Latest Comments by Nurse Beth

Nurse Beth, MSN, RN 203,439 Views

Joined: Mar 8, '07; Posts: 1,281 (68% Liked) ; Likes: 3,846

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  • 1
    tnbutterfly likes this.

    Dear Nurse Beth,

    I'm an neonatal RN and part time writer. I would much rather be a full time writer. How can I follow in your footsteps and get paid more to write than I currently do to be a bedside nurse in a level 3 nicu? Looking forward to your response. Thank you!

    Dear How Can I be a Full Time Writer?

    I would start out part-time as you build your clientele and your income. I still work as a nurse educator in the hospital because I love my job and am not ready to leave acute care yet.

    I write "behind the scenes" a fair amount as a paid consultant. I've had several such "side hustles", which I enjoy. A lot depends on your interest- do you like writing on clinical practice topics?

    Here's my story of how I built up my writing career over the last 3 years.

    Subject Matter Expert

    One way to earn money is to become a Subject Matter Expert. I started by applying to ANCC as a Subject Matter Expert. They don't respond right away, but after a time, and when they have a need for your particular speciality, they contact you. Work may include writing test questions or contributing to different projects.

    Another time a friend of mine at work, who is our HealthStream administrator, gave my name to HealthStream and I have now done several projects for them as an independent consultant.
    They include working working on CE modules, which involves research and best practice. An example is a module I recently completed on peripheral artery disease (PAD).

    Sometimes you can find opportunities through your national nursing organization. Mine is the Association for Nurses in Professional Development (ANPD), as I'm an educator in acute care. They recently revised their certification exam, and I worked on the exam as well as the review book and webinar with them.

    As a volunteer with AMSN, I was asked to update Lippincott Procedures (for a nominal fee). If you go on Lippincott Procedures, you may notice a place where is says procedures updated by AMSN. That's us!

    So many opportunities come through professional organizations, and networking.

    Nursing Articles/Freelance

    Writing for allnurses gave me huge exposure and it's a great way to get published. It's easy to apply.

    I also have a blog, called nursecode, which gave me a platform for my writing and has led to multiple other ventures and offers. I have written for pay for other sites, such as, Staff Garden,, and others. You negotiate a price for articles of a certain length.

    I've been writing for 3 years, and it's entirely doable to build your business being a writer. Be sure and check out the Nurse Entrepreneurs/Innovator Hub for like minded nurses

    Related Articles- there are several successful nurse writers here on site. Here are a couple of helpful articles you'll enjoy:

    A Day in the Life of a Freelance Writer by Elizabeth Hanes
    My Journey from Nurse to Freelance Writer by Janine Kelback
    At Home Work Essential for Freelance Writers by Ashley Hay

    I hope this gives you some help and ideas.

    Best wishes,
    Nurse Beth

    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

  • 1
    tnbutterfly likes this.

    Quote from Flatline

    While the goal is noble, I fear that this constant push for a federal law is misguided. Instead of trying to move a mountain by pushing the entire thing at once, why don't we move it rock by rock? California was the first rock, let the other 43* states be the other rocks. If the national associations would pool their efforts and focus on the issue on a state by state level things would happen a lot faster. The lobby hurdle for each state is far smaller than the entire freaking country.
    I'm from California and the lobby hurdle is no less at the state level. The primary lobbyists against safe minimum nurse-patient ratios (H.R. 1063/S.2392) are the American Hospital Association (AHA) and the American Nursing Association (ANA) and they are strong lobbyists at every level.

  • 2
    ICUman and tnbutterfly like this.

    Quote from ICUman
    I hope the rally really gets our voices heard and can get legislation passed.

    We need California's ratio laws to become a national standard.

    While I remain hopeful, it seems hospitals will push back quite a bit against any sort of ratio law.
    You are right, the American Hospital Association (AHA) is opposing safe minimum nurse-patient ratios.
    But...we are over 3 million strong.

    If we each give our Representative just one phone call and say "My name is Beth Hawkes, I'm an RN and a constituent. I'm calling to ask you to vote YES on S. 2392 and H.R. 1063. Thank you" then these bills will get passed.

  • 0

    Dear Nurse Beth,

    I am an experienced nurse practitioner for 18 years and now I am practicing in Northern California. I was distressed to find out that some of the hospitals pay an RN at $75 per hour whereas an NP will only get $50 per hour. I was told that the RN has union and that's why a RN salary is higher than a NP. Please comment.

    Dear NP,

    Yes, northern CA RNs are well paid. The northern California RN pay rates are a function of long standing unions and also high cost of living areas. The bay area, San Jose, and Sacramento areas pay very well for RNs. By contrast, California RNs in the central and inland areas are making much less per hour.

    The average NP salary in California is 120K according to $50 per hour converts to around 104K, so what you are seeing is below average. Employers typically pay what the market will sustain. Is the market flooded with NPs in your area?

    If you are able to re-locate, you will find higher pay. In some areas of California, experienced NPs earn up to 170K. You should be able to find a higher salary, especially as you are experienced.

    Best wishes,

    Nurse Beth

    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

  • 0

    Your plan to stick to stick it out a year and then transfer is a good plan. Often just having a plan helps to make a situation more bearable.

    I can tell you that how you feel at 4 months out is different than how you will feel at 12 months out.

    Sorry your charge is not more responsive! Try befriending one nurse on your shift who you can trust as a support. You can even consider asking a colleague if they would mentor you over the next 6 months. This gives you someone to help guide you during this intense period.

    What are the nurse patient staffing ratios? 1:4 is max for Tele and pending legislation calls for mandatory minimum nurse patient ratios of 1:3 on Tele. Best wishes

  • 1
    E-commerce likes this.

    Great advice and check out 8 Work From home Jobs

  • 2
    ruby_jane and Ruby Vee like this.

    He created a hostile work environment for his colleagues by his behavior. No employer is going to allow an employee to set them up for a lawsuit.

  • 0

    Dear Nurse Beth,
    I've been an RN for 25 years, I specialized in PICU, loved it, however I became extremely burnt out about 5 years ago. Long story short, I am on disability for depression and PTSD. I am doing very well now, and I'm ready to go back to work, however, slowly. I am looking at Telehealth for the short-term, and long-term I'm thinking of Nurse Navigator, advocate or even Nurse Health Coach. I have my 2 year degree, would it be advisable to get my BSN? Also for the Telehealth, should I do an online course. And, is the pay reasonable for a Telehealth nurse? And lastly, what kind of education is required for a Nurse Navigator, Nurse Advocate and Health Coach?

    Dear Ready To Go Back To Work,

    I'm glad you are doing well and ready to go back to work

    It would be highly advisable to get your BSN. More and more, the jobs available to ADN prepared nurses are limited to clinical (bedside) practice. A BSN will really help you to qualify for more positions and to be more competitive.

    In general, training for the jobs you mentioned (great jobs, by the way!) takes place on the job. On the job training, so after you're hired. Nurse Navigator jobs vary from facility to facility, but are often found in oncology settings. Typically a nurse would work in an outpatient clinic as an oncology nurse, and after time would qualify for a Nurse Navigator role.

    It certainly wouldn't hurt to do a course on TeleHealth, as long as it's a reputable course, but it may or may not increase your chances of landing a job. It depends if the employer is looking more for experience or more for training. Tele-health positions may require a background in disease specific care or adult population.

    Register on to get an idea of jobs available in your area

    If you have been unemployed for a time, you have an extra challenge in getting back in the job market and getting hired.I highly recommend my book (below) to help you stand out in your cover letter, resume and interviewing.

    Consider taking an RN refresher course. Since you have solid experience in PICU, your best bet may be looking for a job in that area just to get back into the workforce. From there you can always transfer.

    Also read 8 Jobs to work from Home (related to your question). Best luck to you, my friend

    Best wishes,

    Nurse Beth

    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

  • 2
    tnbutterfly and ibanda like this.

    Quote from ibanda
    Safe Staffing: S.1063 & H.R.2392 - Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017

    Hi Beth,

    Thank you for bringing up this topic. I am currently a nursing student to graduate in May and i am writing a policy paper on the Safe Staffing Act of 2017. I am doing both bills. As part of this paper i will like to meet with the legislator to advocate for either one or both of the bills. I have not been able to get anyone on the phone.

    I will also like to lobby in DC but it seems the lobby date is in April after i must have presented the bill to my class mates. Any suggestions on how i can advocate sooner than April 9th will be appreciated.

    Also i will like to have a fact sheet and i thought i could find one from the ANA website, but i didn't. Any suggestions as to where i can find a Fact Sheet for these Bills?

    Again, thank you
    Great!! The ANA does not support S. 1063 and H.R.2392, titled Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act.

    They support opposing legislation, as does the American Hospital Association (AHA), titled Safe Staffing for Nurse and Patient Safety Act. That's tricky, right? The titles are quite similar. Just remember that the (recommended) legislation has the word Quality in the title.

    The best Talking Points I've seen are by Dr. Ruth Neese, and I think they will help you with your paper. Talking Points

    To advocate at any time, find your the phone number of your Representative and 2 Senators Find Your Number by Zip Code Call and say "My name is so-and-so, I am a nursing student and a constituent. I am calling to ask (my representative) to vote Yes on S.1063 or H.R. 2392"

    Senators vote on bills that start with an S., and Representatives vote on bills that start with H.R. Your phone call will be tallied and is important because politicians listen to their voting constituents Encourage your classmates to do the same. Best wishes.

  • 1
    not.done.yet likes this.

    Dear Nurse Beth,

    I had a question about what all to include in a resume. I have almost 2 years as an RN and have been at the same job since I passed my NCLEX. I'm looking to switch gears and move into a new branch of nursing. I was wondering if I should still include my experiences from my college clinicals or would it be best to leave them off, since I now have actual RN experience.

    Dear Should Student Clinicals Go on a Resume,

    Once you've worked as an RN, you no longer include student experience. Here's an excerpt from my book (below):

    • Purpose
    • It may seem evident that the purpose of a resume is to land an interview, but resumes are commonly written in a manner that ensures you will be passed over for an interview. Avoid overused phrases- everyone describes themselves as "motivated". 'team player", and so on.

    • A resume is more than a laundry list of experiences; when effective, it's a compelling snapshot of you. If it's sufficiently compelling you'll get the call for an interview.

    • Given that the purpose of your resume is to answer the question "Why should we interview you?" it follows that everything you choose to include in your resume should answer the question "Why should we interview you?"

    • A common example of something that does not answer the question "Why should we interview you?" is a lengthy description of clinical hours. All qualified applicants attended and passed clinical rotations so it only serves to show that you are like everyone else, and that you have a student mindset, not an employer's mindset.

    Best wishes,

    Nurse Beth

    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

  • 1
    not.done.yet likes this.

    Dear Nurse Beth,

    I am an RN from the state of Texas. During the process of moving (NC) I was notified that the BON had a complaint against me from Dec 2015 (I was notified in July 2016).

    I immediately hired an attorney.

    The attorney stated that he was certain it would be dismissed as I was never reprimanded by my employer and in fact worked for that facility until we began the moving process.

    Basically, in December 2015, I came on shift to find that DADS was in the building to do the Big Book Audit. This facility had not yet gone to computers and all was still in written chart form. The only thing in the computer was POC and we were just beginning to learn how they wanted orders entered, but only the DON had the authority to actually enter them.

    Upon arrival for my shift, the ADON told me that I would be with the State and not on the floor and all appeared in total chaos. The charts were not where they were supposed to be as they were being taken for review by the DON, whose office was locked. The intercom system was not working and for whatever reason, none of the LVN's were anywhere to be found nor the NA's. I was up front by myself with only the med aide.

    It was past time for rounds- no one had given me report, but I started rounds. The med aide told me one of the hospice patients was not responding. I found the patient lying flat on oxygen at 4L. I listened and the patient had very poor air exchange and was only able to open his eyes when I did a chest rub. His vitals were not stable.

    I immediately sat the patient up- went to the treatment book/cart and started the prescribed Breathing treatment. His chart was not available and the 24-hour shift sheet was not in the nurses station. I called Hospice. There were stickers all over the Nurse's station which stated that for Hospice patients DO NOT CALL 911- CALL Hospice.

    I called the family and advised them Hospice had been called. I returned to the room every 2-5 minutes, as I still could not find a NA to sit with him. The last assessment showed that the vitals had become more erratic and the patient would not open his eyes but appeared to grimace and was struggling to breathe.

    I administered the Roxanol that was prescribed, hoping the pulse would drop to an acceptable range to re-administer another breathing treatment. I told the MA that I was at a loss and felt this patient wasn't going to be with us much longer. He just wasn't pulling out. After sitting with him, I went back to the Nurse's station and his chart was in a large stack of charts that had been sat on the counter.

    I immediately grabbed the chart. First page stated he was a Full Code. I went into action mode and called 911 and grabbed the crash cart. I saw the back of someone's head at the nurse's stated and called for them to come with me- we had a code. It turned out this was not one of the LVN's but the STATE. I was the only nurse approved to do CPR in the facility at the time other than the MA. The patient at this time was in severe distress and I initiated CPR until the ambulance arrived. The patient died en route to the hospital.

    I was placed on suspension for two weeks while the facility investigated. I was brought back and the facility stated that I was cleared of wrongdoing. I continued to work there.

    Now I live in NC. I worked here for an entire year as a Nurse Manager for a Substance Abuse Clinic. Once my attorney advised me that the state would not dismiss the case- I was forthcoming with my employer and I began thinking I needed to show the board that I am serious about my license. I took every online class that the state offered concerning Hospice/ pain management/ charting/ end of life.

    My employer had said that they would stand beside me but after the paperwork came down- they stated that I had never disclosed this to them and they asked me to resign. I have followed every bit of advice that my attorney gave me. I did not apply for a NC license upon moving here because he stated that they couldn't give me one. Now, I can't work as a nurse...both the NC BON and the TX BON are terribly rude to me and I am having a horrible time.

    I have probation for two years under the supervision (must be somewhere on premises) of another RN. The TX BON permitted me to work in NC with their written permission. They have declined that permission until I meet with them and based on some new ruling the lady at the Board states it is doubtful they will give me permission to work, but they might. What do I need to do to represent myself to the NC board effectively? I don't have any more money for attorneys and I now work at a factory to pay my immediate bills. What can I do?

    Dear Texas RN,

    What a tragic situation. To represent yourself effectively, you need an attorney who specializes in representing nurses to the BON.

    Several aspects of this are confusing. You were pulled off the floor for the audit, and not given report, but made patient rounds? The patient was a full code, and you withheld resuscitation measures because you believed he was a DNR? If the chart was not available and the patient was not banded as to code status, is there a reason you'd not assume he was a full code? I'm not sure how Roxanol would lower the heart rate, or if it was advisable to give a morphine derivative to a patient in that condition, although you do not say what the blood pressure or other vital signs were.

    Could you have gone to the DON's office, knocked on the door and gotten the chart? Where was the nurse who received handoff report on the patient this whole time? By saying you were the only nurse approved to do CPR, does that mean no other nurses hold BLS cards?

    I hope the facility was also sanctioned for their responsibility in this. You were in the middle of a chaotic situation that resulted in patient death. This is a scenario where everyone lost.

    Again, trying to represent yourself is not advisable. One thing the BON will look for is your insight into your own practice and responsibility in the situation. It will help to think about what you would do differently if given the opportunity and be able to speak to it.

    Best wishes,

    Nurse Beth


    Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

  • 0

    Dear Nurse Beth,

    I am a nurse with 9 plus years experience (6 med/surg, 3+ ambulatory surgery). I have read your book, but I am still having trouble revamping my resume. I am looking to pursue non-clinical nursing such as case management but I am finding it difficult to make my current job stand out amongst the crowd.

    Taking pre-op histories, medications, NPO status, pre/post op medication education, equipment education, assessments and interventions doesn't quite stand out compared to those who have experience. Even our quality/patient satisfaction efforts are a group unit effort. What suggestions do you have to make what I do sound better? Thank you in advance.

    Dear Revamp my Resume,

    Leave off the pre-op histories, medications, NPO status and other tasks. You are correct and as I strongly emphasize in my book, they do not help you to stand out as they are a given.

    Nursing duties make for an uninteresting and cookie-cutter resume.

    Here are some tips to help you stand out. They are all included in the book, and more.

    During your 9 years, what gains did your facility make that you were part of? Here's some examples to jog your memory and get you brainstorming:

    • Participated in successful Quiet-at-Night to improve patient satisfaction scores
    • Active in initiating white boards, hourly rounding
    • How about you as an individual? Are your presenting yourself as a solution to their problems (key). How about:

      • Perfect attendance times X years. That stands out!
      • Preceptor to 20 new employees
      • Served or chaired UBC (or nursing committee)
      • Voted Employee of the Month
      • Received multiple letters from patients
      • Proficient in Epic (Medi-tech, Cerner)
      • Trained in AIDET

    • Are you following the tips in Chapter 8 to:
      • Use keywords from job descriptions
      • Customize each application
      • Avoid cliches
      • Give examples (examples are memorable)

    • Are you making effective use of white space, headers, category sequencing and bullets for visual interest as in the examples in the book?
    • Be sure and read Chapter 9 on Cover Letters with dynamic examples. Soon you will have an irresistible resume and then you must read the chapters on interviewing to prepare for all the interviews that will come your way.
    • Best wishes,
    • Nurse Beth

      Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

  • 1
    tnbutterfly likes this.

    Quote from Nursetom1963
    Im a California Nurse, and I have a couple questions and comments. Who are these people organizing the rally? Have they studied the effects this is having in Ca? Not good necessarily in my hospital. Pt.s sit in the ER for 24-48 hour frequently because we can't admit them because we don't have the nurses to take them. Then they come right after shift-change, and are in worse shape than ever. Same with downgrades (Im ICU) I can sit on a pt with transfer orders all shift because we have no one with an open bed to take them; it's not all as good as it sounds. We're so desperate for nurses, I get texted almost every day off to come in for overtime, and often double time.
    Thanks for sharing.

    I'm a CA nurse as well. I worked prior to ratios in ICU and Tele, and there's always been a bottleneck. Bottlenecks are not caused by ratios, they precede ratios by decades.

    Before ratios I had sometimes 9 patients on Tele. Today a tele nurse can only have 4 patients.

    In my role now I onboard new nurses to our facility. Nurses coming to my facility from Florida, and Texas and every other state love our nurse-patient ratios. I talk to nurses a lot in Orientation and I would never practice nursing in another state.

    The effects of the number of patients a nurse cares for and patient mortality are well documented in the literature. Safe staffing saves lives.

    Yes, nursing is still stressful and ratios do not solve all the problems hospitals have with retention, nor are they designed to. Ratios don't address poor management, for example. But they do address public safety.

  • 1
    tnbutterfly likes this.

    Quote from Mini2544
    Sounds reasonable enough. However why would Medicare be billed? Not all patients are over 65 and covered by this entitlement. What about the other patients? Medicare is supposed to absorb all this cost? Also not a single republican sponsored this. What is their pushback? Also how would the ratios be set?
    Great questions, thanks

    Mandated minimum nurse-patient ratios apply to all Medicare-participating hospitals (not patients). Meaning if a hospital bills Medicare they must adhere to ratios. Basically all hospitals are Medicare-participating.

    A simple answer as to partisanship is that Republicans tend to align with business interests, such as the American Hospital Association, while Democrats tend to align with working class people. This is a generalization, of course.

    Is it possible that the AHA and the ANA contacted Republican Representative David Joyce to introduce legislation opposing mandated minimum nurse-patient ratios? I do not know. The same opposing legislation was introduced into the Senate by Democratic Senator Jeff Markley, so again, I don't know his motivation.

    The ratios can be viewed here and include 1:3 on Tele, and 1:4 on MedSurg

  • 1
    RNdh likes this.

    Quote from Bethenurse68
    Hi! I say go for it! I am a 49 year old LPN, going to night school to achieve my RN-BSN! When deciding to go back to school, I wondered out loud to my I too old to go back and finish my education? I mean, I won't graduate for two years! And she looked me right in the eye and said, "How old will you be, in two years, if you don't go back?"
    Best of luck to you!