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Answers to Your Nursing Career Questions

Fake Nails and Nursing Don’t Mix

November 5th, 2010 by – Marijke Durning

For many women, long nails are more than a luxury – the nails help make them feel good about their appearance. They feel more polished and put together. Of course, we want to be well groomed for work and nice nails may add to this, but long polished nails, particularly false nails, really aren’t a good idea in a health care facility.

Remember those nursing school days?

Remember all the rules when we were nursing students? You can’t let your hair down to your collar, you must have short nails, your shoes must be clean… As we went through nursing school, some of the rules made us roll our eyes, but there were often good reasons behind them. The nail rule really was one of them.

We can wash our hands as much as we want and as well as we want, but the nails are never 100% against our natural nail, leaving an opening for bacteria to get in and hide. For those who have naturally long nails but choose to use nail polish, they too present a danger as the polish develops small cracks in which bacteria can – and do – hide.

Would gloves help?

Gloves would be a definite help to protect the patients from any bacteria that may be in or on your nails, but gloves aren’t always available nor are they meant to be worn with longer nails. They could actually be damaged by the tip of a nail.

So, what is a nurse to do for nice nails.

Nails don’t have to be long to be nice. A small growth of white showing above the nail bed can be attractive on a well-manicured hand. You could, of course, paint your nails any color you wish when you’re off duty, just as long as you have a good quality nail polish remover to take it off before you begin your next shift.

False nails when off work?

When vacation rolls around, it’s often anything goes for the vacationers. They do things and try things they may not ordinarily. Getting acrylic or gel nails may be one of those things. If you do decide to get nails, keep in mind that most ways of getting the acrylic or gel to stay on your nails requires a sanding of your natural nails.

Some beauticians use hand tools to do this sanding of your nail, but some use electric tools, such as Dremels, which can – if you’re not careful – go through the nail to the nail bed.

While the nails are protected by the artificial nails while they are on, when the nails are removed before you go back to work, your own nails are left weaker because they are missing the top coating, which was removed to allow the artificial nail to adhere. This means you may have difficulty while the nails are growing out: sensitivity of the nail beds, tearing of nails and ingrown nails, being the most common.

So, maybe our nursing teachers were right when they said that we shouldn’t have long nails or nail polish. What do you think?

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Posted in Work-Life Balance

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Nasopharyngitis

November 4th, 2010 by – Sue Barton

  What is the nursing care plan for nasopharyngitis? 

Nasopharyngitis is a term that refers to inflammation and irritation of the the nasal passages and the throat.  The cause of this is almost always viral with a course lasting on average 7-10 days.  Unless bacterial complications develop, such as sinusitis or otitis,  there is no need for antibiotic treatment.  This means that the nursing care plan addresses alterations in comfort, in hydration, and in respiration.  Evaluate fever, congestion, cough, respiratory status, and fluid intake.  Also evaluate for risk factors such as asthma, and age factors such as the very young and the very old person who may be more at risk for complications from an otherwise fairly benign illness.  Comfort measures include acetaminophen or ibuprofen for fever, sore throat, and general discomfort.  Nasal saline rinses and decongestants such as pseudoephedrine may provide some relief.  Increased fluid intake helps to soothe the inflamed tissues and to keep mucous secretions thinner.  Your patient should be educated to seek further evaluation if fevers persist beyond the first few days, if swallowing is impaired, if respiration becomes labored, if congestion does not improve after the first week, and if sinus or ear pain develop.

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Free Online CEUs

November 3rd, 2010 by – Derek Brocklehurst

Hello. I am looking for 30 hours worth of CEUs for dialysis RNs. Thanks.

Continuing Education Units, or CEUs, are credits that all licensed health care professionals must have in order to renew their license. Some licenses require CEUs every year, others every 2 years. You should contact your state board of nursing to find out how often you should attend continuing education courses.

If you are looking for specific dialysis CEUs as an RN, you should speak with your nurse supervisor or check your unit’s bulletin board. Typically, any CEU courses or lectures you attend will count towards license renewal, even if not geared towards dialysis. You can attend local talks, lectures, courses, or conferences for your CEUs. Just be sure to check during registration for any of these events that the hours you attend will count towards your CEUs.

Also, make sure to check out Medi-smart’s free online directory of CEUs. These can be completed on your computer in the comfort of your home, any time during the day!

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Posted in Continuing Education Units, General

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Conflict in Nursing – a Woman Problem?

November 3rd, 2010 by – Marijke Durning

It’s hard to hear a generalization such as “nursing is a hard place to work because you’re working with all women.” That implies that working with women is difficult and that there are no men in the picture either. But is this true? If you read the nursing discussion boards, it sure seems to be. The boards are filled with stories of nurses being completely unable to get along with others. In fact, if they were in kindergarten, they would likely get a report (assessment) that said, “Does not play well with others.”

Boys and girls – and conflict

As much as we try to deny there is any difference between boys and girls in the playground, it doesn’t take long to figure out that there really is a difference between the two sexes. As a rule (there are always exceptions), the boys are playing active games, pitting themselves against one another or one team against the other. Girls, on the other hand, are more likely to be playing cooperatively, either in a game, helping each other, or playing pretend.

When the boys disagree, it’s often with heated words as they work the conflict out. Sometimes these conflicts come to blows, but if the boys were friends before the conflict, they usually are again after. It blows over. On the other side of the playground, where some girls start quarreling, there’s a small chance it may come to blows, but usually, they are begin using harsh words to inflict as much emotional pain as they can. And after, they might never speak to each other again. Or they may. Maybe. Perhaps. It’s not unusual for new groups of “friends” to form as they start bad-mouthing the odd girl out. Gossiping and back stabbing is also far from uncommon. The girls may be sweet as pie to the face of their former friend, but watch out when she’s out of sight.

Men and women – and conflict

As these boys and girls grow up into men and women, some learn how to resolve conflicts in effective ways, while some never outgrow the playground rules of conflict. When this happens, they bring their feelings to their workplace, bringing along their coping mechanisms – or their non-coping mechanisms, to be more precise.

If a man goes into work and uses his childhood ways, he may be perceived as a bully, as someone who doesn’t know how to compromise or work on a team. While this happens among women if they bring their non-coping mechanisms with them, it’s usually much more subtle.

However, if the man brings good coping skills with him, also maybe learned from the playground, he may have learned that just because you are angry at something an employee or colleague did wrong, it doesn’t mean the person is bad and, yes, they can still go out for lunch.

In the case of nursing, the “bully” may be very condescending to the other nurses. She may watch the nurses’ every move, ready to catch them in an error, no matter how insignificant. If a nurse doesn’t like another nurse, there could be gossip and discussion about the nurse behind her back. And where there’s one such nurse, it’s not all that uncommon to find at least one more. After all, gossiping and talking behind someone’s back only works if there’s a second person there to share this all with.

What have you seen? Do these descriptions sound right to you or do they seem to be totally off base?

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Posted in On-the-Job Fears

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Plastic and Reconstructive Careers

November 2nd, 2010 by – Sue Barton

  What are the duties of a plastic and reconstructive surgical nurse? 

The field of plastic and reconstructive surgery is wide ranging and offers a variety of career options for nurses with varying levels of responsibility.  In an office based practice, nurses would prepare patients for evaluation by collecting health history information, identifying concerns, and obtaining vital signs and measurements.  Nurses are responsible for preparing patients for procedures or surgery, and educating about follow up.  Nurse practitioners  do more comprehensive evaluations, discuss treatment options, do procedures within their scope of practice, and prescribe medications.  RNs may also be trained to do office procedures such as botox injections and aesthetic skin treatments.

Within the hospital and surgery areas, nurses have the same responsibilities as with other surgical patients in preparing, evaluating, monitoring, and educating pre and post op.  Prevention of infection and proper wound care is important.  While the perception of plastic surgery is that it is cosmetic, many practices focus on reconstructive surgery.  In the pediatric population this involves correction of birth defects such as cleft lip and palate, and other anomalies .  Burn patients and trauma patients also are plastic surgery candidates;  their care may be complicated by the other injuries sustained.  Certification in the field and continuing education are both available through the American Society of Plastic Surgical Nurses.  The career comparison page of Medi-Smart also has more information on this specialty.

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Times of Medication Administration

November 1st, 2010 by – Derek Brocklehurst

Hello. I am trying to find out specific information pertaining to the time allowed between the designated time and the actual time of administration of scheduled and prn medications. Thank you.

This is a great question. Even though some medications should be administered on a strict schedule (some psychiatric meds, pain meds, etc.), all medications should adhere to the order written by the prescribing provider. If you have a patient who receives antibiotics QID (4 times in a day), this usually means starting the dose at 7:00, then 12:00, then 17:00, then the last dose at 22:00. This is not to be confused with “q6h” or every 6 hours. Q6h would be starting at 7:00, then 13:00, then 19:00, then 1:00 the next day.

PRN, or “as needed” medications (some pain meds, anti-emetics, etc.) can be administered by the nurse or the patient depending on the facility’s policies regarding medication administration. There should be a limit set to the maximum number of prn administrations over the course of the day that the patient can give themselves. If you find yourself too busy to administer a medication at the scheduled time, delegate your duties or the administration to another nurse or other qualified health care personnel. A 5-minute window is typically allowed but you should check with your nursing supervisor or health care facility’s protocol for specific time allowances.

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Posted in On-the-Job Fears

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Practical jokes at work – yay or nay?

November 1st, 2010 by – Marijke Durning

Now that Halloween is over, did you see any practical jokes at work? Were you the victim of one? Did you play one? What about April Fool’s Day? Does anyone play jokes then? No matter what the profession, it seems that there’s always someone likes to play practical jokes, but is a health care setting or nursing school an appropriate place for them?

There’s the age-old joke of a new staff member or student being told to transport a stretcher to the morgue, only to have the “dead” person sit up and say “boo!” There are also the people who hide in patient closets and jump out at the nurse as he or she answers a call bell.

There’s the chocolate pudding in the newborn diaper trick and the “giving report on the fake patient,” joke, along with the everyday variety of jokes like gluing a coin on the floor, but sometimes people take jokes too far and sometimes the “victim” may not take kindly to being pranked.

Jokes that go too far can be hurtful and sometimes, this is really the goal. Some jokers aren’t trying to be funny but use the “jokes” as an excuse to embarrass someone. When this happens, the joker could really be a bully instead. Alternately, a joke may actually be a way of trying to get back at someone – kind of a passive-aggressive approach.

Finally, realistically, not everyone enjoys being the center of attention and the butt of a joke. While it may seem funny to the prankster, there’s a chance that it’s not funny to the recipient. Who knows what kind of baggage people bring with them and  live with every day?

So, if you do work in a place that is good on practical jokes, it’s best to keep them simple – the simpler they are, the more likely they are to be taken in the right spirit. A joke is only funny if both parties laugh at the end.

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Posted in Work-Life Balance

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What is Malignant Hyperthermia?

October 30th, 2010 by – Sue Barton

  What is malignant hyperthermia?

Malignant hyperthermia (MH) is an uncommon but life threatening complication associated with the administration of certain anesthetic  agents.  MH is a genetic  condition , with an autosomal dominant pattern, so there is a 50% risk that family members of an affected individual will also have MH.  When a person with MH is given succinylcholine (a muscle relaxant), or certain anesthetic gases, they experience a rapid temperature elevation, muscle rigidity, and muscle breakdown.  This process happens quickly and can be fatal.  An excellent resource on this condition for patients and for professionals is the Malignant Hyperthermia Association.  You can find information about muscle biopsy testing for MH as well as sample protocols for the operating room, including how to evaluate and respond in an emergency, and treatment with Dantrolene.  More information, including CEU material on MH for nurses, is available from the Association of periOperative Registered Nurses.

If you work in any setting where anesthetics are administered you already are well informed about MH, both in terms of prevention and emergency response.  If you work in a setting where anesthetics are not used, you can  educate patients that if anyone in their family has ever had a reaction to anesthesia, they may be at risk.  This is a question that must be included  if you are doing pre op clearance evaluations.  The good news is that there are other anesthetics that can be used.

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Online Nursing Degree Programs

October 29th, 2010 by – Derek Brocklehurst

Can I work full time while in nursing school?

This is a good question, one that many stay-at-home parents and full-time workers ask themselves when seeking a nursing degree. If you find yourself too busy to drive or take public transportation to an academic institution, look no further! Online nursing degree programs offer extremely flexible hours and the ability to do most of the course work from the comfort of your own home.

If you currently have a full-time job or are kept busy with at-home duties, apply to an online nursing program. Most of the theory and educational courses can be done at home at your convenience, submitting homework and exams online given specific deadlines by your course instructors. Logging clinical hours for each course (Pediatric Health, Medical & Surgical Nursing, etc.) must be completed in person at an accredited teaching health care institution.

Make sure to check out Medi-smart’s online degree programs directory for more information about online nursing programs that work with your schedule!

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Posted in Online Nursing Degree

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What’s in a Name? A lot!

October 29th, 2010 by – Marijke Durning

A nurse is a nurse, right? Absolutely. But when is a nurse not a nurse? When it’s someone who is trained in another role but who calls him or herself a nurse.

It may seem like a small thing, but if you read the Internet nursing boards and forums, you would see the number of people who are just beside themselves with anger at people who call themselves nurses when they’re not. These people may be certified nursing assistants (CNAs) or medical assistants (MAs), but they either actively call themselves nurses or they imply that they are.

Before a whole group of CNAs and MAs get upset, this is NOT meant to imply that all CNAs and MAs do this. In fact, it’s a minority. But, even when a few do it, it reflects badly on your own profession, leaving the impression that you may also feel that way.

So, what can we do?

The actual term “nurse,” is a licensed term and may only be used by a person who holds a license that recognizes that the holder has followed an approved program and passed the necessary licensing requirements for their place of practice. Legally, no-one else may claim the title of nurse. Of course, what can legally be done and what is actually done is often two different things.

If you find someone you are working with is misrepresenting herself as a nurse, you have two options. You could speak directly to her (not confronting, speaking) asking why she is choosing to call herself a nurse. This choice may be intimidating for some people though, as this could result in negative feelings and behaviors. If this is the case, the only other option is telling the supervising or managing nurse.

Going to so-called authority figures and “tattling” is not what adults want to do. After all, we should be able to work things out ourselves. But, this is not the case when someone is misrepresenting herself and possibly putting the health care facility at risk.

Nurses who aren’t nurses who kind of are nurses…

With all this being said, there are always exceptions to the rule. Many nurses who were trained overseas don’t qualify right away for a nursing license in North America. They may be well trained and experienced nurses in their land of origin, but not licensed here. Technically, they shouldn’t be calling themselves nurses and this could cause issues down the road if their patients expect them to do nursing duties.

So, is it a bad thing if someone who isn’t a nurse calls herself a nurse? Well, it’s not right and it’s not legal – so there’s your answer.

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Posted in Work-Life Balance

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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.