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Answers to Your Nursing Career Questions

Military nurses

June 26th, 2010 by – Sue Barton

  Do I have to join a branch of the military to be a nurse in an army facility? 

Each branch of the United States military (army, navy, air force) has an affiliated nurse corps.  Nurses in the corps hold military rank; a new nurse enters as second lieutenant, with opportunities for advancement.  However, the military also hires civilians for a variety of positions, including nursing.  Nurses may enlist in a branch of the United States military, or may apply for duty as a civilian at a government facility.  Which option a nurse chooses will depend on any number of factors,  among them benefits, pay rate, personal philosophy, career flexibility, family considerations, and continuing education opportunities.  Historically, nurses have played an important role in military conflicts, and in the medical and nursing advances that have come out of war time experiences.  The creation of the US army nurse corps dates to 1901.  Medi-Smart has an article about military and uniformed service nursing which you may find helpful.

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Does a Nurse’s Personal Life Have any Bearing on Work?

June 25th, 2010 by – Marijke Durning

You’re out at a party and have too much to drink. A friend takes a photo of you sleeping on the couch in the middle of the party and posts it on Facebook. Your nursing supervisor calls you into his office a few days later and writes you up for behavior unbecoming of a nurse. He says that he saw your photo when he went to different nurses’ pages to see what they were doing. Then he warns you that if this happens again, you could be fired. Is this fair? Has this happened to someone you know?

Where does a nurse’s professional life stop and personal life begin? Is there a cross over? Should your employer have the right to dictate how you behave when you’re not at work?

In some ways, this is already happening. If you’ve been convicted of a crime, you can see how fast you can lose your nursing license. Of course, there’s a difference between a crime and having fun. Sure, some people would argue, what fun is there in getting so drunk you fall asleep at a party, but then again, what is fun for one person may not be for another.

To go back to the scenario, the supervisor wouldn’t have known about the party or the drunken sleep if the friend hadn’t placed the photo on Facebook. So, maybe this is really a matter of “if you don’t get caught…” After all, before social media, other than gossip, how did news travel so fast? It didn’t. And, now, come to think of it, just what was the supervisor doing checking out nurses’ Facebook pages? What right does he have to do this?

Do nurses have a moral obligation? If a nurse wants to behave in a certain way when she’s not at work, how can that have an effect on her work on the job?

Lots of questions here, not many answers – we need you for that. What do you think?

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Posted in Work-Life Balance

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Adolescent Confidentiality

June 24th, 2010 by – Sue Barton

  How should confidentiality about risk behaviors such as substance use and sexuality be handled with adolescent patients in an outpatient setting?  Do parents have access to this information if a teenager tells me?

You need to know the specific statutes in your state that apply to this issue.  If the information is not readily available through your clinical setting, check with the state department of health.  Generally speaking, the laws provide for any information that the teen and you discuss to be confidential unless you have reason to believe that there is an immediate threat to either your patient or other people.  Position statements from a range of professional groups, such as the American Academy of Pediatrics,  assert that adolescents are best served by developing a trusting relationship with their health care provider.  It is helpful early in adolescence to clarify with the family that you may at times be talking with their teen about choices that could pose risks to their health and that you will maintain confidentiality unless there is a dangerous development, such as suicidal thinking.  Try to assist teens in finding ways to include parents in these discussions whenever possible, and if you must breach confidentiality for their safety, always let them know.

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Medical Assistants

June 23rd, 2010 by – Derek Brocklehurst

Hi, I am a junior in high school and I want to know when I go to college for medical assisting what would be my major?

So you want to be a medical assistant (MA)? An MA’s duties vary from collecting blood specimens to scheduling patient procedures to administering certain medications under the supervision of a practicing physician. Many MAs will act in an administrative fashion answering telephones, keeping patient charts up to date, handling billing and insurance polices, and welcoming patients to the clinic atmosphere. Medical assistants support and advocate for the patient and oftentimes act as the communicating liaison between provider and patient. There are a couple different options in terms of where to go for education. Community colleges, online programs, and vocational or technical schools all offer medical assisting programs. Most of these programs are 2-year commitments and will allow you to practice as an MA after graduating and becoming certified. Check out Medi-Smart’s Medical Assistant page for more information about different schools and degree programs for MAs!

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Have You Considered Being a Nurse Practitioner?

June 23rd, 2010 by – Marijke Durning

Have you ever considered becoming a nurse practitioner? This field in nursing isn’t quite as new as some people may believe. Although the American Association of Nursing Practitioners is celebrating 25 years in existence, the first nurse practitioners in the United States attended the University of Colorado in 1965. Currently, the AANP says there are about 135,000 practicing NPs in the United States, with 8,000 new NPs joining the ranks every year.

Super Nurses?

Certified NPs, sometimes are referred to as the bridge between nursing and medicine, can perform many roles, from following patients through care, managing care, diagnosing and treating some acute and chronic issues (such as wound infections and diabetes), and more. To get to this point, their education is a minimum of a master’s degree in nursing (MSN) and more NPs are obtaining their doctorates, or PhDs in nursing.

Sometimes, NPs are referred to in the media as “super nurses.” The journalists want to make the NPs sound like they can do more than a “regular nurse,” which is true. But by labeling one group of nurses as “super” and another as “regular,” a greater divide forms.

It’s without a doubt that an NP can do more for a patient than can a floor or home health nurse. However, her role is different too. She has blended the nursing whole-patient approach with a touch of medicine. Without a nursing background, she couldn’t have done that. In other words, an NP must be a nurse, but a nurse doesn’t have to be an NP.

Specializing

Although nurses can specialize by virtue of the unit they choose to work or by studying for specialty certificates, one of the many advantages of being an NP is the ability to specialize even further. You could graduate as a geriatric or women’s health nursing practitioner (to name just two) and then you can even specialize further, such as in emergency or orthopedics.

When students enter nursing, are they told about the nursing practitioner option or is it something that they learn about along the way? What about you? Is it something you wish you had done earlier? Would you consider going back to school to become a certified nurse practitioner?

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Rude patients

June 22nd, 2010 by – Sue Barton

  I’m a nurse in a family practice clinic, and some of the patients are just rude to our staff at times.  What’s the best way to handle people like this? 

Illness, and the stress of feeling ill, or worrying about an ill family member, can lead people to act in ways that they might not typically behave.  Try to put yourself in their shoes, and to do whatever you realistically can do to address their concerns.  It may help to reflect back to the person some of the behavior you see, “I can see you are really frustrated about the way things are going.  I’m going to do everything I can to help things go smoothly for you.  Can you tell me what it is that has you so worried? [or angry?]“  Try to defuse the situation by not responding back defensively or rudely yourself, but rather acknowledge the problem as they see it.  If they have been kept waiting, for instance, you may owe them a brief explanation and recognition of the inconvenience.

That said, you do not have to put up with abusive behavior from patients.  Your office likely has a policy dealing with this problem, and patients who are verbally abusive to staff may be asked to leave the practice, so consult with your office manager, and be sure to document the incidents that have occurred.

 

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Patient Care for Paraplegic at T3/T4

June 21st, 2010 by – Derek Brocklehurst

How do you write a teaching plan for a client who is paraplegic at T3 and T4?

Spinal cord injuries (SCI) can occur from trauma or compression to the vertebrae, leaving the spinal cord impaired at any specific point from the cervical vertebrae all the way down to the sacral vertebrae. As the caring nurse for a paraplegic patient, you must assess several different aspects and evaluate the kind of care that is needed. Sensory impairment may be present and should be assessed in all extremities. Muscle tone and motor impairments should be assessed. With a T3/T4 paraplegic, you would expect full lower body paralysis and completely normal upper body movements. Their upper body strength will be dependent on how active they wish to remain with full lower body paralysis, as well as the extent of the SCI at T3/T4. Educating the patient about skin integrity and the importance of personal hygiene and changing positions frequently to avoid pressure ulcers and infections is key to healthy long-term personal care. Evaluating psychosocial aspects can be equally as important as the physical care. Remember to assess where the patient lives, who can help them with daily activities at home, and how their future employment might be affected.

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Older Nurses – Retirement Age, That Is

June 21st, 2010 by – Marijke Durning

As nursing increasingly becomes a popular second (or third) life profession, many nurses are working later in life as well. After all, if you only go into nursing at the age of 50 or 55 years, retirement may not be what you want in 10 or 15 years. There are also nurses who can’t afford to retire come traditional retirement-age time, no matter how long they have been working.

Some professionals, such as pilots, have mandatory retirement ages. No matter how proficient, skilled, and experienced a pilot is, once he or she reaches 65 years, it’s time to step out of the cockpit for good. The retirement age was 60 years in the United States until 2007. The International Civil Aviation Organization (ICAO) had raised the age limit one year earlier, but they do stipulate that one pilot under the age of 60 years old must be on the flight deck for international flights.

Obviously, this earlier cutoff annoyed and upset many capable pilots and the new cutoff gave them another five years of flying, if they passed the twice-yearly medical exams.

Nurses may not be piloting a huge craft with hundreds of lives aboard, but they do make life-and-death decisions. They have to react quickly and appropriately, and they have to be able to move fast. Can older nurses do these things? Of course some of them can – many of them can. But, as with everything else, not all can.

Younger or less-experienced nurses need to have the more experienced nurses around. Nursing isn’t something you can learn from a textbook – although we all remember those nursing theory courses we had to learn, right?

Experienced nurses offer new nurses the years of skills they bring to the profession, skills and know-how that only comes from watching others and by doing again and again. It’s obvious that we need to pass these skills on and we need these nurses to share their knowledge.

There shouldn’t be a cut off age for nurses if they are physically, emotionally, and psychologically capable of doing the job and they want to do it. But what about nurses who must continue working or don’t want to stop working, but they do have issues that make it difficult to continue with active floor nursing? There has to be a place for them, doesn’t there?

Here are some options:

- Train experienced nurses to become preceptors or mentors and have them work with the newer nurses.

- Give adapted work schedules to nurses who can no longer work the crazy hours.

- Provide 8-hour shift options, not only 12-hour shifts

    What do you think? Do you think nurses should be made to retire if they don’t want to? Do you think that we should offer accommodations to nurses who feel they must continue working? What options could we offer?

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    Health Education

    June 19th, 2010 by – Sue Barton

      I have a bachelor’s degree in sociology, but now I’m thinking that I’d like to work in public health.  I’m especially interested in heath education.  Do you think I will need to go back to school?

    You will need to have a health education major to pursue careers in health education, and to obtain certification in the field.  Your sociology degree should be helpful in understanding population trends and community health concerns, but you will need to understand epidemiology and effective educational methods to change behaviors that impact health.  Look into master’s degree in public health programs with a health education major.  You might also check with local or state health departments to see if there are non-certified positions that might give you some experience and exposure to public health.  Health educators work in a variety of public and private settings to promote better health for individuals and the community by educating about  prevention.   Private foundations that focus on specific diseases may employ health educators to get their message out to the public about prevention and awareness. Pharmaceutical companies may use health educators to develop patient information about medication use.  Perhaps you would be able to job shadow someone currently working in the field while you are looking into further education.

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    Heart Attack Symptoms

    June 18th, 2010 by – Derek Brocklehurst

    I have recently been experiencing chest pain on the left side. The pain is high on the left side of my chest and still feels sore after the internal pain is gone. Now I am experiencing severe stomach cramps with diarrhea and I have vomited twice. Are these symptoms of angina or heart attack?

    Angina pectoris, or a chest pain around the heart due to decreased levels of supplied oxygen, can be felt during or prior to a heart attack. Specific heart attack symptoms can vary between men and women but the underlying symptom is generally the same: a pressure or heaviness of pain around the chest area. This pain will oftentimes radiate to other areas of the body such as shoulders, arms, neck or back. Prior to a heart attack, some women will not feel any chest pain at all. Most women report unusual fatigue, and some women report sleep disturbances, shortness of breath, and indigestion prior to the attack, according to a study published by the American Heart Association. For men (and some women alike), other symptoms include nausea, cold sweat, dizziness, and a sudden feeling of impending doom. If you are questioning yourself during any of the above symptoms, it is a good idea to go to your primary care provider and get it checked out. You can never be too safe when dealing with cardiac issues and heart attack symptoms.

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