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Answers to Your Nursing Career Questions

Hiring Freeze

September 11th, 2010 by – Sue Barton

 I’m an RN and work as the manager for the operating rooms in a regional hospital with a busy OR schedule.  Right now I have 9 open positions for scrub techs and nurses on my staff that the hospital won’t let me fill.  This means we are frequently short staffed, and urgent cases can’t get onto the schedule in a timely fashion.. Everyone is so frustrated; what to do? 

Hospitals, like other organizations, are in a cost cutting mode right now, and the situation you describe is unfortunately not uncommon.  Your best chance to change this is to document, document, document.  Can you demonstrate that the reduced staffing leads to inefficiencies, that lead to decreased volume, that lead to lost revenue for the hospital?  Are frustrated surgeons taking some of their cases elsewhere?  There is a renewed emphasis on the safety culture in the hospital; can you show that safety is more likely to be compromised by short staffing and nurses working overtime?  How is staff frustration being addressed? Does your staff have suggestions for cost cutting in areas that do not involve cutting positions?  Nurses need to know that they are valued by administration and that their concerns are heard.  This involves more than the occasional patronizing “freebie” such as bringing in lunch or giving away movie tickets.  One of the frustrations of middle management positions such as yours is that you are well aware of the issues on the front lines, but may not have the authority to make the changes that need to happen.  Consider getting more education in hospital and nursing administration so that you can be in a position to make an impact.

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Posted in General

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What Nursing School’s All About

September 10th, 2010 by – Derek Brocklehurst

What do you learn in nursing school and where do you do your clinical rotations?

Nursing school can vary in duration depending on what program you apply to, how many prerequisites you have completed, or what degree you are looking to obtain. Typically, nursing schools are about one-to-two years long. In lecture, you will learn nursing theory, the history of nursing, clinical skills, and how to care for and assess six different populations. These six groups are maternal and childbearing health, pediatric health, medical and surgical nursing, geriatric populations, psychiatric nursing, and community health nursing. Once you have successfully completed these six lecture and clinical courses, you should have a firm grasp on how to assess, treat, and care for all populations.

Your placement for clinical rotations depends completely on the regional location of your program. Depending on how many teaching health care institutions (i.e. hospitals) there are that contract with your academic program, clinical rotations can sometimes be as far as a couple hour’s drive from your school to right around the block from your house.

For more information on different nursing schools, programs, and degree types, make sure to visit Medi-smart’s Nursing School directory!

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Why Do You Want to Be a Nurse?

September 10th, 2010 by – Marijke Durning

What is it that brings you to the nursing profession? Are you studying to be a nurse now or are you looking to become a nurse (if you’re not one already)? Did you know for a long time that you wanted to be a nurse or is it something you are deciding about now? So many questions…

It may not be so, but it does seem that people in health care and public professions get asked the question a lot: “Why did you want to become a nurse/dentist/social worker/doctor? And often, those who are nurses get a follow up question, something like, “Didn’t you want to be a doctor?”

So, why did you want to be a nurse? There are many reasons and there isn’t a right or wrong answer.

Passion for health and science. People who enjoy science and learning about the human body have many options, from working in research to working with the public. This interest may also lead into nursing because nurses can continue to grow and learn as research progresses in their individual fields.

Nurturing. Some people are nurturers, more so than others. If you are looking for a career that allows you to, quite literally, care for someone, then nursing could be a good choice. Other nurturing types of professions include teaching and veterinary sciences.

Variety. Nursing is a profession with multiple options available to the nurses. You could work in nursing in long-term care or home care, or you could end up working in an emergency room, in the military or in palliative care.

Career security. Despite word of too many nursing and not enough nurses in some parts of the United States, there are some areas that have nursing shortages and more shortages are predicted.

Working with people: It seems sometimes in our societ we have on one type of workers, office people, and on the other side, people people. This translates roughly to one group that works behind a desk, working more with paper than interacting with people. On the other side, you have professionals, like nurses, who work with people – a hands on profession. Mind you, ask any nurse and it’s very likely he or she will tell you that just because you’re working with people, it doesn’t mean you won’t have reams of paperwork to do!

So, why are you interested in nursing?

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Posted in Nursing School

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Asthma Medications

September 9th, 2010 by – Sue Barton

  What medications are used in asthma?

Asthma medications fall generally into 2 categories.  “Rescue” medications provide immediate relief from the coughing, wheezing, and shortness of breath that are part of an asthma episode.  Typically these are short acting bronchodilator medications that are administered by inhalation.  Bronchodilators, such as albuterol, work by allowing the smooth muscle of the airway to relax and open up breathing passages.

“Maintenance” medications are used by people with persistent symptoms or moderate to severe asthma on a daily basis to prevent problems.  Since asthma symptoms are the result of an airway inflammation, maintenance medication are targeted at decreasing that inflammation.  Most maintenance medications are inhaled steroids.  Some combine inhaled steroids with long acting beta agonist medication.

Key to asthma treatment is identifying what triggers the inflammation and resulting symptoms in the individual.  If allergies are the trigger, antihistamines and nasal sprays may be useful.  Some asthma is triggered by viral upper respiratory illnesses such as the common cold.  Excercise may be a trigger, as can environmental exposures such as smoke and air pollution.  Nurses can help the asthma patient to identify triggers and learn to use medications appropriately.

Posted in General

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Scope of Practice for LPNs in Arizona

September 8th, 2010 by – Derek Brocklehurst

In AZ, can an IV certified LPN hang an antibiotic after an RN has done the first dose?

Licensed practical nurses, or LPNs, can do many of the same procedures that RNs can do, depending on the state board of nursing and the scope of practice. Some antibiotics, regulated narcotics, and blood transfusions may be excluded from the list of products an LPN may hang from an IV, even after an RN has checked it.

Placing IVs and hanging medications takes careful consideration and attention to detail that RNs and LPNs must be aware of. RNs  must check the “5 rights”: right patient, right dose, right medication, right time, and right route. These actions are typically double-checked by another RN to ensure quality health care.

I would suggest checking the Arizona State Board of Nursing’s Scope of Practice web page to inquire about specific details regarding what an LPN can and cannot hang. Even under proper supervision of an RN, you do not want to assume you can hang a medication without knowing your legal rights and responsibilities as a licensed practical nurse!

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Posted in On-the-Job Fears

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Making the Perfect Nurse

September 8th, 2010 by – Marijke Durning

If you could draw a caricature of a nurse, what would she look like?

Nurses are the jack-and-jills of all trades in the health care world. They are expected to be everywhere, know everything, see all, and anticipate anything. In other words, nurses have to be superhuman. So, because we all could use a little nursing humor, what would the perfect nurse look like if you described him or drew a caricature of her?

- Eyes in the back of the head, that’s a given.

- X-ray vision, so you can always tell what is going on inside a patient.

- Ears the size of tubas – to hear the slightest sounds.

- Shoulders as wide as a mountain – to carry the blame for everything that goes wrong.

- A brain built like the best and fastest computer to remember everything that was ever said about your patients and their illnesses.

- A 10-gallon bladder, because it’s hard to say that you have to go pee while performing CPR.

- Ten hands, all on separate arms, although that will likely still not be enough to do everything at once.

- Roller skates attached to the feet, to reduce travel time.

- Bulging, rippling biceps so you can lift any patient at any time.

- A nose with a filter to block out unpleasant odors.

- Thick skin to absorb needle picks and verbal barbs.

Oh, and a big smile, because no matter how hard the job is, sometimes a smile is what gets you – and your patients – through yet another day.

What would you add?

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Posted in Work-Life Balance

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Using “Reflection” With Your Patients

September 7th, 2010 by – Derek Brocklehurst

What is reflection and how can I apply it to daily patient care?

Reflection is a practice common in psychiatric fields of nursing. Psychiatric nursing involves listening to the patient, understanding where they are coming from, and using statements in a way that is meant to help the patient’s mental health. Oftentimes, psychiatric patients are trapped in a specific thought or mindset from which it may be difficult to free themselves.

Reflection is meant to echo statements that the patient says back to them, so they can actually hear what they are saying. Sometimes, when psychiatric patients are trapped inside their minds, they cannot comprehend their thoughts or actions and refuse to hear themselves speak. When a nurse reflects a statement or question back to the patient and the patient really hears it and understands what they said, it may trigger a deeper understanding within them.

This tactic is not necessarily restricted to psychiatric units. It may be used in times of grieving, counseling, or during emotional conversations about the patient’s overall health. Try reflecting statements back to your patients!

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Posted in Common Nursing Procedures, On-the-Job Fears

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Volunteer experience

September 7th, 2010 by – Sue Barton


I’m interested in nursing, and have been told it’s a good idea to job shadow someone, or volunteer at a hospital.  I’ve applied to volunteer, and I’m on a waiting list, told it might be 6 months, that they will call me.  And how do I find someone to job shadow? 

 Both of these areas have gotten harder to line up than in years past, and with good reason.  HIPAA, the Health Insurance Portability and Accountability Act, makes patient privacy a top priority, so anyone who is not acting in an official capacity may not be allowed access to the patient.  This has put a damper on the sort of casual job shadowing that used to be fairly common.  Concern for the protection of vulnerable populations from abuse has also rightly gained attention, with the result that the volunteer application process is almost like a job application, with background checks, etc.  The only way to job shadow may be to be already affiliated with an academic program.  If your school or institution arranges a clinical placement, there are policies in place to ensure compliance with privacy regulations and to cover liability.  Although the process to gain volunteer experience is more cumbersome, it is still worth pursuing.  Contact a variety of health care facilities to find out about volunteering. If possible, work through a group that you are affiliated with that already has credibility, such as a church or community organization.  Ask about the application process, length to start, what types of work you might be helping with.  Sooner or later you will find a good fit.  Meanwhile, you might just want to get started with applying to nursing schools since that process too can be time consuming, and involve waiting lists!

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Posted in General

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Fall Prevention: A Big Part of Nursing

September 6th, 2010 by – Marijke Durning

Fall prevention is a big part of nursing. Patients of any age and with any type of health condition can – and do – fall. And while falls can happen anywhere, the biggest problem is in long-term care and nursing homes.

If you are studying to be a nurse or a certified nursing assistant (CNA) this will be emphasized many times throughout your education because of the severe outcome that can result from falls.

An elderly person who is in perfect health but falls because she trips on the edge of a rug or slips on a slippery floor, could end up disabled as a result or, without exaggeration, she could die. A fracture could limit her mobility, increase risk of complications, reduce her ability to socialize, and limit her independence.

Malnutrition and dehydration could result if she can’t get her food or drink, or if she has no appetite. Being unable to get to the bathroom could result in elimination problems and immobility could result in skin breakdown and muscle atrophy. Certain chronic illnesses can worsen as a result of the pain and immobility, and infection could set in, leading to sepsis.

Knowing all this, it’s not hard to see why fall prevention is such an important part of nursing and nursing care. Let’s look at some hard facts about falls in long-term care and nursing homes, taken from the Centers of Disease Control website:

- About 1,800 people living in nursing homes die each year from falls.

- About 10% to 20% of nursing home falls cause serious injuries; 2% to 6% cause fractures.

- The major cause for falls is weakness and/or difficulty walking.

- Close to 30% of falls are related to the environment, such as slipping, poor lighting, tripping, getting out of a wheelchair that didn’t have brakes on, and so on.

- Medications can contribute to falls. Medications that make a patient sleepy or light headed are the obvious ones, but also medications such as diuretics or laxatives can make a patient hurry too fast to the bathroom, causing a fall.

As a nursing student or a nurse, it is your duty to help ensure the safety of your patients. This includes times where you are not doing hands-on care. If you are in charge of a unit or are doing paper work and you see a patient who is in danger of falling, you must act. If you see an unsafe situation, you must act to reduce the risks of anyone – even staff – falling.

Preventing falls is a good example of team work in the health care system and it’s something that is started in the very first days of nursing school.

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Posted in Common Nursing Procedures

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Changing Specialties

September 4th, 2010 by – Sue Barton

  I am an RN in California working on a med/tele unit. I would now like to work in a Labour and Delivery department.   Should I take classes now or will the employer educate me? 

Because you are an RN, you have the basic preparation to work in labor and delivery as part of your nursing education.  Employers routinely provide orientation to  nurses as part of starting a new position.  Specific training to bring you up to speed in the skill set for this specialty area may or may not be provided.  It certainly seems wise to bone up and refresh as much as you can since this is an area you are interested in and wish to pursue in the future.  One way to do that would be to take continuing education courses in labor and delivery nursing.  Online courses may be available.  If you are thinking of transferring from your present position to a labor and delivery position within your current facility, you may be able to talk to nurses who work in this area, or set up an interview with the nurse in charge to find out more about what training is offered.  Another resource is the Association of Women’s Health, Obstetric, and Neonatal Nurses.

Posted in General

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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.