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Answers to Your Nursing Career Questions

Working With Seniors

September 20th, 2010 by – Marijke Durning

Working with seniors has never been a popular area of nursing. It’s not exciting like it is working in the neonatal intensive care (NICU) or in emergency. Many times, nurses choose to go into so-called chronic care when they tire of acute care nursing, feeling that it will be an easier, less stressful job.

That being said, as the North American population ages in greater numbers, more nurses and nursing assistants will be needed to care for those who can no longer care for themselves. And more need to approach it with the same respect that they do other areas of nursing. After all, all our patients deserve our respect, don’t they?


Until recently, a lot of senior care was really just warehousing. Hospital and long-term care facilities would set up a floors or units for seniors, some locked because of the need to contain patients who wander due to dementia. Once the floors were established, the minimum of caregivers (often) would be hired and the patients were given the physical care they required, but that was it.

Life in many places consists of the patients being woken up in the morning, bathed, put in chairs for breakfast, sitting in hallways or common rooms until lunch, being toileted, given lunch, put to bed for the afternoon, roused for supper, and then put back into bed for the night. Is this a life?

Nurses are trying

To be fair, not all facilities are like this. There are caring and devoted nurses in long-term care and they do go out of their way to help their patients as best they can. The nurses advocate for their patients, give them the care they need and deserve, and do their best to ensure their patients are as comfortable and happy as is possible. However, since long-term care and senior care is often at the bottom of the list for funding and staffing, the nurses who do care can only do so much.


Now, the field of gerontology is coming to the forefront as both doctors and nurses study the aging process and the people who come into their care. Health care professionals are learning that the disease process differs in the elderly as do medical treatments. As the field grows and more research is done, more discoveries will happen, hopefully improving the medical and physical care of this age group.

Nurses of all levels can work in gerontology, licensed practical nurses (LPNs) or licensed vocational nurses (LVNs) are often hired to work in long-term care. Registered nurses (RNs) can choose to go on for gerontology certification and those with a bachelor’s degree in nursing (BSN) or master’s degree in nursing (MSN) can go on to study to become a gerontology nurse practitioner.

Gerontology nurses do more than just the physical care for their patients. They must have good assessment skills, to determine how a patient is doing from day to day. They must be able to adjust care and expectations as a patient’s functioning status changes, and they understand that their patients need more than just medications and skin care – they need an understanding nursing staff who will help them as they move through this final stage of life.

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Posted in Patient Interaction

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Requests from Family Members

September 18th, 2010 by – Sue Barton

 Is taking the blood pressure of a patient’s family member if asked to do so a bad idea?

A lot depends on the circumstances.  If you are working in a family practice office, and a spouse is with the patient who is also a patient in the practice, it’s reasonable .  If you are in an intensive care unit and the same thing happens on a busy day, it’s not.  The safety and privacy of your patient come first.  Also, if the family member is not your patient as is likely the case, you have no way to record the findings or to intervene if necessary.  Nonetheless, a simple BP reading, and a word of reassurance that it’s in a normal range, or conversely, that it’s high and should be rechecked by the person’s own health care provider is in the realm of what might happen in a community screening event.  If you are too busy or if the request seems to you like it will open the door to more complicated requests, simply state that you need to focus your attention on the patients under your care.  Perhaps you could direct the family member to another clinic or resource that could provide both assessment and treatment if they do not have a primary care provider.

Posted in General

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Triple-Checking Medication Orders

September 17th, 2010 by – Derek Brocklehurst

Can a nurse refill a prescription if a protocol is written and approved by the doctor?

You should check with your specific state’s nursing board and the scope of practice, but in general, nurses cannot simply refill a prescription without a written order from the provider. Check with your charge nurse, nursing supervisor, or state board of nursing regarding the specifics of refilling medications. Some medications might be easier to refill than others and it is important to know the difference. It is always good to be on the cautious side of things and double check with the provider about the prescription if you have any questions at all.

In general, it is good practice to triple check prescriptions for patients. You want to check the “5 rights” with a fellow nurse and/or the provider: right dose, right route, right patient, right time, right medication. You will want to check these against your medication order from the provider for a patient, typically with another nurse before you administer. This is especially important for narcotics and other highly-regulated medications. Follow these rights to avoid legal issues, liabilities, and patient safety errors!

Posted in General

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Once a Med/Surg Nurse, Always a Med/Surg Nurse?

September 17th, 2010 by – Marijke Durning

Med/surg (medical-surgical combined floor or unit) is a very common first stop for new graduate nurses. With shiny new nursing license in hand, they are pointed towards med/surg because many people believe that the variety of care needed in that environment is a good build up to overall nursing knowledge.

There are some arguments in favor of this approach. After all, you see many different types of patients in the med/surg environment and the loads can be pretty heavy, forcing the new nurses to learn how to organize themselves and be effective nurses.

On the other hand, some nurses don’t feel that the med/surg experience will make or break the new nurse and that new nurses can begin their career anywhere in the hospital environment, from the general med/surg to the specialized NICU. Some argue that if a nurse stays in med/surg, he or she will find it harder to adapt to a different environment than, say, a NICU.  So, does this mean once a med/surg nurse, always a med/surg nurse? It doesn’t have to.

No matter what floor or unit you work in, you must keep up-to-date on the latest techniques and findings in your area. But that doesn’t mean you can’t learn about other areas in nursing. If you graduate from nursing school and want to work in psychiatry, but the only job you can find is in labor and delivery, it doesn’t mean that you won’t ever work in psych. It just means you won’t work in psych right away.

While you work in L&D, you can take continuing education courses to obtain continuing education units (CEUs) on psychiatric subjects, you can read about psych nurse issues, and can even complete certificates in the specialty, either at a brick-and-mortar school or through online nursing schools. The point is, the onus is on you, the nurse, to learn as much about your goal as you can. By doing so, when you do fill out an application or go for an interview, you can show that you are proactive and eager to learn about the field that interests you most.

Nurses who work in long-term care (LTC) often face the same type of dilemma. They’re often told that once they work in LTC, they’ll have a hard – if not impossible – time finding work in an acute care hospital. On the surface, this could sound right; after all, LTC nurses use a different set of skills than acute care nurses. But, a nurse is a nurse, and if the LTC nurse keeps up-to-date and does his or her best to stay on top of learning, there’s really no reason why the jump can be made from LTC to acute care.

So, is it once a med/surg nurse, always a med/surg nurse? It doesn’t have to be. It depends on how badly you want to get into another area of nursing.

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Posted in Continuing Education Units

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Scope of Practice

September 16th, 2010 by – Sue Barton

  What are the legal issues if a nurse practices outside her scope of practice?  What nursing act or acts would constitute malpractice? 

To answer your question, refer to this article titled Legal Issues for Nurses on Medi-Smart.  Malpractice is defined as negligence by a professional.  Each state board of nursing has a Nurse Practice Act which defines the scope of practice for nurses in that state.  The Nurse Practice Act is the standard that is used if a malpractice suit is filed.  It’s important to be familiar with and in compliance with the statute for your state and your level of nursing license.   Take note that it is your responsibility to know your scope of practice, and to follow it in the event your employer asks you to do something that falls outside of those parameters.  Travel nurses should request this information from their employer if they are moving to various states in the course of employment.  You can find the Nurse Practice Act for your state by going to the website for the state board of nursing.   The article also discusses the importance of malpractice insurance, along with other helpful information.

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Posted in General

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Starting Up a Career in Oncology

September 15th, 2010 by – Derek Brocklehurst

How can I get started in oncology?

The field of oncology can be a challenging one for any health care provider involved with direct patient care. Oncology, or the study of cancerous tumors, is a growing field in both medicine and nursing. The longer people are living in the United States, the higher the chances of contracting some kind of cancer are. Cancer patients require special treatment called chemotherapy, which makes many patients feel nauseous, fatigued, and worn out. In order for patients to get the care and treatment they need, it is imperative that the nurses are well-trained and have the heart to care for this needy population.

There are several different ways to get involved in the field of oncology. Special hospital volunteers, traditionally called candy-stripers, are now widely accepted and placed into cancer wards at local hospitals. I would suggest seeking out volunteer opportunities at your local oncology center, hospital, or hospice ward. This way, before you even jump into specific oncology nursing, you can see if caring for cancer patients is your forte! If you are already in nursing school, you might request an alternative rotation on a cancer unit to see what a typical day is like for an oncology nurse.

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Posted in General

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“LTC Isn’t ‘Real’ Nursing”

September 15th, 2010 by – Marijke Durning

How many times have nurses heard or said that long-term care nursing (LTC) isn’t “real” nursing? If those words aren’t used, there are other comments, such as

- If you can’t find work anywhere else, you can go work in LTC

- If you can’t handle acute care, you can always to work in LTC

- If you don’t like to work hard, you can always go work in LTC

But is this true? Quite frankly, no, it’s not.

Registered nurses (RNs) and licensed practical nurses (LPNs) – or licensed vocational nurses (LVNs) – who work in LTC facilities work just as hard as nurses who work in acute care – the difference lies in the intensity and the approach to nursing care, not the quality of care.

Without a doubt, nurses who work in high acuity environments, such as intensive care and med/surg, need to keep up to date with the latest developments in patient care, but so do LTC nurses. Patients in LTC facilities need good quality nursing care every bit as much as those who are in a hospital.

Nurses in LTC rely heavily on their assessment skills, as do nurses in acute care. In acute care, changes in some patients can be detected quickly, while changes in a patient in LTC can be much more subtle. An elderly patient who is normally alert and oriented all around who suddenly becomes confused needs to be assessed. Why did this confusion occur all of a sudden?

Does the patient have an underlying dementia that hasn’t shown before now or is there a problem that is reversible, like a urinary tract infection? Urinary tract infections can easily lead to something much more serious, such as sepsis, causing death. But if a nurse picks up on the possibility of a UTI and assesses the patient for it, most UTIs can be reversed successfully, returning the patient to his previous level of health.

Nurses in LTC need to be aware of how medications interact with one another. Patients in LTC settings often take numerous medications, all of which have potentially very harmful side effects. LTC nurses are often left to be quite independent. Doctors may not be readily available or easily accessible, leaving decisions, using facility protocols, up to the nurse in charge.

Nursing in LTC may also be emotionally draining. While in acute care, patients come and go, LTC patients stick around, making it easy for nurses to develop relationships with them. If the patient is not to be resuscitated and is comfort care in his last days, this can be tough on the care givers who remember laughing and talking with him in better times. It’s easy to get attached.

Are nurses who work in acute care and LTC different? No, they’re not. A nurse is a nurse. But a nurse who works in LTC is more experienced and likely more knowledgeable about seniors and chronic illnesses than is an acute care nurse, while an acute care nurse knows more about other issues.

It’s not a competition. Nurses give care, wherever they work.

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Posted in Work-Life Balance

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LPN Free Online CEUs

September 14th, 2010 by – Derek Brocklehurst

I’m looking for a government institution that provides free LPN course for people who are interested in continuing their education but don’t have the financial resources.

Continuing your education as a nurse is as important as how you practice everyday in the clinical setting. Health care, policies, treatment, and preventative measures are constantly changing due to many evidence-based practices and studies getting published monthly. As a nurse, it is your job to keep up on the literature and to know how to best perform on the job.

There are many different ways to get your continuing education units (C.E.U.s), both in person at live lectures, workshops, and conferences and online. Sometimes, all it takes is a couple hours in front of the computer with a couple quick clicks of the mouse pad to get all the CEUs you need for your impending renewal! You should go check out Medi-smart’s CEUs directory for an updated list of free online ways to get your credits!

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Posted in Continuing Education Units

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Influenza Vaccines 2010

September 14th, 2010 by – Sue Barton

  What’s new with influenza vaccines for the coming season?

This season, the seasonal influenza vaccine incorporates the H1N1 virus that caused so much concern last year.  As you remember, last year there were 2 separate vaccines, and supply was variable.  This caused some frustration and confusion as people had to make 2 visits to get the vaccines in many cases, and often multiple phone calls to the provider to check on availability.  As of August, many health departments and providers have this years influenza vaccine on hand and are giving it.  While flu season does not usually begin in the US until fall, the vaccine protection lasts for about a year.

As before, there are 2 forms of the influenza vaccine.  The live attenuated vaccine comes as a nasal spray and is an option for people from age 2-49, if they are not pregnant and do not have certain health conditions.  The inactivated vaccine is given by injection.  Influenza vaccine is recommended for all people over the age of 6 months.  It is especially important for health care workers because of their contact with higher risk groups such as infants and elderly patients.  Detailed information about influenza is available at the CDC website.

Posted in General

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Float Nursing – Can You Refuse?

September 13th, 2010 by – Marijke Durning

If there’s something many nurses don’t want to hear when the get to work it is, “you’re floating to another floor.” Floating isn’t uncommon in nursing; some hospitals even have float teams, nurses who go from floor to floor as needed. But floating when you’re not used to moving around like that is different. In some cases, it might not be so bad because you’re familiar with the unit or floor but other times, it may be a nightmare. You don’t know the floor, the type of patients, the routines, anything. So what do you do? Can you refuse?

Whether you can refuse to float to another floor or unit may depend on several things. For example, if your experience is strictly orthopedic nursing with adults, being floated to an NICU would be foolhardy. Refusing that type of float may land you in the Bad Books of administration, but it likely would earn you brownie points from the nurses in the NICU who would have not been able to use your services anyway.

Changing the scenario a bit, you work in med/surg in pediatrics and the supervisor wants to send you to labor and delivery. Should you go? Many nurses would refuse this assignment too. After all, working with children in a pediatrics environment isn’t the same as working with women who are delivering babies.

It could be argued that you can only learn and get more experience if you agree to float – but is covering for a short-staffed floor the right place and time to learn? It hardly seems like that shift would be an effective learning experience.

So, what to do? In some parts of the country, nursing jobs are very difficult to get, even if you have recent nursing experience. The fear of losing a job can make it tempting to take a float assignment you aren’t comfortable with. But, what you need to do is determine if the assignment is uncomfortable or if it is dangerous.

Uncomfortable assignments may be going to a floor where you don’t know anyone. Dangerous assignments are going to a floor where you don’t know the patient group, their level of care, and the type of care. If the assignment is only uncomfortable, you’d be hard pressed to have a good excuse to refuse it. But if it is dangerous, lives could be at stake.

In a perfect world, you wouldn’t be put in such a position but it’s not a perfect world – so have you been floated where you feel you shouldn’t have been or been put in a position that you felt floating would be dangerous? What did you do?

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Posted in On-the-Job Fears

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