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