regular report for the
right people - have your supervisor help you with that.
People pay attention to improved patient care, and we
all know education is a great way to improve practice.
It sounds exciting to me……good luck!
Nurse Nancy
October 28, 2003
Dear Nurse Nancy,
I am a 23 year old nursing student. I will be graduating
in December of 2003. I am very excited to be entering
the field of nursing. My problem
is that I am unsure of what type of nursing that I would
like to go in to. I am afraid that if I specialize too
early, then I will always be "stuck" in that
area of nursing. On the other hand, I feel that Med-Surg
is too general for me. Please give me some advice.
Sincerely,
MC
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Dear MC,
Well, first of all, welcome to Nursing! We are happy
to have you, and it is a great time to be entering the
profession. As for specializing, I would encourage you
to think about going to a Med-Surg unit for a lot of
reasons. It is a specialty in nursing (one we often
don't value, but I believe it to be a specialty) for
several reasons. Some that come to mind are:
- You need to learn time management, critical thinking,
and organizational skills. You will be amazed at how
much you can learn on a Med-Surg unit.
- As the acuity of patients increases, patients who
were formerly cared for in Intensive Care Units are
now on Med Surg units. It is not uncommon to find
patients on ventilators, dialysis, and so forth on
Med Surg units.
- Generally, managers are looking for experienced
nurses before they will take them in specialty units.
You will be much more marketable if you come as a
confident nurse rather than a (understandably) terrified
new grad.
Med Surg units also help you figure out what kind of
patients you might want to specialize in. You will have
the variety you won't have in a specialty area. It is
a great place to be exposed to all sorts of patients.
I wish you well as you make your decision. Good luck!
Nurse Nancy
October 24, 2003
Dear Nurse Nancy,
I have a career dilemma and would like to ask your
opinion. At the ripe old age of 58, I am a registered
nurse, retired from 30+ years in higher education as
a nurse educator, master's degree in nursing, and would
like very much to re-enter clinical settings. With the
life expectancy lengthening all the time, I can look
forward to many years of being active in nursing. Even
though there is supposed to be a nursing shortage, finding
a clinical position proves to be somewhat difficult.
Now I need to
prepare for the clinical arena, and having difficulty
finding a re-entry course. In your view, what are others
doing to re-enter nursing? Also what should one do who
would like to make a continuing contribution to health
care? Thanks and I am looking forward to your response.
BJ
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Dear BJ,
Well, you certainly have excellent credentials! Given
your background, I think you would be a great staff
development instructor. That position would utilize
your platform skills, as well as give you the opportunity
to be at the bedside with your new orientees. In 30
years, you have had to keep up with trends and issues
in nursing - I think most organizations would appreciate
that.
As for what are others doing to re-enter nursing (and
in your case, you have been working for 30 years, so
I don't see this as re-entering, as you really never
left) is going to refresher courses, generally offered
by local community colleges. Also, some hospitals have
a one day update (for new per diems, agency nurses,
and travelers) that reviews pumps and equipment used
in that facility. I would look to see if you can find
a place that does that.
Given the shortage, I agree that you have a lot to
offer. You just have to go out there and sell yourself…..you
bring much to a new position.
Good luck and have a great weekend!
Nurse Nancy
October 23, 2003
Dear Nurse Nancy,
I would like advice about the CCRN exam course
materials.
I received my BSN in 1996 and worked as an ICU (open
heart recovery) nurse for 3 years until I took time
off for my family. I would like to get my CCRN as a
way of getting back into nursing and to serve as a "refresher"
course after being away from it for so long.
I am looking for a critical care text (not just
a review course) to learn the information I need to
past the CCRN exam. The "review" books and
courses I have encountered thus far seem to be outlines
of the material and involve rote memorization. I am
looking for a more comprehensive text, to truly understand
the material. I have the "AACN Core Curriculum"
and "Pass CCRN!"
Is there anything else out there?! Or will I have
to suck it up and
learn by these bibles? I am not opposed to buying graduate
school texts, if you have any titles you would recommend
to help meet my goal.
Best regards,
AC
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Dear AC,
It is great that you are interested in obtaining your
CCRN. It is an impressive credential which denotes to
the public those practitioners who possess a distinct
and clearly defined body of knowledge called critical
care nursing. Currently there are 40,000 proud RNs who
have this credential.
Before you move forward, though, I would encourage
you to review the eligibility criteria for taking the
exam. Reviewing for it certainly will be a good way
to get back into nursing, but you are not eligible at
this time to take it. You must have 1750 hours in direct
patient care within the last two years, with 875 of
them being in the year preceding the exam. You will
also need to submit the name and address of a supervisor
or coworker who can verify that the requirements have
been met. You can find all this, and more information
regarding the exam, on the American Association
of Critical Care Nurses website
As for your question about texts and calling the AACN
Core a "bible" - you would be wise to study
from these books, as they cover the material that is
on the test. Each certification board develops a blueprint
for their tests, and the Core Curriculum covers the
material to be reviewed. Buying other texts will help;
I would suggest you look in the reference section of
the Core, and use those books listed, as the authors
recommend them.
So - welcome back to nursing, and I hope you achieve
your CCRN when you are eligible to take the exam. Good
luck!
Nurse Nancy
October 21, 2003
Dear Nurse Nancy,
I graduated BSN at 1991,but never work as a nurse
I have a California RN license and cannot find a nursing
job anywhere due to no nursing experience.I plan to
enroll in an RN Refresher program at a community college
this fall. Will I be able to find a nursing job after
the refresher course even though I have no nursing experience
yet? How and where can I gain my first nursing experience?
Please help me!!! I want to work as a nurse. Please
give me some advice!
SG
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Dear SG,
I think what you need to find is an incredibly helpful
nurse recruiter and an even more understanding nurse
manager. Not an easy combination to find, but I bet
there are some out there. You are in a unique situation,
as you are not really a new graduate, and so much has
happened in health care since you were in school. I
would go out and buy a drug book right away - there
have been many new medications since 1991.
Another possibility is a nursing internship that some
hospitals offer. This allows you to re-enter in a bit
of a less stressful environment. The pay is often much
less than a registered nurse, but so are the responsibilities.
It is also a good way to see if you really want to do
this.
When you do find a sympathetic recruiter, I would advise
you to be open to any position he or she is offering.
This includes any unit, any shift. As with all new employees,
you will have a probationary period so that your supervisor
can evaluate your performance. You will have to work
very hard to prove yourself, but you sound like you
really want to do this.
I wish you luck. If you do find a manager who will
take a chance on you, I know you will be a model employee
and remember what was done for you.
Good luck!
Nurse Nancy
October 18, 2003
Dear Nurse Nancy,
I am a retired R.N. with a master's degree in counseling.
Where can I find information on becoming a certified
diabetic educator?
Thank you
BG
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Dear BG,
I think this is a great combination - your counseling
masters will really help your patients with diabetes,
as there are so many issues in a chronic illness.
The certification (CDE) is an interdisciplinary one,
awarded to not only nurses, but nutritionists, pharmacists,
social workers - all of the professions who work closely
with patients with diabetes. The certification is awarded
through the American Association of Diabetes Educators,
and of course we at NurseWeek.com try to link you with
all of the specialty organizations.
You can reach them through our site, just click
here!
Good luck in the next chapter of your professional
life! Have a good weekend everyone!
Nurse Nancy
October 17, 2003
Dear Nurse Nancy,
I am a RN trying to re-enter the nursing field.
I have been a neonatal intensive care nurse for more
than 10 years. I have been out of nursing for at least
10 years. I have a current job in another field which
I like, but I am interested in trying nursing again.
The only problem is that I don't want to give up my
full time non-nursing position. Are there any week-end
RN refresher courses or orientation programs for RNs
wanting to get back into nursing on a per diem or part-time
basis?
NG
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Dear NG,
This is quite a tall order, isn't it? Ten years to
be away is a long time, and I think you will be amazed
at the differences in health care.
Most RN refresher courses are given by community hospitals,
so I would start looking there first. Perhaps they have
an evening or weekend course. If not, I would suggest
taking a leave from your current position, and see how
you like being back in nursing. You might meet with
some nurse recruiters also, and see if they have vacancies
in that area, and if they would employ you on a per
diem or part time basis.
I wish you well in your exploration. Good luck!
Nurse Nancy
October 15, 2003
Dear Nurse Nancy,
How do you feel about educational programs that
are completed on-line? I would like to obtain a Masters
in Nursing but with a full time job and a child at home,
I don't have a lot of time to sit in a classroom. Appreciate
any advice!
Thanks
SGN
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Dear SGN,
I think on-line education provides an opportunity to
many nurses who for whatever reason cannot do a traditional
classroom experience. As an employer, I would think
the individual has commitment, the ability to complete
projects, and the discipline to work alone. I have taken
one course on-line, and I was amazed at how much work
was involved. To complete an entire Masters degree would
require much discipline.
I would be careful to select a program that is accredited
by the National League for Nurses, so that it has credibility
as an educational program. Do some investigating before
you start - ask to speak to faculty and former students.
Ask them what was good and bad about the program. What
most nurses tell me is that it is isolating; you might
miss the interaction among classmates and the richness
of "live" discussions.
But given your personal schedule and busy life, it
might be the right thing for you. Just be sure to do
some investigation before you start. Check
out NurseWeek.com's Nursing Schools link. Good luck!
Nurse Nancy
October 14, 2003
Dear Nancy,
Is it legal for an RN to work a schedule of seven
nights without a break on a six weeks schedule (RN works
seven nights every night for the next six weeks schedule)
Help!
GV
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Dear GV,
Well, if I understand your question, you are scheduled
to work seven nights in a row for six weeks straight?
Of course this is not legal, but more importantly, it
is not safe. Working that many hours can only lead to
fatigue and errors. While I would be concerned about
your personal health working that many nights in a row,
I would be very concerned about your patient's well
being - what nurse could function given that assignment?
This is not a safe practice at all, regardless of the
reason. I would take this through the chain of command,
through your direct supervisor, and then on to your
Human Resource Department. Hopefully you can settle
this locally, but the HR professionals can tell you
about the Labor Laws that dictate practice. I would
start a paper trail and document all of this.
Good luck in your efforts.
Nurse Nancy
October 13, 2003
Dear Nurse Nancy,
I am a brand-new RN grad (associate degree program)
and just started on a med-surg floor at a hospital.
I will be able to "orient" for about 7 or
8 weeks. It seems time management is a critical element.
I have only been on the floor five different days, and
am slowly building up to taking 5 patients. Right now
I feel overload with just 3 patients. Is this normal
or I am just slow? Thank you for any advice or input
you have.
SS
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Dear SS,
First of all, welcome to nursing! I can understand
how you must feel like there is so much to learn, in
such a short time. My advice is to remember that you
are a new practitioner of nursing, and that no one learns
time management over night. Like all skills, this comes
with time and repetition. The more you practice this,
the easier it will get. Ask for feedback from your preceptor
and manager; they have helpful hints on what works for
them, and can help you be realistic in your goals.
I am happy for you that you have 7 or 8 weeks to orient;
that is more time than most programs that I know about.
Just take each day as it comes, and you will see how
much progress you will make. My advice is to take care
of yourself - have some balance in your life as far
as sleep, nutrition, exercise. I am an advocate of getting
off of your unit during your shift - just see other
scenery, even if it is the cafeteria.
I am hopeful that by the time you are reading this,
that you are already feeling more organized. Hang in
there - we all felt this way at one point in our career!
Nurse Nancy
October 10, 2003
Dear Nurse Nancy,
I was only 5 months into my first job as a new RN
when I gave birth to my first child and my husband got
a new job across the country. Now that my daughter is
7 months old, I want to just work a couple shifts a
week, weekends and/or evenings. With my little amount
of experience, are my options only in acute care?
AT
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Dear AT,
One of the realities of the nursing profession is our
mobility in the work force. We move. We take time out
to raise our families. We move in and out of the work
force depending on our current situations.
I think what you need is a great nurse recruiter to
find a niche for you in nursing. Given the nursing shortage,
and your willingness to work some weekends or evenings,
I don't think you will have any problem finding a job.
Look around - perhaps long term care might be your niche,
or perhaps some kind of ambulatory setting. Many healthcare
organizations are recognizing the difficulty new mothers
have in arranging for day care, and have on site day
care for employees.
Recruiters are networked, and likely know about positions
in other hospitals, as they keep up with trends in vacancies.
Your situation is very understandable, so just be confident
that you have something to offer - you will find it.
Good luck.
Nurse Nancy
October 7, 2003
Dear Nurse Nancy,
I am an RN (ADN) currently working in neonatal intensive
care in North Carolina. I have been told by my peers
and superiors that I am a natural-born teacher. I am
interested in pursuing the possibilities of becoming
a nursing instructor for a local college or university.
Do you have any advice on selecting the correct curriculum
to help me achieve this goal?
Thank you,
WM
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Dear WM,
What a compliment that both your peers and supervisors
are so encouraging! Along with the current nursing shortage,
there is also a tremendous shortage of qualified nurse
educators, so there are many opportunities for you in
the future. And your specialty as a neonatal nurse make
it even more valuable, as not many nurses have the clinical
expertise to teach others about this specialty.
First things first. You need to go back and complete
your BSN, as this will be your requirement for graduate
school. You live in a state with many excellent graduate
schools (my bias as a UNC graduate is acknowledged here).
Many programs offer a Masters in Nursing Education,
or a Masters in Education. The courses you would be
looking for are those which will help you learn about
the whole process of teaching and learning - how people
learn best, how to write a lesson plan, and so forth.
I would look for a program that has a student teaching
component, so that you can work with a nurse educator
mentor who can help you find your teaching style. Examine
all of the options that each school offers, and talk
to alumni of the programs to make your informed decision.
Teachers influence nurses in so many ways. I think
it is a great skill to be able to teach - I wish you
luck as you begin this process.
Nurse Nancy
October 6, 2003
Dear Nurse Nancy,
What are the nursing implications involved in organ
donation?
ZF
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Dear ZF,
Nurses play a very important part in organ donation.
There are thousands of individuals waiting for organ
and tissue donation, and I think the first thing nurses
should know is the process of organ donation. You might
have heard of the Arkansas LVN who donated a kidney
to her RN colleague… that was truly a gift of life
and was great press for nursing and organ donation.
As nurses, we connect with our patients and their families,
and at times families will ask our opinion in this difficult
situation.
I would encourage you to be in touch with your local
organ donation organization. They are always willing
to come and speak with nurses about what we can do in
terms of organ donation. Where I work, they are a part
of each nursing orientation, so that all of our staff
know how to be in touch with them. They have all the
information you need, are supportive in recognizing
that this is difficult for some families (and nurses)
and are there to help.
I think once individuals have the information, they
can make the decision with some clarity. And by all
means - sign your organ donor card, tell your loved
ones your wishes. Sadly, many families have no idea
what the wishes would be of the patient - talk about
it, get the information so that if the time comes, you
are all on the same page about this issue, and you can
honor the wishes of your loved ones.
We have several excellent articles at NurseWeek.com
related to organ and tissue donation - type in "organ
donation" in the search engine and you will find
them.
Thanks for the question.
Nurse Nancy
October 1, 2003
Dear Nurse Nancy,
I graduated from a practical nursing program several
years ago with diploma. I currently work in a job that
requires some nursing triage, phlebotomy, EKG etc..
I do not give any injections because I don't have a
license. I do however do everything else that the LPN's
do, that does not require a license. My job claims because
I have no license that I am NOT a nurse I am a medical
assistant. Is this true? I am currently studying for
my state board exam which requires a nursing diploma.
Doesn't the nursing diploma mean I am a nurse? Please
help me clarify this.
Thank you,
LC
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Dear LC,
Well, you are well on your way to be a licensed practical
nurse, but your employer is correct. Graduation from
a practical nursing program prepares you to be able
to sit for the exam and become licensed. The nursing
diploma means you are a graduate nurse, but not a licensed
one. All of our practices are defined by the State Board
of Nursing Practice Act. You can read about your state
by clicking
here. They define what can and can not be done -
for example, you do not need a license to do phlebotomy,
but you do (in most states) to start an IV. The difference
may be subtle, but it is a function limited to someone
with a license.
We need all the members of the team - Medical Assistants,
LPNs, RNs (and others). But we all must practice within
the scope of our practice. I wish you good luck as you
become licensed!
Nurse Nancy
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