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Answers to Your Nursing Career Questions

Retirement or Not?

October 5th, 2010 by – Sue Barton

I’m 71 years old & may not want to go on retirement basis. My current  license expires July,2011. If I submit completed CEUs  do  you think I still have a chance to stay in active status?


Many nurses choose to maintain active licenses into their retirement years.  In the current economy, nurses are frequently delaying retirement because of the need to rebuild retirement savings, or because  a spouse is not working.  Nurses may choose to move from more physically demanding jobs or those requiring shift rotation as they age.  Seniority may allow them to choose better hours or to work fewer hours.  In ambulatory care, for example, an experienced nurse may give up being on his or her feet all day and move to a telephone triage position that utilizes those years of experience. 

Retirement age nurses also are often involved in using their nursing skills in volunteer roles in community agencies or relief work. The CEU requirement is an excellent way to keep current on topics in the field that are of interest, whether or not you are currently employed.  Many nursing organizations offer reduced rates for membership to nurses who are retired, but who wish to stay informed professionally.    All in all, there are many good reasons to keep that license active.

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Weighing In: The Desire for Weight Gain

October 4th, 2010 by – Derek Brocklehurst

What kind of medicine can I use to add weight in my body?

Sometimes, you will get messages or see images from society that tell you to dress a certain way or weigh in at a specific weight. It is a prickly path you go down when wanting to change anything about your body and simultaneously maintaining a healthy lifestyle. The desire to increase or decrease your weight, depending on your current weight at baseline, can be a positive or a negative thing.

First, check out the CDC’s Body Mass Index webpage for specific information regarding your current weight. If you are underweight and wish to achieve a more healthy weight, you might consider increasing the amount of physical activity or weightlifting in your life. Muscle weights more than fat and if you bulk up on muscle, you may see an increase in weigh. To find an exercise regimen or suggestions from the CDC that work for you, check out the physical activity page.

It is not recommended to add medications or alter your current medication list in any way before you consult your primary care provider. Slight changes, even with the intention of putting on weight, can be detrimental to your health.

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Everybody Dies

October 4th, 2010 by – Marijke Durning

There are two certain things we’re not supposed to talk about at parties and social gatherings: politics and religion. After all, these are issues that people can be quite passionate about, possibly causing the discussion to go from friendly to loud and angry in a matter of moments. But there’s another topic we don’t like to talk about, as if it is a mutual agreement: death.

As nurses, we see death constantly. Even in the happier areas of nursing, such as labor and delivery, there are situations when people die. Of course, some nurses see it much more than others and some see traumatic deaths (emergency, for example) while others see expected and even peaceful deaths, such as in palliative or hospice care. But there’s no escaping it. Everyone dies.

When student nurses begin their clinical rotations, if they’ve never experienced death before, the idea of it can be frightening. Seeing a dead body for the first time isn’t something you can usually prepare yourself for – particularly if it was a sudden death and the medical team did what they could to prevent it. Emotions can be difficult to control, so this isn’t an unusual situation.

So how can student nurses and those nurses without a lot of experience with death become comfortable with it? Unfortunately, there’s no easy way. The only way is by learning as much as you can about the death process, knowing what to expect, and experiencing it by having seeing the process as it unfolds.

The one thing to remember is that death is not a failure. Unfortunately, too many health care professionals do see a patient’s death as a failure. However, if a patient’s body is no longer able to keep him alive, this is not a failure of the doctors and nurses. This is nature taking its course.

When someone looks at death as a failure, then this is upsetting to them and often those around them. When someone sees death as a natural, inevitable part of life that happens when it’s time, then the deaths need not be as disturbing.

If you’re afraid of confronting death, of patients who die, maybe you could sit down and examine how you feel about death and dying. This may explain a lot about your reactions.

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Posted in On-the-Job Fears

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Newborn Circumcision

October 2nd, 2010 by – Sue Barton

 Please explain the pros and cons of circumcision for newborn boys

Both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists agree that newborn circumcision is an elective procedure.  There are some studies indicating that circumcision may have a protective effect in preventing urinary tract infections in baby boys, and may decrease the transmission of sexually transmitted infections in adults.  The debate over such studies is inconclusive, and most providers agree that  there is no medical reason to circumcise newborns.  The reasons for doing so are primarily cultural or religious.  It is interesting that circumcision is less common in other parts of the world than it is in the United States.

Parents sometimes express concern over teaching hygiene, which in reality is a simple matter.  In uncircumcised boys, the foreskin normally does not retract in the first few years.  By school age, boys can be taught to wash under the foreskin.  Parents may also be concerned about whether their son will match or not match his father, or at a later age, the other boys in the locker room.

  Parents should understand that while risks are rare, they can occur.  Risks associated with the surgery include infection, bleeding and scarring.  Parents should have information about how the procedure is performed, what analgesia is offered, and how to care for the baby after the circumcision.

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CEUs for the At-Home Family Member

October 2nd, 2010 by – Derek Brocklehurst

How do I start on line courses to obtain CEU credits?

Obtaining continuing education units, or CEUs, can be easier than you think. You need these hours in order to keep practicing as a nurse. Attending lectures, workshops in a particular specialty, conferences, and even report-backs can count towards renewing your license.

Most of the time, people only think about the in-person aspect of CEUs. There are a myriad resources online that offer free CEUs that can be completed in the convenience of your home and at your own pace. Are you working full-time while going to school, or raising children and trying to make ends meet? Think about online CEUs to fulfill those requirements for your license early on, before it’s last-minute and you’re cramming to get them submitted.

Check out Medi-Smart’s Continuing Education directory for more information about what CEUs are, how to get them, and more importantly how to get them for free!

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Patient Confidentiality (and It’s HIPAA, not HIPPA!)

October 1st, 2010 by – Marijke Durning

Patient confidentiality has always been an issue in nursing. One of the first things student nurses learn is the importance of maintaining patient confidentiality. This is drilled into them and the consequences of betraying this confidentiality can and often does result in expulsion from nursing school.

In the past, there have been stories of medical staff illegally obtaining information from patient files to get information they’re not supposed to have. This information could be anything from undisclosed illnesses to be used in court cases to learning about a celebrity who was treated in a particularly facility. In either case, the patient whose confidentiality was breached could have suffered as a result.

This need for patient confidentiality has grown to the point that in 1996, the government of the United States government developed and enacted the HIPAA act, Health Insurance Portability and Accountability act. The HIPAA act is often mistakenly written as the HIPPA act – a pet peeve for many in the medical field.

Without a doubt, something had to be done. Confidentiality was becoming a joke in some places. The implementation of HIPAA reminded the staff about the importance of watching what they say and what they write, and who may hear or see it.

Gone were the blackboards and whiteboards at nursing stations that listed patient names and diagnosis. After all, how confidential is the care if anyone walking on the unit could see that J. Jones in Room 202 was admitted for rule out tuberculosis? Also gone were the days of admitting to anyone who called that “yes, Mrs. Smith was on the floor, yes, she’s in room 111 and she’s feeling much better now that her Foley has been removed.”

These moves, and those like them, are good. They protect the patients from unwanted invasion of privacy. But could it be that HIPAA – or its interpretation – sometimes goes too far? Nursing forums and chat rooms are often filled with messages from nurses who feel they were unfairly punished for committing a HIPAA violation when they clearly felt they hadn’t. Other nurses feel that HIPAA is often used as an excuse to get rid of nurses the administration has been targeting.

What do you think? Have you had any situations come about because of HIPAA?

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Legal Issues

September 30th, 2010 by – Sue Barton

[question] What are two legal issues affecting the health care profession? [/question]

Medi-Smart has a couple of articles on legal issues affecting nurses.  The concern about malpractice liability is without a doubt the top issue most health care professionals would cite.  Stemming from that issue are the topics of malpractice insurance, proper documentation, and patient privacy, among others.  Knowing the legal statutes of the Nurse Practice Act in your state is important for all nurses.  Be familiar with the policies for your employment setting as well.  Another Medi-Smart article gives nurses information on how to protect themselves from malpractice suits.  It is important to keep licensure and certifications current, and be up to date with continuing education topics in your field.  Communication skills and proper documentation are essential.  Malpractice insurance may be purchased through a nursing organization or may be provided by your employer.

Even prior to the enactment of HIPAA in 1996, confidentiality and privacy issues have always been critical both from a legal and an ethical standpoint.  An exception to this principle is the legal obligation to report any suspicion of abuse that comes to the attention of the nurse or other health care professional in the course of caring for any patient in a vulnerable situation. Balancing the ethics of providing optimal health care with the need for documentation and sometimes defensive practices due to the reality of malpractice issues is a challenge!

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Being a Patient Advocate: The Uphill Legal Battle

September 29th, 2010 by – Derek Brocklehurst

I am a nurse and I care for two critical care children in the home health setting. I am finding that there is not enough of “me” to go around. How can I construct a legal argument for the quality of life of these two children, for whom I care, against the group billing insurance industry for home health care?

This sounds similar to some of the nurse-to-patient ratio issues that both hospitals and nurses face, especially in states that do not specify ratios. Oftentimes, nurses can feel overworked and underpaid, particularly when they are the ones battling the insurance industry and advocating for a patient’s rights and health.

The #1 thing you can do to help your case is to document, document, document! If you performed a specific procedure or assessment on a patient, document the time performed, what was done, what instruments (EKG machine, intubation set, etc.) were used, and what the results were. Everything that a nurse documents can be used in court against insurance companies (and for the patients) that may not want to pay for something.

Contacting your state’s board of nursing and requesting advice in patient defense is one place to start. You should also check out the American Nurses Association Patient Safety & Nursing Quality webpage for a more comprehensive list of online resources for nurses facing legal issues.

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No Means No – But You May Need to Practice

September 29th, 2010 by – Marijke Durning

A complaint made by many nurses is the number of times they get called in to work extra shifts. They weren’t scheduled, but they were called because another nurse was sick or the schedule came up short.

Of course, it is to our benefit as a team if all the nurses pitch in and fill in once in a while, but doing so once in a while and being asked to constantly are very different. There are some nurses who are asked almost every week to do an extra shift or overtime and many don’t seem able to refuse.

Is voice mail the solution?

Before voice mail and answering machines were commonplace, nurses answered their phones blindly during the day and particularly during the night, especially if they had elderly parents. Unfortunately, this also meant they answered the phone when it was someone calling them to work as well. So when voice mail became available, an easy solution became not to answer the phone and let the caller go to voice mail.

The nurse would check the messages, call back who she wanted and ignore the others. Seems simple enough – but is this a good solution or just a way around dealing with the true issue at hand?

Is not answering your phone the way to go?

There may have been a big shout of joy among nurses when call display became an everyday phone feature. Having call display allows you to decide if you want to answer the phone, based on who is calling.

If you don’t recognize the number or you know it’s from your place of employment, the solution is simple: you don’t answer the phone.

The problem with both the voice mail and the not answering the phone routes is the managers and schedulers are doing a job: filling a needed spot. If they can’t ask, they won’t know if someone will get back to them later or if the nurses won’t get the message until it’s too late.

Passive-aggressive versus being assertive

A nurse’s private time is just that – her private time. Her day off is just that – her day off. If nurses choose to work extra shifts, this is their prerogative, but unless they work in a mandatory overtime state, no-one can make them work. So why do nurses feel they have to take the passive-aggressive approach of avoiding answering the phone if it’s their workplace calling?

“Can’t say no” syndrome

Saying “no” isn’t as difficult as it seems. Nurses who find it difficult really should practice because saying no is a skill that is just as important in life as is saying yes. It may be a stretch, but it seems that nurses who can’t say no to employers likely have a difficult time saying no to people around them, from relatives and friends to people who are looking for volunteers. If that’s the case with you, then learning how to say no is even more important because saying yes all the time may lead to resentment and burnout.

No is no

No means no and only no. “No” isn’t maybe and it’s not “no, but…” No is no.

When someone asks you do to something you don’t want to do, you don’t need an excuse. If your nurse manager says, “can you work tomorrow night?” and you don’t want to, the answer is “No.” Not, “no, I have to be at XYZ,” or “No, I have plans to ABC.” It is no.

You could say, “No, I have plans” and leave it at that. What? You don’t have plans? Sure you do. They may only be to watch your TV show curled up with your dog or to read a good book with a glass of wine in your hand, but they are your plans. Plans don’t have to involve going out or entertaining, plans are what you plan on doing with your time off.

What if you say no and your manager asks why? Well, it’s not really her business, is it? You have plans. What plans, she asks. You aren’t under any obligation to explain. No is no.

Until nurses start standing up for themselves, people will continue to try to take advantage of them. Hospitals and health care facilities can get away with not hiring extra people if they can convince their current staff to pick up the slack. But if they burn out their nurses, they’ll end up with no-one to do so.

For your own sake and those of your fellow nurses, if you have trouble refusing and it’s bothering you, learn and practice a new skill: saying no. You’ll be surprised how liberating it is.

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Genital Herpes

September 28th, 2010 by – Sue Barton

Can you catch herpes without having sex? Like if someone wore my clothes?

Genital herpes is a sexually transmitted virus.  The virus does not live on other surfaces, such as clothing or toilet seats.  Herpes simplex virus can be type 1 or type 2.  HSV-1 is typically associated with oral outbreaks such as cold sores, but could be transmitted to the genital area via oral-genital sexual contact.  HSV-2 is the virus associated with genital lesions in most cases.  An outbreak of genital herpes involves fluid filled lesions in the genital or rectal area that become painful and ulcerated.   The initial outbreak may occur about 2 weeks after transmission, with sores lasting for 2 to 4  weeks before healing.  The virus also can be dormant for long periods of time.

Interestingly, most people who have HSV never have symptoms.  Those who do have lesions may have future outbreaks, but severity and frequency typically decrease over time.  Women are more likely than men to have HSV-2, and are also more likely to be symptomatic when they do acquire the virus. 

HSV-2 can be diagnosed by viral culture from a lesion, or by blood tests for the HSV-2 antibody.  While herpes cannot be cured, antiviral medications can prevent or shorten outbreaks, and can also reduce transmission of the virus to sexual partners.  Of course, condom use is also helpful is reducing transmission.  You can find more detailed information on both HSV-1 and HSV-2 at the Centers for Disease Control, http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm

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