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Answers to Your Nursing Career Questions

Taking a Break – Even Nurses Need One

November 29th, 2010 by – Marijke Durning

Break time: A few minutes to sit and not answer call bells, not pass out medications, and not do anything nurse-related. Sound impossible? Even if you can only spare 15 minutes, that is 15 minutes that you can use to regain your energy.

So, what can a nurse do during a short break to make it feel it worth while?

Eat a Healthy Snack

Apples are supposed to be a better waker-upper than caffeine. Did you know that? You know they’re good for you and they’re easy to carry to work. Of course, there are other healthy snacks too, such as yogurt, cheese and crackers, and even a chicken wrap you may have brought from home – so as long as it’s healthy, take the time to sit down and eat it. The food will help you maintain your energy level and keep you from getting that “I’m starving” feeling later in your shift.

Drink Some Water

Even if you’re taking a coffee break or you aren’t really thirsty, make it a point to drink some water while you’re on your break. Hospitals tend to be quite dry, either because of air conditioning or their heating systems. We can’t always take a drink of water while we’re working because our hands are full or we just can’t get near a tap – so by making a habit of drinking water at break time, you know you’ll get at least one or two glasses down at some point in your shift.

Lift Up Your Feet

Being on your feet all day can be tough on your feet, your legs, your hips, your back. Even if you’re sitting at the nursing station to do charting or paper work, it’s highly unlikely you can put your feet up. So, on your break, if you can find a comfortable place, sit with your feet slightly elevated, not high above the level of your hips. This allows your body to sit in good alignment and gives your feet a break.

Wash Your Face

Believe it or not, some nurses find it very refreshing to go and thoroughly wash their face. The clean water, the washing (massaging) action, and the rinsing, can all be quite refreshing, giving you a sense of energy and well-being.

Meditate

If you like to meditate, you know that 10 or 15 minutes – although short – is plenty of time to relax. Go into the break room or a quiet place and just concentrate on your thoughts and your breathing. You may want to set an alarm on your phone or watch for this one as it is easy to doze off or just get carried away.

Read Something Fun

If you like light reading, it could be a good idea to keep a book of short stories, essays, or  jokes (even nursing jokes!) in your bag. That way, if you sit down for a few minutes, you can sit and read, taking your mind of more pressing and serious matters that you left behind on the ward.

Sometimes it doesn’t even seem to be worth it to take a break – after all, you say to yourself, it’s only for a few minutes. But they’re your few minutes. You’ve earned them and you deserve them. Take them.

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Evaluating Online Programs

November 27th, 2010 by – Sue Barton

  How can I tell about the quality of online classes/programs?

Here are a few pointers taken from the May 2010 issue of U.S. News & World Report magazine in an article titled  “Maximizing an Online Education” by Rebecca Kern.  It’s critical to make sure the program is accredited.  For nursing programs the accrediting agency should be the National League for Nursing Accrediting Commission.  Consider the reputation of the school in your field of study.  Have you heard a lot about the school?  Do you know graduates of the program who can recommend it?  Access to a physical campus may be a consideration especially if you  need to do labs or some classes/clinicals on site.  Look at the quality of the faculty for the program you are considering.  Do they have experience with online teaching?  Are they accessible to you? 

Not surprisingly, Kern states that success is dependent on student self motivation.  Students also need to be tech savvy and disciplined in time management.  Look for the ability to be involved in online class discussions, and to communicate with other students about projects and homework.  The good news is that online education is becoming more common, and also increasingly well accepted as a quality route to furthering your education.

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What Is a Nursing Care Plan?

November 26th, 2010 by – Marijke Durning

When you are a nursing student, you hear a lot about nursing care plans. You hear about writing them up, reading them, and following them. Ok – that’s all fine and good, but what exactly IS a nursing care plan?

Quite simply, the nursing care plan is the roadmap that all nursing staff follow in order to properly care for a patient. The care plans outline what nursing problems the patients have and what interventions nurses do to help the patient.

When a doctor cares for a patient, her concern is to diagnose and treat the problem. For example, if a doctor diagnoses a broken hip and does surgery to repair it, that is what she concentrates on.  When the patient comes to the floor, the admitting nurse has to see what nursing problems the patient has aside from the medical diagnosis.

The nurse is concerned with the fact that the patient just had surgery, which means he must watch for:

- Pain

- Signs of infection at the surgical site and systemically

- Issues with immobility

- Issues with nutrition due to pain, immobility, and recent surgery

- Issues with elimination due to surgery, pain, immobility and possible lack of appetite

- Issues with safety – will the patient try to get out of bed alone when it’s not safe?

- Psychosocial issues, such as depression, isolation, etc.

This goes for every area of nursing, from the example above (orthopedic nursing) to home health nursing to palliative care nursing. Every patient has a goal that needs to be met.

Each potential problem must be listed and the interventions that the nurse will do when he assesses and cares for the patient. If there is no problem, then the nurse’s goal is to ensure the patient stays status quo – unchanged. If there is a problem, the nurse has to outline the goal and how the nursing team should act to reach towards that goal.

As you can see, a nursing care plan isn’t all that different from any other type of plan any professional may use. If lawyer has a case to fight in court, she will need to identify all the strengths and flaws in her case.  You can’t fight a good fight unless you can figure out what needs to be addressed.

Nursing care plans aren’t something to be nervous about. Sure, while you’re learning, you may make mistakes or leave some things out – but that’s why you are learning.

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Posted in Nursing School

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Your Role in Quality Improvement

November 26th, 2010 by – Derek Brocklehurst

What is my role in quality improvement?

Quality assurance, now called quality improvement, means that all health care workers seek out tasks and duties that can make the work place healthier, safer, and more secure for all patients and workers. Between keeping medical records, administering medications, delegating tasks, and performing procedures, quality improvement can be quite the rigorous addition to daily work. Luckily, if you follow these tips, quality improvement will be easily integrated into your everyday tasks:

  • Double check that you documented times that procedures (collecting vital signs) were completed on the patient’s chart
  • Make sure you check the 5 “rights” of drug administration
  • Delegate appropriate tasks to CNA, LVNs, or other RNs if you have multiple patients to assess
  • Take your time when assessing patients
  • Read up on your health care institution’s policies, protocols, and standard operating procedures
  • Get to know your nurse’s station and locate your unit’s emergency equipment
  • If you’re unsure of something, ask for help

As a nurse, it is your #1 priority to maintain patient safety in all situations. If you have any questions about procedures or policies, ask your charge nurse or nursing supervisor for help! It is better to err on the side of caution than to cause harm.

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Posted in Common Nursing Procedures, On-the-Job Fears

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Informed Consent and Financial Disclosure

November 25th, 2010 by – Derek Brocklehurst

If a nurse receives commission for surgical instruments as the sales representative for a specific company and is paid as the NP during surgery, can he or she be both a the surgical nurse and the sales rep with out the patient’s consent?

This is a good question that deals with the patient’s full knowledge of procedures. Typically, a nurse would stay away from putting herself or himself in this situation. If the surgery went wrong or if the outcome was unpredicted, it could place a lot of weight on the nurse for malpractice.

Informed consent requires the patient to have full and complete knowledge about everything surrounding the procedure, including if the surgical nurses or providers have financial ties with the instruments used during the surgery. If you disclose this information to the patient prior to surgery, make sure you honestly answer any questions they might have. If they choose to sign the consent form, you should be able to practice and assist during the surgery.

If there is any question or you think there is a gray area in the consent form, do not perform or assist in the surgery. Ask your nursing manager or consult your state board of nursing. The last thing you want is a lawsuit from the patient, the sales company, or the practicing health care institution.

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Posted in On-the-Job Fears

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What now?

November 25th, 2010 by – Sue Barton

  I graduated in 1994 with my ADN degree but I never did anything with it.  What can I do with my degree now?

If you are in a place in life where you can consider returning to school, your best bet would be to build on the ADN degree by pursuing a BSN.  Let’s assume you never took the NCLEX or pursued obtaining a nursing license and never practiced as a nurse.  If you want to pursue a nursing career, rather than taking refresher courses or exam prep courses, make an appointment with a nursing educator in a college in your area to discuss options.   Ask about RN to BSN programs,  part time classes, online classes, and financial aid.  By obtaining a BSN you will be in a position to do more with a future nursing career. 

If you do not want to pursue nursing, the ADN degree could be a springboard to a career in a related health field such as health care administration.  The variety of health care careers is large and the demand in most fields ensures good opportunities for employment.  If you give some thought to what career is the best fit for you, and explore moving ahead with your education. there are sure to be some great options for you.

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You Have Your Nursing License – Now Where to Work?

November 24th, 2010 by – Marijke Durning

Now that you’re a graduate nurse, nursing license in hand, what are you going to do with it? There are so many possibilities, so many choices – which one is right for you? Here are a few examples of how varied work options are:

Travel nursing

Travel nursing is appealing to many nurses because it allows them to move from place to place without being tied down. Many nurses like not only the freedom of travel nursing, but they also like the variety. Some use the opportunity to see what areas of nursing they prefer before settling down. However, as appealing as travel nursing may be, it isn’t always an option open to new graduates. Most travel nursing agencies prefer that their nurses have at least a year or two of experience before they hire them.

So, if this is what you want to do, you may want to find a job – maybe on med-surg – to get your skills and practice in, and then apply to be a travel nurse.

Military nursing

Unlike travel nursing, military nursing is a commitment to one area and one employer – the military. But, in the military, you still may be sent to various places around the country or around the world. Some arms of the military take newly graduated nurses and even offer help in repaying student loans in return for a set time of service.

Many people don’t realize this, but military nursing can be just as varied as civilian nursing. Nurses work in all fields, including pediatrics and obstetrics, depending on where they are stations.

Home health care

Home health care nursing is quite different from hospital nursing and requires an ability to work alone. Nurses visit their patients in their homes and have to do their assessments without the benefit of asking a coworker for another opinion, for example. On the other hand, home health nurses also often end up caring for the same patients consistently, allowing them to get to know the patients well. This means they may notice little changes in a patient that other health care staff may not have the opportunity to see.

Some home health services do hire new graduates, but it is often recommended that nurses have some experience in hospital care first, so they can fine tune their assessment skills first.

Office nurse

Not everyone wants to work in the hospital environment and for some, the doctor’s office or a medical clinic setting is just right. What a nurse does in a doctor’s office depends entirely on the doctor and the setting. Some nurses do a lot of administrative work in addition to their nursing tasks, while others do strictly nursing work.

If an office job interests you, it is important that you understand before you begin how much nursing you will be doing, so you aren’t disappointed if the job does turn out to be more clerical.

Correctional services nursing

Now here’s a job that not many people may consider, but it’s one that many nurses find satisfying: nursing in a correctional facility.

Nurses who work in prisons see a great variety of health issues, as whatever happens “outside,” also happens in the prisons. The nurses work with physical, as well as mental issues, as they work with the inmates on a daily basis.

While the thought of working behind prison walls may be intimidating, for some nurses, it’s the only thing they want to do.

There are scores more types of work environments for new nurses. What is interesting you?

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Posted in Work-Life Balance

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Acne Treatment

November 23rd, 2010 by – Sue Barton

  What are the medications used to treat acne? 

 Acne medications act by decreasing oil production and bacteria, specifically P. acnes, as well as by decreasing inflammation and desquamation, all of which are involved in acne outbreaks.

Benzyl peroxide is an ingredient in many non prescription acne products, and is helpful in  drying the skin as well as having some antibacterial effect.  One side effect to be aware of is bleaching action if the cream comes in contact with clothing or  fabrics. 

The retinoid family of medications is also useful in drying acne prone skin.  Tretinoin comes as a cream or a gel, and in a variety of strengths.  Other topical retinoids such as adapalene or tazorotene may have excellent results with less  irritation.  Accutane is a systemic retinoid that is used by dermatologists for severe cystic acne that is unresponsive to other measures.

Antibiotics can be applied topically, such as clindamycin gel, or taken orally.  Doxycycline and minocycline are common choices for oral treatment.  Antibiotic resistance is a consideration, and is one reason tetracyline is less commonly used than it was years ago.  Oral antibiotics are a better choice if  acne is widespread over the chest, shoulders,and back.

Combination products combine 2 of the above topicals into one product, such as Benzaclin cream (benzyl peroxide and clindamycin)  or Epiduo ( adapalene and benzyl peroxide).  While convenient, these products are more expensive, and not necessarily more effective than applying generic topicals separately.

Birth control pills can also be helpful for women.  Yaz and Ortho Tri Cylcen are 2 brands that have indications for acne treatment.

Acne is a serious concern to teenagers.  They need to know that medications take 6-8 weeks to see results, and that there are many options to improve outcomes if the initial treatment plan is not satisfactory.

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Caring for Your Suffocation Patient

November 22nd, 2010 by – Derek Brocklehurst

Hello. I am looking for a nursing care plan for suffocation. Thanks.

Suffocation, or a lack of oxygen to the brain and major body organs, can cause an urgent or emergent situation at any time. The brain requires a constant supply of oxygen in order for all body systems to function properly and efficiently. Once oxygen levels are cut off to the brain, even if for a couple of minutes, dire consequences can ensue. If the brain doesn’t get the oxygen it needs, it can result in brain tissue damage which is oftentimes irreversible, causing partial paralysis depending on the area of the brain affected.

As a nurse, you should make sure oxygen is readily available in the form of a nasal cannula, oxygen tank, oxygen face mask, an intubation kit, and an emergency tracheotomy kit. Monitoring oxygen saturation with a pulse oximeter, as well as monitoring other vital signs per the provider’s orders is key in preventative care and anticipating problems.

If oxygen was depleted for more than 3-4 minutes, assess for oxygen deprivation as any of the following symptoms: partial body paralysis, slurred speech, confusion, decreased level of consciousness. Collaborating with the physical therapist, oxygen therapist, dietitian, and primary care provider would prove beneficial for the patient’s overall prognosis.

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Posted in On-the-Job Fears

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Nursing and Working on the Holidays

November 22nd, 2010 by – Marijke Durning

Not very many people want to work on a holiday and we can’t blame them. If family and friends are getting together, the idea of missing the fun can be disheartening. Unfortunately, the reality of nursing is that it is a 24-hour, 7-day per week job – 365 (or 366) days per year. Holiday or no holiday, nurses are needed. In some areas, the administration may be able to cut down on staffing by closing some beds or units, but those areas are in the minority.

The thing is, most holidays are arbitrary days that have been chosen on our annual calendar. For those who celebrate Christmas, example, it’s believed that Jesus wasn’t even born in December, given the details of the weather at the time of his birth.

Days like January 1, for New Year’s Day and the last Thursday in November in the US for Thanksgiving – those are just days that were decided on once upon a time. Of course birthdays, wedding anniversaries, those are based on actual chosen dates – but they are still just days.

It’s the event that counts

Being together and celebrating together is what really counts. Does it make that much of a difference if you have your holiday dinner the day before or the day after the actual calendar date? Or even the week before or after? There’s actually a lot to be said to celebrating on off days because stress levels are down, more items are available, and the world around you doesn’t seem to be filled with “we MUST do this NOW”

Even traveling may be easier; it may be cheaper for those visiting friends and family afar, for both travel and accommodations.

There are exceptions, of course. In some families, out-of-towners may only be able to visit at certain times or there are other schedules to keep in mind. However, nurses aren’t the only people who have to work on holidays – so do a multitude of other people in other careers and professions – from bus drivers to flight attendants to emergency personnel.

So, as much of a drag as it can be to be scheduled to work on a holiday, at least the nurses get to go home after the shift and leave the thoughts of the hospital behind. The same can’t be said for the patients and those who love them.

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The material on this site is for informational purposes only, and is intended as a supplement, not as a substitute for medical advice, diagnosis, or treatment provided by a qualified health care provider.