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Answers to Your Nursing Career Questions

An Injection of Guilt Serum With That Nursing License?

June 18th, 2010 by – Marijke Durning

When I hear statistics that describe the nursing shortages where I live and how nurses have to work so hard because of these shortages, I feel guilty. I no longer actively work as a registered nurse. I work as a writer for the most part, but the tug of nursing pulls awfully hard sometimes.

It’s not like I’ve not worked my share as an RN. After taking some time away from nursing, I went back yet again – the last time working in a long-term care facility as a resource and infection control nurse. Before that, I used to work the odd day here and there for an agency; my favorite work was doing the wellness clinics that some employers hold. It’s nice to work with people who are happy to see you. The best part is you get to do some hands-on teaching sometimes. Earlier in my career, I worked in many areas, from active med/surg to rehab to school teaching, even palliative care. I even have worked in occupational health and taught nursing aides and orderlies how to do their clinical work.

Many nurses leave active nursing for a variety of reasons. And there are so many areas where nurses can work. Some leave to go work in private industry, others because they’ve decided to stay home with their families. We have the nurses who burn out and those who feel that they have outgrown nursing. They leave to move up the chain in the health field. And then there are those who just don’t want to do nursing any more. They’re not burned out, but they just don’t want to do it. That’s probably what category I’d fall into. I left nursing to follow my passion of writing. I’ve always loved to write and it was something that stayed dormant but would rise up every once in a while.

So what’s with the guilt? So many nurses I know feel guilty when they refuse extra shifts or can’t stay for overtime. They even feel guilty calling in sick. They know that if management can’t find a replacement, their coworkers are left with the extra load.

Do they somehow hypnotize nursing students and leave us with a guilt complex of some sort?

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Posted in Work-Life Balance

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Getting In

June 17th, 2010 by – Sue Barton

  I’ve applied to nursing school every year for the past three years, and I keep getting wait-listed.  Is there any way to make my application stronger?  I’m so frustrated!

The fact that you are getting wait-listed rather than rejected  indicates that you meet the criteria for admission, but you are getting caught in the bottleneck of too many applicants for too few program slots.  Unfortunately that dilemma has become all too common as limited availability both of qualified faculty and of clinical sites has prevented nursing schools from expanding as rapidly as the demand.  You are not the only qualified applicant being turned away.  If the available slots are going to students with higher GPAs, then that is the thing to work on.  Recommendations and past experiences may play a role, but more likely the grades are the determining factor.  If you are able to, consider broadening your search to other schools, looking for programs that may have non traditional approaches.  One young man recently told me he applied to 17 schools before getting into a clinical program!  Remember that some BSN programs admit freshmen directly into the nursing school, others admit for the final two years of clinical after two years of prerequisites, and of course associates degree in nursing programs are also now getting many applicants.

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Posted in Nursing School

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Financial Aid for a Second Degree in Nursing

June 16th, 2010 by – Derek Brocklehurst

Are there grants that you can apply for nursing school if you already earned a previous degree in another field?

Many people discover a passion for nursing after they have already completed a degree in some other field during undergraduate work. Depending on when you apply for your second degree in nursing, there are a number of scholarship, grant, and financial aid options in your favor.

For many second degree programs, there is a “cut off” age for deeming an individual a dependent on their parent’s income. This usually hovers around 24-26 years old. If you are older than the age of dependency specified by the institution, then your financial aid package will reflect your past year’s income and not your parents’ (whether that is in your favor or not is determined by your current profession vs. your parents’ current professions). Your income can determine whether you qualify for federal grants, which do not need to be repaid, or loans, which do need to be repaid, but typically can be deferred until after you graduate from nursing school. Federal loans for students typically offer competitive interest rates, and sometimes defer interest while you are in school.

You might also try contacting your desired nursing program’s financial aid center to inquire about demographic-specific (racial minorities, socioeconomically challenged populations, underrepresented nursing specialties, etc.) scholarships or grants. Also, the American Nurses Association has helpful links to grant options around the nation.

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Posted in Nursing School

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Actress Helen Mirren Likens Prostitutes to Nurses

June 15th, 2010 by – Marijke Durning

It’s all over the Internet by now: British actress Helen Mirren was on Dave Letterman’s Late Show promoting her new movie, Love Ranch. Dave was talked to Helen about visiting a brothel and asked Helen about her research for her role. After she told him about the experience, he asked her if she thought that hookers were victims. She actually said this, as seen on YouTube clips of the inteview:

I think that’s true. A lot of them are damaged. They come from dysfunctional backgrounds and that’s what led them to this place. But also, a lot of girls who work in that industry actually come from the nursing industry, which kind of makes sense. Because they’re used to naked bodies. It’s not intimidating to them, the body and the bodily functions, if you like.”

If you watch the video, it seems that Dave is trying to clarify what Helen meant, and she more or less reiterated her comments.

We live in a time when nurses are still being misrepresented in the media either as bumbling fools, sex objects, or doctors’ handmaidens, or we are non-existent – because we all know that doctors do absolutely everything in the hospitals, right? Where is a sarcasm font when I need one?

I don’t usually let what celebrities say get under my skin, but this is beyond portraying a nurse as a bimbo – it’s saying that hookers and nurses are not that different, you know, “because they’re used to naked bodies.” Seeing as nurses are trying so hard to get people to understand that they are professionals, with very many with university degrees and more studying towards them as they work as a diploma nurse, this comment is infuriating.

Maybe it’s time that nurses stand up altogether and tell Helen Mirren exactly what we think about her comments..”

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Posted in Work-Life Balance

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Prescribing Patterns

June 15th, 2010 by – Sue Barton

 I’m a pediatric nurse practitioner, and I’m frustrated because parents of my patients keeping asking me to prescribe antibiotics for viral illnesses.  I think they are used to having the doctors do this even when it’s not appropriate in my book.  Any advice?

This is a trend you are going to see change as both patients and providers become more aware of the microbial resistance problems that are a result of over-prescribing patterns.  That said, everyone wants sick children better as soon as possible, parents need to get back to work, and in a busy pediatric practice or family practice, it’s easier to write the prescription rather than taking the time to educate about the usual course of a viral illness and symptomatic measures to keep the child comfortable while the virus runs it’s course.  Parents also are concerned about the time and cost of a return office visit if there are complications.

You need to acknowledge all of those factors and concerns, and take the time to walk them through what to expect from the illness and what to do for their child.  I think you will find that most parents will respect your stance if they understand that using antibiotics inappropriately is not in their child’s best interest.

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Posted in General

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Comatose Patient Care

June 14th, 2010 by – Derek Brocklehurst

What is a nursing diagnosis and nursing care plan for a patient in a coma?

Comatose patients are typically deemed critical and will need to be monitored by the nurse carefully throughout the shift. The comatose patient will have a mechanical ventilation device to assist in their breathing. Aspiration can cause death or other emergent health problems in this delicate patient population. As the nurse, it is your job to make sure the comatose patient is draining secretions properly (chest tube drainage, oral drainage, vacuum drainage system). By checking the status of the drainage, you can prevent aspiration of liquids, bodily fluids, or anything else that should not be aspirated. Oral fluids should also never be given to the comatose patient. Monitoring their swallowing ability, gag reflex, level of consciousness, and oral hygiene can help to prevent a death due to aspiration.

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Posted in Common Nursing Procedures

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Nursing Theory or Hands-On Licensing Exam – Which Is Best?

June 14th, 2010 by – Marijke Durning

Once you start nursing school, you begin hearing a lot about the NCLEX, the licensing exam you must pass to be certified as a registered nurse (RN) or a licensed practical nurse (LPN). This exam consists of a certain number of questions delivered by computer. If you answer enough questions correctly, you pass and may receive your nursing license, providing you meet your state’s Board of Nursing requirements.

In other countries, the exams aren’t always the same. They may test the same type of knowledge, but not in the same way. In Canada, the RN exams are offered by the Canadian Nurses Association (CNA) in all provinces and territories, except Quebec, which administers its own exams. The Canadian exams consist of 200 multiple-choice questions are that are offered throughout the country at the same time, twice a year, unlike the United States, where they are offered through a private company, whenever the graduates wish to take them.

Several years ago, the province of Quebec began a unique way of testing its RN graduates for licensing. While some of the exam process does include multiple choice exams, as US and other Canadian nurses are accustomed to, the Quebec exam includes hands-on testing portion, to test how the graduates would react to certain types of situations.

To do this, the Order of Nurses of Quebec (ONQ), the Ordre des infirmières et infirmiers du Québec (OIIQ) in French, hires actors to portray patients in certain medical or surgical situations. Observers watch how the exam-takers react to the situations and grade them according to the graduates’ assessments, reactions, and performance. The exam may be taken in either English or French, depending on the graduate’s preference.

When this type of examination was launched with the first year of graduates, nurses who worked in the hospitals, those who would be working with these new nurses, weren’t sure how to take this new type of testing. They were concerned that the graduates may not be tested well enough to fully assess their skills.

The new examination type has had its growing pains. In the first few years, the failure rate was higher than the older multiple-choice only exams, but this has evened out over the past years, as the schools became accustomed to preparing the students for the licensing exam.

So, what is the best way to test a graduate nurse’s skills and knowledge? The more accepted manner of only multiple choice exams, or the newer Quebec-led format, of skill test? What do you think?

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Posted in NCLEX

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Job transitions

June 12th, 2010 by – Sue Barton

  I’ve been a cardiology nurse for 15 years, but I’m ready to start a family, and I want to switch from working shifts in a hospital to working in an office.  How easy is it to make this transition?  I’d love to work in an environment that isn’t so stressful-do you think I could get hired in family practice? 

What you have going for you now is the wealth of experience and expertise you have accumulated in those 15 years of cardiology nursing practice.  That should make you a desirable candidate for an office or outpatient clinic setting.  Family practice would require you to get current on health concerns across the age spectrum, but would also be a place to encourage your patients to adopt lifestyles that will prevent some of the cardiac illnesses you have been seeing in the hospital.  Another outpatient  area to consider is obviously the cardiology office or clinic setting and cardiac rehab programs.  Transitions to new jobs are inherently somewhat stressful, but in your situation I would imagine it will go very smoothly.

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Posted in General

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Causes of Unconsciousness

June 11th, 2010 by – Derek Brocklehurst

What are some causes of unconsciousness?

Unconsciousness, referred to as syncope in the medical field, can vary from mild to life-threatening depending on the circumstances in which it occurs. Syncope usually happens due to a sudden decrease in blood pressure, thereby reducing oxygen levels supplied to the brain. If a patient with known hypotension attempts to stand up too quickly from a sitting or lying position, syncope might ensue. Brain or head trauma, overdose on substances altering the central nervous system, heart attacks, and infarctions can also cause sudden syncope. It is your job as the nurse to assist the patient (or civilian) in potentially dangerous situations. It is best to get the patient to a lying position with their legs and feet elevated to help supply more blood (and more oxygen levels) to the brain, resulting in increased consciousness levels.

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Posted in Common Nursing Procedures

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Slow Cookers, a Nurse’s Friend (Part 2 of 3)

June 11th, 2010 by – Marijke Durning

Last week, we wrote, High Pressure, Slow Cooking – Not at Work, but in the Kitchen, which was part one of a three-part series. Nurses, whether it’s due to  shift work or stressful jobs, tend to fall short on the nutrition aspect of life. It doesn’t have to be that way. A few simple tools in the kitchen and some preparation will have you eating nice, hot, and tasty meals even when you have no energy to prepare them.

Slow Cooker – Your New Best Friend

One of the last things most people want to do after a long day at work is to slave over a stove or oven preparing a family meal. For people living alone – or maybe especially for people living alone – this can be even more unappealing. But, other than having someone cook for you or picking up your meals and warming them up, is there a solution? Yes – a slow cooker and yes – even if there’s just one of you.

Slow cookers can be bought in a variety of sizes, from small to large, in a range of prices, depending on how fancy or plain you want the cooker to be. But they all provide the same thing in the long run – a hot, cooked meal, just waiting to be eaten.

The trick to using a slow cooker is to find the right recipes and the right ingredients. For example, pot roasts are great slow cooker meats, while the expensive cuts of meat are not. Because the meat is cooked over a long time, the fibers break down, softening the meat, making it more tender. The more expensive cuts are already tender, so they don’t do well being cooked for so long. The recipes are also important, because the amount of fluid in a slow cooker recipe plays a large role in how well the recipe will turn out.

Cookbooks

There are many good slow cooker cookbooks that have been published over the past few years. A very popular one is Fix-It and Forget-It Cookbook: 700 Great Slow Cooker Recipes (Fix-It and Forget-It Series), by Phyllis Pellman Good. There are also many tried-and-true type recipes from Betty Crocker, and Campbell’s.

Special Diets

What about vegetarians? Or people with diabetes? Fear not – there are slow cooker cookbooks for all types of diets, medical or otherwise. For vegetarians, there are books like The Vegetarian Slow Cooker: Over 200 Delicious Recipes, by Judith Finlayson and Colin Erricsson. Low carb? No problem, there’s a book for you: The Everyday Low-Carb Slow Cooker Cookbook: Over 120 Delicious Low-Carb Recipes That Cook Themselves, by Kitty Broihier and Kimberly Mayone. Do you keep kosher? There’s a book for you too: Jewish Slow Cooker Recipes by Laura Frankel .

Websites

Several people have taken to slow cooking and have written blogs just for the slow cooking lifestyle. One of the most popular blogs began as an experiment: to make one slow cooker meal every day for a year. The result? A Year of Slow Cooking with Stephanie O’Dea.

Buying a Slow Cooker

Buying a slow cooker isn’t difficult. There aren’t too many options to choose from – the only caveat is to be sure you buy the right size. If you don’t, you may become frustrated and not use the appliance as much as you could.

For single people, you can make a batch of stew, spaghetti, or a pot roast and freeze the left over part in serving sizes for future meals. For larger families, you can have the main part of the meal prepared, leaving you to slice some bread, toss a salad, sauté some veggies – and you’ve got a meal you can be proud of.

Next week: The Pressure Cooker

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Posted in Work-Life Balance

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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.