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Answers to Your Nursing Career Questions

Troubleshooting Nipple-Itching

October 28th, 2010 by – Derek Brocklehurst

What causes a hard, itching nipple in a man?

There might be several different etiologies at play here. Should you choose to see a health care professional about this issue, you would want to know the answers to the following questions: when did the itching start? How long has it been going on? What does the nipple feel like upon examination? Is there pain associated with touch? Is there erythema (redness) around the site? Have you done anything to try to make this issue better?

There are several common causes of pruritus around the male nipple: shaving or trimming around the nipple could cause ingrown hairs or a mild folliculitis; using a new soap can cause mild irritation around your nipple; or a small bug bite around your nipple could cause a hardened red area with some itching. More infectious causes might include poison oak, poison ivy, staphylococcus aureus or the herpes simplex virus.

You could use Hydrocortisone cream 1% to treat a mild dermatitis around the nipple, applying it to the skin once a day after a warm shower (don’t take hot showers as that could irritate it further). Calamine lotion is good for soothing itching caused by poison oak or ivy.

Posted in General

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Childhood Vaccines

October 28th, 2010 by – Sue Barton

  Why are parents sometimes refusing vaccines for their children? 

This unfortunately does seem to be a growing trend.  Many factors have been cited for parental reluctance to immunize on schedule.  Young parents today ( and for that matter health care professionals) have grown up without having ever seen many of the diseases that we immunize infants against.  That success has generated a certain amount of complacency; we don’t live in fear of polio; cases of devastating meningitis in infants from such vaccine preventable agents as haemophilus influenza b (Hib) are far fewer than a generation ago.  Unfortunately, polio is just an airplane ride away, and we have experienced measles outbreaks and an increased incidence of pertussis in the United States. 

Another factor is the large number of vaccines included in the routine schedule now.  Parents question the need for all those vaccines, and sometimes will attempt to pick and choose. There may be an erosion of trust in the advice of professionals, which leaves parents struggling to understand complicated science in the fields of infectious disease and immunology.  For instance there is  fear that vaccines suppress the immune system; in fact they stimulate it.  Fears about vaccine safety also abound, when actually vaccines today are safer than they have ever been.  We now use an acellular pertussis vaccine,  and inactivated polio vaccine.  Mercury as a preservative (never proven to be dangerous in such minute amounts, but nonetheless a worry to parents) has largely been eliminated.  The measles/autism connection has been soundly discredited as well.

Clearly there is lots of confusing information on the Internet about vaccines.  Two sites with trustworthy information for parents are  www.vaccine.chop.edu and www.immunizationinfo.org.

Posted in General

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When You’re the Patient

October 27th, 2010 by – Marijke Durning

It’s not easy being sick. Not only do you feel awful, you lose a sense of control because your body has been taken over by microscopic enemies that can knock you flat. If you are sick enough to require care, you may feel even more helpless because you now have other health care professionals looking after you instead of you looking after someone else.

Should you speak up and say you’re a nurse?

This is an age-old debate: should you tell hospital staff that you’re a nurse. Some people feel that it’s important because you could benefit from a bit of professional courtesy and the staff may speak to you in such a way that you understand everything, not just bits and pieces. On the other hand, others feel that if you speak up, you’re dooming yourself for limited care and explanations because the staff may feel that you can manage on your own. After all, you’re a nurse, right?

Is it scarier if you’re a nurse when you’re sick?

As with telling if you’re a nurse or not, this can go both ways too. It could be less scary because you’re a nurse and you understand what is going on, but it also could be more frightening because you know what is going on.

When someone is terribly ill and going through testing, it’s often said that it’s the not knowing that is the most frightening. Once a diagnosis comes through, no matter how bad, at least then you have a name for your opponent. But, until then, it’s the not knowing that takes a toll on you. But the reverse can be true as well. As a nurse, you have a lot more insight into how the body works and what happens when certain parts of the body does certain things. In this case, it could be that ignorance is bliss and knowing the details could just make it worse.

So, which would you rather be? In the know or ignorant of what is happening around you? Do you speak up and tell others you are a nurse?

Posted in Work-Life Balance

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Office Spirometry

October 26th, 2010 by – Sue Barton

 I work in a family practice; I’m an LPN.  We are getting spirometry equipment, and I’ll have to learn to do the tests on our patients.  What do I need to know? 

Office spirometry is becoming the standard of care in evaluating asthma and COPD in the primary care office, in part because of the development of less expensive and easier to use equipment.  Spirometry measures how much air the patient can blow out, known as the forced vital capacity (FVC).  It also measures forced expiratory volume over one second (FEV1).  A decrease in the FEV1/FVC ratio indicates airway obstruction.  Office spirometers are typically hand held and portable, with printouts for the patient record.

 If spirometry equipment is new to your office, most likely a company representative will be training you and the rest of the staff in the specific details of the model you will be using.  Before administering the test, you need to calibrate the spirometer to check for accuracy.  You will enter patient information into the data base, including an accurate height, and insure cleanliness with a disposable mouthpiece.  Explain the test, demonstrate how it’s done, and coach the patient through the exhalation, doing three good trials.  Test results depend on a good effort, so you may find yourself in the role of cheerleader!  In some cases, you may be asked to administer a bronchodilator medication such as albuterol, and repeat spirometry to look for improvement.  You may also have a teaching role in helping the patient and family to understand their disease and the treatment plan.

Posted in General

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Levels of Comfort: What To Do When You Question Your Scope of Practice

October 25th, 2010 by – Derek Brocklehurst

Can an employer force a nurse to do a job she has not been properly trained for under “other assigned duties?

This is a good legal and ethical question. As a nurse, it is your responsibility and right to accept all assignments and duties which fall under your scope of practice. Visit the American Nurses Association website for more information about the code of ethics and scope of practice for nurses. You should also visit the website for your state board of nursing for information related specifically to your state.

If you do not understand a specific practice or procedure that is in your scope of practice as a registered nurse, it is your responsibility to ask for assistance or supervision. Remember that the patient’s safety is your #1 priority! Never compromise patient safety and integrity because of your false pride in a procedure.

It is also your responsibility to know your scope of practice and all nursing-related procedures. Know when to ask for help, know when to stop what you are doing and double-check a procedure, and know how to check for patient safety. If you are uncomfortable performing something, it is okay to request an alternative position or list of duties.

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Posted in On-the-Job Fears

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Resigning From a Nursing Job

October 25th, 2010 by – Marijke Durning

Resigning from a job seems to be quite stressful for some people. Whether they are resigning because they are going on to a better job or  they just can’t do the current one any longer, they still find it difficult to find ways to tell their employer they are leaving.

Resignation letter

When you resign from any job, from a nursing on a floor to being a lead nurse practitioner in a group office, you need to write a resignation letter to your boss. Much of the stress comes from what to put in the letter but in cases of resignation letters, the less said, the better – particularly if you are leaving on less than stellar terms.

The letter must be on paper, unless your particular place or work has an email or website system for this type of communication. You may follow-up with email, but your actual letter must be on paper.

An example

So, what do you put in the letter of resignation? You only put what you need and you remain professional. A resignation letter is not the place to write about how incompetent you think your coworkers are, how awful  you feel the management is, or what a nasty place  you work in. No matter what the circumstances, you must remain professional.

Dear XXX

I am submitting my letter of resignation from my position as XXX (insert place) effective XX date. My last scheduled shift will be XXX.

Thank you for the opportunity to work at XXY.


Your signature and name

That’s it! That’s how simple it is to write a letter of resignation.

What the letter doesn’t need

Your current employers don’t need to know why you’re quitting and they don’t need to know where you’re going. You may tell them that in person if you wish, but you aren’t obliged to tell anyone. Some reasons that are ok to include are that you’re moving away or you’re going back to school. Everyone understands those reasons.

You must give your employer enough notice that they can’t raise a fuss. In most places, this means two weeks, but check your employer’s policy to be sure about that.

Don’t feel guilty

It’s not clear why, but some nurses feeling guilty when quitting one job to go on to another, better job. The new job may be a better fit work-wise, it may be a higher level job, or just a more convenient one. Whatever the reason, it’s the right one for the person who wants to move on.

The guilt may come from not wanting to leave coworkers stranded and short-staffed. It may also come from a feeling that you’re letting down a boss, leader, or mentor. However, work is a business. They hired you because they needed you. They would let you go if they didn’t. You must think of it in the same way. It’s business and you have found a better deal.

Stay professional and don’t badmouth your former employer

Some bosses don’t take resignations well. For some reason, they take them personally and they may make it difficult for the person who is leaving during their remaining time. If this unfortunate situation happens to you, don’t rise to the bait. Stay calm, stay professional.

Finally, no matter how the situation was when you left, don’t badmouth your former employer. New employers may wonder what you’ll say about them later on.

Giving in to the temptation of badmouthing – it may give you a sense of satisfaction to tell everyone how awful it was where you left, but this is something that can come back to haunt you. If you are discussing the less than ideal situation that you left, keep it to the facts and keep it brief.

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Posted in On-the-Job Fears

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Dual Degrees

October 23rd, 2010 by – Sue Barton

  What can I do with an MBA and an associate RN degree ?

You should have many options as an RN with a master’s degree in business administration.  Since your business degree is at the master’s level, and your nursing degree is at the associate degree level, it makes more sense  to focus on the area where you have the greatest knowledge.  At the same time, your understanding of the nursing field and experience in health care milieus should make you a good fit for a position in health care administration and planning.  If you have expertise in budgeting and finance for example, but also understand the implications of budgeting decisions on patient care, you have a perspective that many administrators do not. 

You likely will not be a candidate for nursing administration positions  because you do not have an advanced degree in nursing.  However, if you have an interest in human resources, your degrees may be a good fit there.  Don’t overlook the administrative jobs in practice management of physician groups and outpatient facilities. If you end up with a “desk job” in the business end of health care, you might want to look into ways to do some clinical nursing practice as well.  Working resource, home care, or volunteering in a community clinic can keep your skills up to date and keep you in touch with the front lines of patient care.

Posted in General

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“It’s Time For Your Evaluation”

October 22nd, 2010 by – Marijke Durning

Is there a more stress-inducing phrase for an employee than “it’s time for your evaluation”? Perhaps, but that would likely be “we’re reevaluating our workforce….”

Nurses and student nurses are subjected to evaluations throughout the course of their studies and their career. After all, we need to know what we’re doing right and what we could work on so we can do better. For some nurses, evaluations are reinforcement they’re doing well and for others, it’s important for them to learn (if they don’t know already) that there are problems they need fix. But, the idea of an evaluation is so stressful sometimes that the negatives may far outweigh the benefits.

Effective evaluations

What makes a good, effective evaluation? A good evaluation isn’t necessarily one that tells you that you’re doing fabulously in nursing school or your work as a floor nurse is beyond reproach. A good evaluation focuses on not only your good work, but on areas where you could learn and grow. Even the best nurse can always find something worth working on, right?

A good evaluation details your strengths and your weaknesses. It has firm statements that can be backed up with solid examples. All statements should be verifiable and free of any possible bias. This is an evaluation of your work, not you as a person.

Balanced evaluations

There are no perfect nurses, but there are some who could use a lot more help than others in order to raise their level of ability. When giving an evaluation to someone who needs to work on several issues, it’s important to balance out the evaluation. Unless someone is bad enough to fire, then there must be something that the nurse or student is doing well.

While some may seem this as grasping at straws or being unrealistic, it’s not. If someone sits in front of you and reviews an evaluation that is essentially all negative, with little positive mentioned, this can leave a sense of “is there anything I do right?”, leaving the person quite discouraged.

Being on the receiving end, nursing student evaluation

Remember that receiving evaluations is part of the system. If working hard to get through nursing school, you need these to find out if your interpretation of your growth as a student is the same as what your teacher sees. At the end of a clinical day, you may feel that your nursing instructor nagged you the whole time, always on your case. But in your evaluation, you may learn that the teacher thought you were doing a great job, but just needed to be kept on track a bit.

If you aren’t doing well and your evaluation is less than what you hoped it would be, it may be difficult to sit and listen to what your teacher has to say. After all, no-one likes to be criticized. This is where you put on your big-girl panties (or big boy!) and act like a future nurse. Accept the criticisms and ask for advice on how to improve. If your teacher isn’t specific, ask if he or she could be. It’s easier to learn when you know exactly what you’re looking for.

Take that information, as unpleasant as it may be, and make an action plan. How are you going to take this evaluation and use it to your benefit? Don’t be afraid to ask for help from fellow students, the evaluating instructor, and other instructors.

Nursing evaluation, employee

Annual or twice-a-year nurse evaluations aren’t uncommon in the hospital system. Sometimes they’re issued by charge nurses, other times they may be peer evaluations.  Truthfully, the advice given to the student nurses isn’t that different from in the working world. If there are comments about your work, suggestions of areas where you need improvement, you need to look at yourself and your work to see from where these criticisms evolve.

And what if you don’t agree with your evaluation? Come back next week when we discuss this very topic.

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Posted in On-the-Job Fears

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Interviewing Strengths and Weaknesses

October 22nd, 2010 by – Derek Brocklehurst

What should I say when the interviewer asks what my strengths and weaknesses are?

New-grad nursing position interviews are never easy. Despite the fact that there may always be a shortage of nurses, you will still be competing against other new graduates as well as experienced nurses for high-demand positions. It is good to try and stand out in some way as an applicant, particularly during the face-to-face interaction.

If an interviewer asks what your strengths are, focus on nursing skills in which you excelled from nursing school. Maybe you are great at placing an IV line, or perhaps you can read an EKG like no other. Talk about how great a team player you are and how you would collaborate with your colleagues to create a new charting protocol. Highlight the things that make you unique!

Focusing on your weaknesses can be a bit more tricky. Think about a time in nursing school where something was difficult (emotionally connecting with a patient on a psych ward, or emptying a chest tube drainage set, etc.) Elaborate on the steps you took in order to right the wrong (went to your supervisor to inquire, asked a fellow nurse for help, etc.) Check out Medi-smart’s tips on nursing job interviews for more information about interview troubleshooting!

Posted in General

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Don’t Call In Your Personal Prescription

October 21st, 2010 by – Derek Brocklehurst

Is it legal for a nurse to call in his/her own prescription?

If there is a question about legality involved, it’s a good idea to stay away from it. Generally speaking, nurses can call in prescriptions on behalf of the provider if the physician or other licensed health care provider has approved it and signed off on it. It’s always a good thing to have the provider’s medical license number, DEA#, phone number and address when calling in a prescription. It is also good to give the patient’s date of birth, spell out the first and last name, and their phone number as well. This helps in avoiding confusion that may lead to potential errors.

As a nurse, you should avoid calling in your own prescription even if it’s approved by your personal health care provider. Never mix the professional with the personal. Once lines begin to get blurred, there is a greater room for error and if you or the provider’s practice gets audited  for prescription abuse, you might have some unpleasant surprises (subpoena) waiting in your mail. Make sure you check out the American Nurses Association’s Code of Ethics here, for more information.

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Posted in General, On-the-Job Fears

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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.