Answers to Your Nursing Career Questions

When a patient dies, the nurse’s immediate physical tasks may be over, unless he must do the after-death care, but his psychosocial care of the family and friends may continue a while longer. Not everyone is comfortable talking about death, but it is a reality and one that most of us deal with every day. So what can nurses say when families ask them questions about what to do after a death?

Here are some examples:

Funeral homes

If the death was expected, the family may already have made arrangements with a funeral home. Or, regardless of how the patient died, the family may have pre-planned funeral arrangements. If this is the case, the family must contact the funeral home to get the process going. If the family does not have arrangements, they must choose a business that they feel is best for their needs. Choices may be made based on location, for the convenience of visitors; the size, if many people are expected; religious beliefs; and family tradition, just to name a few.

The family needs to provide the funeral home with information about the deceased, such as the name, age, where the body is located, and a few other details as requested by the individual funeral directors.

Death notice

Not all families choose to put a notice in the paper (or online now), but those who do may choose to write it themselves or have it done by the funeral home staff. This is usually one of the services they offer.

Telling others about their loved one’s death can be very difficult. Sometimes it is easiest to ask one or two friends or family members to be the point person to give out information to people who ask about the upcoming service if there is to be one.

Burial or cremation

If the family hasn’t discussed this before the death, it could be a touchy subject. Unfortunately, this can also cause rifts in families. There’s not much a nurse can do in the way of suggestions, but maybe just hearing them out can help them make their decision.

Death certificate

Death certificates are valuable documents that must be kept safe. If possible, the family should get more than one copy because many of the needed tasks, such as dealing with the bank to insurance usually requires a death certificate.

Who to notify

After a death, there are many people who should be or need to be notified:
Governmental agencies (governmental assistance,  car registration, licenses, anything official that was in the deceased person’s name)

Insurance companies if there was life insurance

- Banks and financial institutions, to close credit and bank accounts that belonged to the deceased person

– Employers, to allow the employer to activate any benefits that may be provided by the company- Companies to whom the deceased paid bills, they will have to be settled, closed, or transferred

- Lawyer who holds the will, if one was written

Death, even when it’s expected, usually throws a family into chaos – some more than others. But if a nurse is able to answer some of their questions, this may make a big difference in how they remember their loved one’s last hours and death.

Depending on your background and any prior work in the sciences you might have achieved, you might be closer to nursing school than you think. All RNs must sit for and pass the National Council Licensure Exam, or NCLEX to become a practicing RN. In order to sit for the NCLEX, you must attend an accredited nursing school or program. Nursing schools are divided up into different programs:

• There are diploma programs in which hospitals or other health care institutions provide training on the job for nurses, leading to the ability to obtain your RN license by sitting for the NCLEX.
• Community college programs for nurses are typically 1.5-2 years long and focus heavily on clinical rotations to prepare you for different fields of practice. At the end of this program, you would be eligible to sit for the NCLEX.
• Bachelor’s degree programs are anywhere from 18 months to 4 years in length depending on any prerequisite science courses you might have completed in a past degree. If you are brand new to the science or nursing field and have not received a previous bachelor’s degree but are interested in the theory of nursing and going into nursing management and leadership, a bachelor’s program might be right for you.

Registered nurses, or RNs, can work in a variety of settings. Most RNs work in a specific health care setting such as a hospital, private clinic, community clinic, or research facility. It is in these settings that real patient contact is achieved. You might be performing CPR, placing an IV catheter, checking a chest tube for drainage, consenting a patient for a clinical trial or procedure, or monitoring a patient’s blood transfusion.

Some RNs can go into more administrative settings such as medical billing firms, insurance policy auditing groups, or patient advocacy groups. In these settings, the nurse plays the role of an expert health care provider and might provide testimony in medical malpractice court cases, audit the medical billing for certain health care institutions, or defend the rights of a patient.

Regardless of the type of setting an RN works in, he or she must be sure to log the appropriate number of continuing education units, or CEUs, for each period of license renewal. These can be gained by attending workshops, conferences, lectures on specific health care matters, or by completing online work.

Be sure to check out Medi-smart’s free online CEU website for more information!

It sounds like you are in your first year of clinical rotations and nursing courses, and you probably are not the only nursing student who is feeling stressed by classes and anxious about clinical experiences.  Talk to some of the other students if you can to share some of these feelings.  Just knowing you are not the only one feeling green around the edges will help.  Some nursing instructors will include a post clinical seminar where students can debrief by talking about the time in clinical and learn together from each other’s experiences.  Do try to be as well rested as you can on clinical days, and be as prepared as possible by studying in advance about the nursing care you will be expected to provide.  Don’t ever hesitate to ask for help if you feel unsure of yourself; every nurse has had that experience at some time.

Pharmacology is another one of those important classes where you need to understand the science and the principles, and also just need to memorize some information.  What is your best learning style?  Would study groups help?  Are you more of a visual learner (make charts and diagrams of the material) or more auditory (use recordings of lectures and texts)?  Again, ask for help, perhaps a tutor, if you are really struggling.

Uniforms are a fact of life when you’re a nurse. Even if you wear street clothes to work, chances are you have your own certain uniform – types of clothing you’ll wear for work and other types that you would never considering wearing on the job. For the most part though, standard uniforms are the norm among nurses. But what is standard?

It was in the early 1970s that nurses in the United States began being vocal about their displeasure with the awful stiff and scratchy uniforms they had to wear to work. While they were acceptable in the day when there were no other fabric options, the newer fabrics made the old uniforms unnecessary.

Soon, we began seeing nurses in different styles of uniforms – still usually white – and sometimes, are you ready for it? Sometimes, we saw them in pantsuits! Yes, pants. At work. On a nurse.

Of course, it didn’t take long for nurses to realize that pants were much more practical than dresses for work, so they quickly became the default uniform, although dresses still might be seen from time to time. But then things changed again. Nurses didn’t want to wear just white. White got way too dirty too easily and it could be an uncomfortable color to wear, particularly at certain times of the month. Perhaps part of this realization came when some facilities instituted a color system, different staff members wore different colors. For example, in one hospital, certified nursing assistants (CNAs) may have worn green, licensed practical nurses (LPNs) blue, and registered nurses (RNs) white.

So, as the times changed, so did the white-only uniforms rule and nurses began wearing solid colors. We started seeing pastel colors, pinks, blues and greens. But alas, nursing fashion didn’t stop there. It seemed as if it was almost overnight when the traditional nursing uniform was replaced with scrubs, the loose tops and drawstring pants favored by so many health care professionals now. And, on top of that, the pastel colors started getting very unpastel-like and solid, brighter colors began to appear and after that – patterns: Stripes, shapes, designs…and cartoon characters?

The cartoon or happy characters first began in the pediatric units, where they helped the children as they recognized fun animals and figures. But again, just as the skirts moved to pants and white moved to color, the character scrubs moved over to the adult sections of health care too.

How would a nurse, who worked in the 1930s, feel if she came back to see how nurses dressed now? Would she feel that this was a fun and light-hearted approach to patient care or would she be horrified at the sight of professionals wearing tops covered with Hello Kitty or Christmas trees?

What do you think? Is the trend toward colorful and happy-looking scrubs a good one or would you be happy to see nurses going back to more traditional colors on their uniforms?

ER stands  for emergency room, and nurses working in this setting  care for all kinds of people, and all kinds of problems at all hours of the day and night.  Both small community hospitals and major urban trauma centers will have emergency rooms, and in both one of the primary functions of the ER nurse is to triage those patients with life threatening crises needing immediate intervention and stabilization from those with less acute problems.  Unfortunately many times the ER is used like a walk in clinic for minor illness that would more appropriately be managed by primary care.  The ER can also be a triage point for mental health crises, so ER nurses need to be skilled in a wide variety of problems.  Medi-Smart has two articles on emergency room nursing, one of which describes the role of the ER nurse, and another which describes an ER nurse’s day.

Both licensed practical nurses and registered nurses can be ER nurses, with RNs assuming greater responsibilities.  Nurse practitioners also function in the ER in an expanded role.  Certification as an ER nurse is available through the Board of Certification for Emergency Nurses,  which is affiliated with the Emergency Nurses Association.

Studying nursing from abroad can be easy, fun, and relaxing all at once. It’s important to check out the qualifications needed for the nursing program of your choice. If you are looking into United States nursing schools, check out specific websites from programs or schools of your interest so you can know which online classes you can take in order to fulfill their requirements.

Nursing programs often look for students from varying specialties, including the social sciences. Taking courses in something other than nursing typically produces a well-rounded student who may offer a different perspective to a nursing education.

If you go to Medi-Smart’s directory of nursing schools and programs, you can search for nursing schools by location, type of program, and degree received. Play around with these options especially if you are studying online nursing classes from abroad. The United States is large and there are hundreds of different programs available to help you become a nurse!

The whole idea about providing health care to patients is to cause no harm. We can’t always help people heal, but we can try our best, as nurses, to help the patients be as comfortable as is possible. However, sometimes our best isn’t good enough and our patients suffer from severe pain and discomfort in their final months, weeks, and days of life.

We check to see if we truly are doing all we can. We can go over our patient’s care and what the doctors have ordered. If we find there may be areas we can work on, we can speak with our colleagues – the doctors and other health care workers – to see what improvements can be made. But sometimes, we’ve reached the limit of what we can do. Then what?

Assisted suicide and euthanasia have been much in the news lately although they’ve never really been out of the news. People have been fighting for the right to die for generations, sometimes publically, sometimes quietly and in private.

What would you, as a nurse, say if a patient’s family requested that you help your patient die? What would you say if someone you loved wanted you to help them commit suicide because they had an incurable disease?

Much of the assisted suicide and euthanasia debate centers on the patients (rightly so) and doctors – but what of the nurses who become entangled in this debate as well?

It’s rare that doctors start intravenouses. It’s rare that doctors hang medications or administer them. This is usually the role of the nurses. So, shouldn’t nurses be weighing in on this debate as well?

What do you think?

Laws in most states protect the confidentiality of minors when they are seeking health care related to sexual and reproductive concerns.  So, while you should check the law in your state, in most cases  nurses cannot talk to the parents about  pregnancy if the girl asks that this information be kept confidential.  An exception to this confidentiality principle would exist if there was an imminent danger, such as suicidal thinking, that required immediate intervention.   Helpful articles about confidentiality in adolescent health care and pregnancy can be found at the MassGeneral Hospital for Children website.

Most communities have clinics where prenatal care can be confidentially obtained.  The law varies from state to state  as to whether parental consent is needed if the girl wants an abortion.  If a 14 year old girl tells a nurse that she is pregnant, the nurse can build on that trust to help her in getting appropriate care as soon as possible.  It’s important to verify the pregnancy and determine dates.  Her physical and emotional health history, plans for the pregnancy, support system, and involvement of the father are other concerns to evaluate.  If possible, the girl should be assisted in telling her parents so that they can be involved in helping their daughter.  A team approach to care with appropriate counseling for the girl, the father of the baby, and the parents would be ideal.

Mental health, or psychiatric nurses tend to operate in a different manner than other hospital unit nurses (ICU, post-op, cardiac, etc.) Because nurses on other units may focus more on the physical ailments of patients, looking at the prognosis and treatment options of failing organ systems, their work ethic might seem more straight-forward than nurses on a mental health unit.

Psychiatric nursing deals with an individual’s mental health and psychological disorders (schizophrenia, bipolar, depression, etc.) Because a patient’s brain chemistry might be altered by the psychiatric illness, thereby causing their mood or demeanor to be out of the normal range, nurses must be astute and on their feet. Anticipating dangerous situations, keeping every patient safe, and assessing each patient for cognitive impairments are at the top of the nurse’s priorities.

Some examples for care plans for the mental health nurse will involve how to help the patient stabilize their mood (bipolar), assist the patient with engaging in social interactions (depression), or help the patient recognize a certain reality in a situation that is not falsified by voices or ruminating thoughts (schizophrenia). Check out the American Psychiatric Nurses Association website for more information!