Answers to Your Nursing Career Questions

I’m  sorry you’ve had such a disappointing experience.  The transition from school to the work world can be stressful.  It’s becoming more common for new grads to take positions that involve a mentor, or something along the lines of an internship, to ease the adjustment.  I’d encourage you to not give up on nursing quite yet.  With so many varieties of practice sites and specialties, there probably is something that is a better fit for you than what you have experienced so far.  Think about the things that drew you to nursing in the first place, and what experiences as a student were the most rewarding for you.  I’d also recommend looking into MSN programs.  A graduate degree can be a stepping stone into a job with more autonomy and recognition.

It can be a difficult time transferring between units when your mindset is so thoroughly grounded in your old unit’s way of charting. It might be worth the effort to ask a senior nurse or the charge nurse in the ICU to spend a little extra time with you, when on a break or during a slow shift, and go over how the charting works on their unit. Spend some time reviewing patient’s charts and getting to know how diagnoses, treatments, and procedures are all documented. It’s important to learn how to properly document in a chart on a new unit early on, as there can be liability and legal ramifications if charting is incomplete or insufficient. Even during high stress nursing shifts, just remember to take a deep breath and take the time you need to avoid long-term problems and questions down the line.

Blogs, Twitter and Facebook – you would be hard pressed to find someone who hasn’t heard of these icons of social media, even if they don’t use them. Using social media can be fun and a good way to keep in touch with friends and family, but do you know where it can cross the line? And what about blogging? Is it harmless fun or could there be something more serious that comes out of it?

Blogging

Blogs are the new diaries and journals. For generations, people have put pen to paper to write their thoughts, ideas and experiences except now, it’s frequently online instead of in a locked diary hidden under a mattress. Of course, those locked diaries were easily unlocked and often read by annoying siblings or even intrusive parents from time to time. But blogging has not only been made easier, it has become even more public than ever, password or no password.

So, where do nurses and blogging come in? There’s a school of thought that says nurses shouldn’t blog and if they do, they should never write about their work. This invites HIPAA violations, people say. But – does it? What if a nurse writes a hypothetical case? After all, what med/surg nurse hasn’t had patient in his or her sixties, with type 2 diabetes and hypertension, who now is at risk for a below knee amputation? Would discussing this patient be a violation of privacy? It absolutely could if you identify where you work, even what city you work in. If the patient happens to be reading blogs and stumbles upon yours, it wouldn’t be a far reach to come to the conclusion that the comments are about him or her. Or, what if the nurse discusses a difficult coworker – or a hypothetical coworker. What nurse hasn’t worked with someone who micromanages everything – or is the exact opposite and you can’t pin down him or her to do anything specific?

Many nurses have blogs, some very popular ones are Emergiblog, The Makings of a Nurse, and At Your Cervix – but there are many others. Some are written by students, others by specialists.

Social Networking

Communicating through Twitter or on Facebook can be even trickier than blogging. The words you type out quickly may not be as “thought-through” as they should have been and nurses may end up writing things that perhaps were better left unsaid. At least with blogging, you can write up your post and then hold it for a while before clicking “publish.”

Business owner Mark Hayward writes for businesses and how to use social media to their advantage. He has put it very clearly: “It can take a very long time to develop a trusting follower base for your small business on Twitter but it only takes one Tweet to alienate and lose the trust of your followers.”

While Mr. Hayward is speaking to businesses, this is very much in real life as well. If you, as a nurse, maintain an online presence through Facebook or Twitter, it only takes one bad comment to lose the respect and trust of those who are following you.

So, what is right when it comes to a profession like nursing? Does your facility have any rules about social networking? Do you have a blog? How do you feel about nurses, blogging, and social networking?

This can be so frustrating; and it is understandable that patients perceive that many of the things nurse practitioners do, such a taking their history, doing their physical exam, making a diagnosis, writing a prescription for them, have traditionally been seen as medical roles.  The very first NP programs date back to 1965, and over the years studies have documented over and over the high quality of care by NPs.  The best advertisement you have is that very care; as your patients get to know you they will learn to trust you.  The office can help by displaying your name as part of the practice, along with your degrees and certification.  At times you will be consulting with a physician about more complex problems, and patients will learn that you are working as a team to provide them with the best of both nursing and medical practice.

Ostomy care if very important to get right early on, thereby preventing long-term problems. Frequent cleanings and changing of the pouch (depending on which type of pouch is prescribed) is usually the best way to prevent skin breakdown. Try to estimate when a bowel movement will happen. Changing and cleaning the pouch and skin around the ostomy is best done when the stomach is near-empty and no liquids or foods have been consumed (when the patient first wakes up in the morning). If the patient is frequently leaking stools, it sounds as though the ostomy pouch might not be the best size. Consult with the patient’s primary care provider regarding the size of the pouch and making sure it properly fits the stoma. This should help to reduce some of the leaky stools and prevent skin breakdown.

We’re long past the days that tattoos were for sailors and prisoners. And, although it would be next to impossible to get accurate statistics of how many North Americans have tattoos, we can say that there are many more people with tattoos now than ever before.

Who is getting these tattoos?

It would be a safe bet to say that it’s likely you know several people who have tattoos that you may not even know about. The great thing about tattoos is they don’t have to be visible. Not everyone gets a full “sleeve” of tattoos nor does everyone choose visible spots like around their ankle or on the side of their calf.

Should people in certain positions not have tattoos?

While tattoos are definitely more mainstream now, they still are frowned upon by some people and in some areas in life. A server in a family style restaurant may get away with a tattoo of roses around her wrist, but it might not be the same for a server in a five-star restaurant, serving the richest of the richest patrons. Of course, we also have to take into account the type of tattoo someone may have. This could make a significant difference as to what is considered acceptable in a certain environment and what isn’t.

If you have a tiny butterfly on the back of your shoulder, is this any different than someone who has a full sleeve of violent scenes? Or how about a sleeve of pretty flowers and birds? Is the second sleeve more acceptable than the first?

Nurses and tattoos

Should an employer have the right to tell its nursing staff that the nurses can’t have visible tattoos? In some workplaces, the nurses have to cover their tattoos, either by bandages or long sleeves, depending on where the inking is. But what about the people who tattoo a wedding band on their finger? This is a trend that is gaining some ground and, if you think about it, it is cleaner than wearing a ring at work.

Knowing the reticence of some employers hiring people with visible tattoos, is this something that nursing schools should take into account? What if a heavily tattooed woman comes in for an interview at the nursing school she wishes to attend? Can or should the interviewer say something about the tattoos? What if the tattoos are covered and only discovered once class has begun?

What about you? Do you have any tattoos? Do you think they aren’t appropriate on nurses?

Interesting, according to the website for the Tennessee Board of Nursing, continuing education is not required in your state for relicensure.  Continuing competency is required which is defined as having practiced as a nurse during the preceding 5 years.  You might wish to check out the specific rules for your state.  Generally speaking however, in states that do require CEU documentation, credits approved by another state board of nursing are accepted.   It’s a good idea to keep documentation of earned CEUs in your files for at least 4 years in case you are audited.

Nurse practitioners (NPs) operate in very similar ways as primary care physicians and other primary care providers. Depending on the state in which they practice,  an NP’s autonomy (owning their own clinic vs. working under the supervision of a consulting physician) may vary. In some states, an NP must be within a phone call’s reach of a consulting physician. In other states, NPs can own and run their own clinics and see their own patients without a consulting physician. Check your state’s nursing statute for NPs to find out more information regarding autonomy for NPs. Generally speaking, NPs can write prescriptions, see their own patients, make diagnoses and consult on long term prognoses. NPs can work in a variety of health care settings, including hospitals, research facilities, outpatient clinics, public health clinics, and private offices.

Nurses are people whose jobs are about promoting good health. As we try to teach our patients good health habits and the importance of complying with medication and treatment protocols, we know how living a healthy lifestyle is important to living well. But how many times have you seen a nurse deliver the message, but not live the message? Or maybe, that’s you?

Exercise and nutrition seem to be the biggest bugaboos when it comes to maintaining a healthy lifestyle. It may start as early as when we’re nursing students, studying, working, and keeping odd hours as we try to live life at the same time. And it crosses all lines, whether we’re a certified nursing assistant (CNA), licensed practical nurse (LPN), or registered nurse (RN). It’s the shift work, the odd hours and the stressful work environment that can play havoc on how we treat our own body.

But eating well doesn’t have to be difficult or time consuming. If you have one – or both – of two simple kitchen must-haves – you can make life and dinnertime much, much easier for you and your family.

Slow Cookers and Pressure Cookers

The slow cooker (or crockpot) and pressure cooker are making a big comeback in today’s kitchens. Crockpots are very popular because of the diversity of food that can be prepared. And, while many people are hesitant of using pressure cookers, the new generation of pressure cookers is not your grandmother’s pressure cooker. They are fool-proof and idiot-proof, making it so they won’t explode, coating the ceiling with colorful beets or beans.

By planning ahead to have the right ingredients on hand and by using your appliances, either the slow cooker or pressure cooker, you can make full meals with just a few additions to throw together, like a salad.

So, stay tuned next week for parts two and three, where we’ll talk about ways to use the appliances and the best types of recipes to use.

As with many nursing fields, you can be part of the hospice team with varying levels of education. It certainly is to your advantage to pursue the BSN degree, and it will be needed for many positions in hospice care, and certification.  Hospice nurses often practice in settings such as homes that require a high degree of independent judgement.  Medi-Smart has more details about hospice nursing careers here.  Another excellent resource is the Hospice and Palliative Nurses Association, which can give you information about certification.