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Answers to Your Nursing Career Questions

It’s a Juggling Act

November 20th, 2010 by – Sue Barton

  I’m  starting a second degree BSN program, but I need to work full time, and I also have a family.  I’m just not sure that this is realistic, but I really want to get that nursing degree to have a better job in the future. 

Second degree BSN programs are usually set up with people like you in mind, in that classes are often in the evening or online, and clinicals may be on weekends.  While this sort of flexibility helps tremendously to allow you to work and pursue your educational goals at the same time, there are only so many hours in the day.   It’s only fair to say that you are going to need to be very focused and disciplined to pull this off, and on top of that you will need the understanding of your family. 

It may help to have a master schedule with your work hours and class times blocked out, including time  for studying.  Think about where you can study with the fewest distractions to make the best use of your time.  Try not to short change yourself in the sleep department.  Block out some sacred family time, and let your family know how much you appreciate their support in this endeavor.  Typically with a full time job it will take two years to finish your BSN degree, but you will have many years after that to practice in your new career.

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Dialysis Nursing

November 19th, 2010 by – Derek Brocklehurst

How can I become a dialysis nurse?

Dialysis is the medical process of artificial kidney filtration because the kidneys cannot function, either due to acute or chronic renal failure. The kidneys are responsible for electrolyte balancing (sodium, potassium, magnesium, chloride, calcium, etc.) and filtering fluids and toxins through the body.

Chronic dialysis patients may make anywhere from one visit per week to daily visits to the dialysis treatment clinic. Acutely infected renal failure patients may need more attention and patient care involving diuretics use and electrolyte replacement. Monitoring consistent blood work, nearly hourly, might be needed to anticipate impending total renal failure.

While there is no specific dialysis focus or degree for RNs, you might want to check with your state board of nursing for a dialysis accreditation or certification program. Some dialysis treatment centers or hospital units might require their RNs to be certified in specific dialysis care. Some nursing focuses where you might encounter more dialysis patients than you would otherwise encounter would be acute care, intensive care, and emergency care nursing.

Check out the American Nephrology Nurses’ Association website for information about programs!

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Posted in General, On-the-Job Fears

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Friday Funnies – Nursing Style

November 19th, 2010 by – Marijke Durning

It’s hard to be a nurse and not have a sense of humor. We have to laugh sometimes and some of the things we laugh about would not be evenly remotely funny to someone who doesn’t experience the nursing life on a daily basis.

Here are some “You know you’re a nurse when….” lines that may make you smile. Some are old and  have been around for a long time, others are newer:

You know you’re a nurse when:

- you’re standing in line at the store and you notice the cashier’s great veins, just ready for an IV.

- you don’t think all patients are annoying – some are unconscious.

- no-one will watch a medical show with you because of your corrections, comments and shots of “that’s not true!”

- you’ve told a confused patient your name was that of your coworker and to HOLLER if they need help.

- your bladder can expand to the same size as a Winnebago’s water tank.

- you’ve sworn more than once you’re going to have “NO CODE” tattooed on your chest.

- you imagine incredible torture scenes for the inventor of the call light.

- you consider a tongue depressor an eating utensil

What do you have to add?

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Posted in Common Nursing Procedures

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Entrance Requirements for Nursing School

November 18th, 2010 by – Sue Barton

  What is the entry requirement to study nursing?

The basic educational requirement to study nursing is completion of the 12th grade, or high school graduation.   The minimum grade point average from high school varies, but typically is at least a 2.5.  Applicants to nursing schools in some states are also required to have a negative urine drug screen and to complete a criminal background check.  This is because clinical sites require these tests to be done before staff or students may have patient contact. 

The most direct and shortest route to a career as a registered nurse is a 2 year associate degree, usually from a community college.  Many nurses with associate degrees will at some point complete RN to BSN programs to advance their careers. 

 High school students may apply directly to 4 year schools of nursing also.  Some programs are direct entry, with the freshman student directly accepted into the nursing program.  In direct entry programs, some nursing and introductory clinical are included along with the core classes and basic sciences during the freshman and sophomore years.  Other BSN programs consist of pre nursing courses during those first 2 years.  During the sophomore year, students apply to the nursing program and must be accepted, typically on the basis of their GPA thus far, along with recommendations.  This process can be stressful for students, since it requires them to apply to the college in the first place, and then to have the hurdle of getting into the nursing school still ahead.  However, knowing that many students change majors during their early years of college, it may be the most efficient way to utilize clinical faculty and sites.

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Signs and Symptoms of Stroke

November 17th, 2010 by – Derek Brocklehurst

I’m looking for the signs and symptoms of a stroke associated in patients with chronic diabetes mellitus.

Those with diabetes mellitus are at an increased risk for stroke because of the risk for high blood pressure. If your blood vessels have too much sugar, cholesterol, or other hypertensive factors (cigarette smoke, stress, etc.) flowing through them, you will be at increased risk for stroke. Your brain needs a constant supply of oxygen in order to go about your daily life. Strokes occur because blood supply is suddenly cut off from one part of your brain, either due to a blood vessel blockage or blood vessel rupture.

Signs and symptoms of stroke include:

  • Sudden loss of consciousness
  • Slurred speech or difficulty understanding speech
  • Unilateral paralysis or numbness (affecting muscles on one side of the body)
  • Unexplained and sudden migraine
  • Difficulty swallowing or chewing
  • Dizziness or trouble with coordination

Strokes should be treated with emergency care, as any loss of oxygen to the brain for more than a couple of minutes can have disastrous long-term effects. Make sure to assess a patient’s vital signs immediately as well as their respiratory capability. Intubation kits should be available in patient populations suspected to be at increased risk for stroke.

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Posted in General, On-the-Job Fears

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5 Things for Nurses May Be Thankful For

November 17th, 2010 by – Marijke Durning

Ah, the crunchy leaves on the side of the road, the smell of turkey roasting in the oven, the anticipation of a good meal – the end of November is a good time to remember all that we have to be thankful for.

While we’re aware of all the “regular stuff,” like a roof over our head, food to eat, and so on, how about having a look at what nurses may be giving thanks for this year.

1- Uniforms that don’t need ironing

Any nurse who has been running late and had to grab a nursing uniform or scrubs out of the dryer should send a thought of thanks to the person who invented “permapress” fabrics. Sure, we can still buy 100% cotton – and many nurses prefer them because of their comfort, but there’s something to be said about having a couple of no-iron uniforms hanging around.

Originally, permapress fabrics were treated with a substance that contained a high level of formaldehyde. In 1987, a new process was discovered that used significantly less formaldehyde and this became a popular treatment by clothing manufacturers.

Fast forward to 1998 and a new nano-technology was applied to fabric, removing the need to use the controversial formaldehyde. It’s nice to see how science is working on improving our daily life.

2- Microwaves

What did nurses do before microwaves? Before they could warm up their meals in a rush or heat up their cup of coffee yet once more?

Although the household microwave became available to the general public in the 1970s, they actually have been around since 1945 when the first microwave oven was tested out in a Boston, MA, restaurant. They began as industrial ovens but as manufacturing improved and prices dropped, microwave ovens became increasing popular in the mid-1980s.

Now, you’d be hard pressed to find a health care facility that doesn’t have microwaves for both staff and visitor use.

3- Coffee makers

Working nights? Where’s your coffee? Working days? You may just need your cup of joe to get that shift started. Thank goodness for the modern coffee maker and its ability to make a pot of coffee within minutes.

There have been ways to make coffee for centuries. From drip-type makers to vacuum-type brewers, people have always been trying to find a way to make a better cup of coffee.

The first coffee percolator was patented in the mid-1800s and while these could make good coffee, they weren’t the most convenient or easy to clean of appliances. Enter Mr. Coffee in 1972 – the first commercially available home coffee maker. Since the introduction of the Mr. Coffee coffee makers, appliance companies have been working hard to improve the product.

Whether you set your coffee maker on a timer so you have a fresh cup waiting for you when you wake up or you pour yourself a cup of coffee as soon as you get to work, that coffee maker may be a major part of your life.

4- Electric beds

If you are one of the nurses that can remember the crank beds – the ones with handles at the bottom of the bed that raised or lowered the head and foot of the bed, you likely also smacked your shins against those cranks at least once or twice. They left wicked bruises – if you were lucky. They left open cuts if you weren’t.

Getting patients comfortable in a crank bed could be difficult because you had to turn the crank until the patient was just right – and that could change just minutes later. Depending on how stiff the cranks were, this could also be a major feat as you fought with the crank to get it to do what you wanted it do.

Electric beds that could go up and down with the press of a button were major convenience for nursing staff. The beds were invented in 1945, but not readily available for many decades due to their expense. They couldn’t get rid of the crank beds fast enough!

5- Running water and central heat

Pity the poor nurse in 1887 whose duties included not only caring for her patients, but fetching pails of water, dumping chamber pots (mind you, we do have bedpans still!), and stoking the fire in the central stove.

As America modernized, running water became more available in the last quarter of the 1800s and the early 1900s. Before that, nurses had to depend on what they could bring into the hospital for their needs. Clean water was needed to bathe the patients and to provide care, so a constant supply was needed. Water was also needed to do washing and cleaning.

Coal stoves were the most commonly used heating systems of the early hospital days. The nurses were responsible for ensuring there was plenty of coal on hand and in the fire, keeping the patients warm.

Yes, nurses have a lot to be thankful for. While we admire what the nurses before us had to do with what they had and we’re grateful for the path they paved, there are likely very few of us who would willingly go back to those times.

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Posted in On-the-Job Fears

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Mental Status Testing

November 16th, 2010 by – Sue Barton

  How do I test for mental status?  When is it important?

Evaluation of mental status is part of the standard neurological exam.  It’s useful in a variety of situations, including evaluation of concussions and head injury, in general in trauma,  in elderly patients, and in any neurological condition.  The mental status exam consists of three components; orientation, concentration, and memory.  Orientation is tested by asking the patient to tell you their own name, the time or date, and where they are or how they got there.  They may be asked for instance to tell you the circumstances of the injury.  Concentration can be evaluated by asking the patient to state the months of the year in reverse order, or to repeat a string of three to five digits in reverse order.  Memory tests often involve asking the patient to recall three words or three objects after the examiner gives them, and then again after five minutes have passed.  Remembering common information such as address, phone number, who is the president, their place of work or the name of their school, other recent events also is useful in evaluating memory.  In evaluating for concussion, mental status abnormalities that resolve within fifteen minutes are consistent with grade 1 concussion, those lasting more than fifteen minutes are consistent with a grade 2 concussion.

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Caring for Guillain Barre Syndrome Patients

November 15th, 2010 by – Derek Brocklehurst

I need a good care plan on Guillain Barre syndrome for a nursing home patient. Thank you.

Guillain Barre syndrome (GBS) is a degenerative autoimmune disorder affecting a patient’s peripheral nervous system. Depending on the progression of the condition, GBS can cause general muscle weakness, which could eventually lead to muscle paralysis. This patient population requires a multidisciplinary approach to ensure proper long-term care is delivered.

A nursing home patient is already at risk for decreased independence in activities of daily living (ADLs). GBS will only increase the likelihood that patients rely more on aides than themselves for assistance. It is your job as the nurse to help patients complete activities they may be unable to perform independently (getting in and out of their wheelchair), but to also encourage patients to perform acceptable ADLs autonomously (brushing teeth, cooking, bathroom privileges, etc.)

It is also your job to make sure there are precautions in place for acute respiratory failure, as diaphragmatic muscle failure might be impending in the patient with GBS. Oxygen tanks, nasal cannula, intubation kits, tracheostomy kits, and vital signs equipment (pulse oximeter, blood pressure cuff, etc.) should be readily available for use. You might think about incorporating a physical therapist, respiratory therapist, occupational therapist, doctor and other relevant health care staff into the care for this vulnerable patient population.

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Posted in On-the-Job Fears

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Nursing in Business Mode

November 15th, 2010 by – Marijke Durning

As nurses, we are supposed to treat all patients equally, from the homeless to the uber-wealthy. Unfortunately, despite our best intentions, this may not always be the case, particularly in a country where the quality of health care may depend on how much money you can spend.

Some hospitals focus more – it seems – on “client satisfaction” than the actual treatment process. Nurses are told they must say certain things to keep their customers (who used to be patients, then they were clients, now they’re customers) happy. This can and does result in some issues that wouldn’t happen if nurses were more concerned about the actual patient progress than customer service.

For example, every nurse has at least one story about a patient who can do things on her own, but prefers not to and demands that the nurse do it. There are two reasons why the nurse wants the patient to be self-sufficient:

1- Because it takes time out of the busy nurse’s shift to do something that could easily have been done by the patient.

2- Patients need to be as self sufficient as is possible to be able to go home.

However, if the nurse refuses to help, no matter how politely, she risks having a complaint lodged against her for not providing friendly and prompt service. This is nursing?

So, what is a nurse to do? Not much if you speak with nurses who are in this type of situation. As long as private companies run the show, they are going to call the shots. But, sometimes those shots are ill-advised and they really should begin to listen to the nurses more carefully.

While they company may be in the hospital business to make money, the nurses are there to help the patients recover or live their lives out in a manner that is most comfortable. If the nurses are more concerned about saving their job because of management/service conditions, then it’s the patients who end up suffering in the end.

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Posted in On-the-Job Fears

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November 13th, 2010 by – Sue Barton

  Do nurse practitioners have reciprocity between states? 

Reciprocity is the ability to transfer professional licensure from one state to another.  While many states have agreements that allow for reciprocity for the RN license, there are no such agreements for NP licenses.  This means that NPs must apply individually for licensure in each state in which they intend to practice.  This lack of reciprocity results from the variation between states in how NP practice is defined and regulated.  If you are a nurse practitioner who is moving to a new location, it is important to check with the Board of Nursing for that state to be clear about the scope of practice as defined in the state’s advanced practice nursing statute.  For example, the regulations governing prescribing privileges vary from state to state, as do details regarding collaborative practice agreements with physicians.  In order to apply for a NP license you will need to have a current RN license in the state you wish to practice in, and submit evidence of current NP certification in your specialty area.

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