Latest Comments by Nurse Beth

Nurse Beth, MSN, RN 210,421 Views

Joined: Mar 8, '07; Posts: 1,382 (68% Liked) ; Likes: 4,122

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  • 1
    CityofAngelsRN likes this.

    Dear Nurse Beth,

    I am currently a registered nurse working on a med surg floor. My background for the past three years has been emergency room. Unfortunately I have had ongoing health issues and had to leave the ER.

    I am on a reduced schedule now working 4 x 8 hour shifts , I can just about survive on the pay but unfortunately my health is continuing to deteriorate and I am finding it harder and harder to work on the floor.
    I do not know where to go from here , I think I can probably manage another year or so on the floor but then will likely have to move on to something less physically strenuous.
    I do not know what to do and what sort of jobs are out there , I am 35 years old, I have a BS in nursing , I have a mortgage and two children and need to keep working.


    Dear Needs Less Physically Strenuous Work,

    I'm so sorry to hear about your health. Clinical nursing is on your feet, often over concrete surfaces, with no guarantees of breaks.

    There are many jobs that are less physically strenuous than clinical bedside nursing.
    I would try to get a non-bedside job ASAP so you can gain skills. Later, if your health does not improve,
    you'll be in a better position to negotiate part-time work.

    Consider case management, infection prevention, Quality, Risk, Informatics....there are many options away from the bedside.
    Inpatient case management experience could qualify you to work from home later as a case manager. Read 8 Jobs to Work From Home.

    Also think about outpatient/clinic oncology or infusion- get yourself positioned now with skills before your health deteriorates further.

    Best wishes,

    Nurse Beth

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

  • 1
    chare likes this.

    Dear Nurse Beth,

    I've interviewed twice for a certain job & have been unsuccessful at answering a "role play" scenario where I am a supervisor & a nurse is refusing to float. There is supposed to be a response that will get her to float "happily" but I have been unable to discover it.

    Any advice would be helpful I've interviewed twice for a certain job & have been unsuccessful at answering a "role play" scenario where I am a supervisor & a nurse is refusing to float. There is supposed to be a response that will get her to float "happily" but I have been unable to discover it.

    Any advice would be helpful. I've interviewed twice for a certain job & have been unsuccessful at answering a "role play" scenario where I am a supervisor & a nurse is refusing to float. There is supposed to be a response that will get her to float "happily" but I have been unable to discover it. Any advice would be helpful.


    Dear Unsuccessful,

    That's an interesting interview question, and really puts you on the spot.

    The question is testing your conflict resolution skills, and interpersonal skills, although whether or not she floats "happily" is her choice and not within your control. Your role is to provide safe staffing, match the patient's needs with the nurse's skills, and be fair.

    Let's assume the nurse is being floated according to facility procedure, which includes having been oriented to the unit, and floating in turn. Refusing to float is not an option when procedure is being followed.

    Show concern by asking the nurse what makes her uncomfortable about floating and address the concern. You can ensure that her assignment matches her skills and experience. You can round on her later in the shift to see how's she's doing.

    If she is still unwilling to float, clarify the nurse's responses "Just to clarify, are you refusing to float?" Make sure the nurse understands the consequences of refusing to float.

    Best wishes,

    Nurse Beth

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

  • 1
    Wisco50 likes this.

    Dear Nurse Beth,

    I am a RN with 2yrs tele/med Surg, and a couple months of home health experience. I happily made it out the hospital and tried HH.

    I loved it but the company had unrealistic working requirements FOR ME, 12/14 pts a day, working M-F 8-5, on call every other weekend, meaning 12 days on, 2 off- too much for me. I have had interest for sometime to be a field hospice nurse. I actually got that job and start tomorrow. Before hearing that I got hospice position, I saw a position at my son's school for school nurse, only requiring 2 yrs nursing experience. I applied and now have an interview for that position as well.

    I am trying to weigh the benefits of both. The school nurse schedule seems to be the biggest plus and I feel confident I could quickly learn the other objectives required for school nurse. I feel I will have a real shot with the nurse position being I know people at the school and I interview well. I am very torn! Any thoughts would be appreciated?!?!

    Dear Torn,

    You could probably succeed in both positions. The question is:
    Which is better for you? and only you can answer that, given your individual situation. You have to think it through carefully, decide, and then stick with your decision. Right now you are enamored with all the jobs you now qualify for, and acting somewhat like a kid in a candy store.

    Maybe the more important question is:
    Is it OK to start a new job and then quit for another job?
    You quit the hospital to work home health, quit home health for hospice, and you're now ready to quit hospice for school nursing. This is concerning.

    If you continue this pattern, a short time after working as a school nurse, you will spot an ad for another position that looks attractive and quit school nursing. This is not the professional work history you want to build, and it shows a disregard for employers who have invested in you.

    It's important to think through what you are looking for in a job, and commit before accepting a job. Stop looking at job boards and concentrate on learning your new role. Stay put for at least 2 years.

    If you choose to leave the hospice position, do so as soon as possible, but not until you have a firm job offer from the school.


    Best wishes,

    Nurse Beth

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

  • 3

    Dear Nurse Beth,

    I started a new job and I'm still not in the system for clocking in. I was scheduled to work. Other people called in. Which would have left 2 people for 53 residents. I told the schedule person that I quit and left. The DON called me left a message saying they going to report me for abandonment.


    Dear Threatened with Abandonment,

    A nurse-patient relationship must first have been established before a nurse can be charged with abandonment.

    You don't say if you had taken an assignment before you quit and left. If you had not yet accepted report on your patients, or received your work assignment, then it's not abandonment. If you had started to care for your patients, and then left without handing off care to another qualified person, it likely is abandonment.

    It is probably an idle threat on the part of the DON, who is reacting from frustration. Unfortunately this misinforms nurses. Go to the BON website in your state and you will find the definition of abandonment.

    It's unprofessional to "quit and leave". The situation was extreme, but there are other ways to handle it that would not reflect poorly on you.

    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 who just finished my bachelor's degree online this month. I am 28 years old, and I have been a NICU nurse for the past 4 years. I started as a new grad in the NICU and I have been there ever since. I love being a NICU nurse, but recently I have been wondering if I should look into other areas and get more experience in a different field. I love working with the babies, but there is a part of me that wants to work with adults or possibly Pediatrics.

    I would love to be a family nurse practitioner who sees patients in a clinic or possibly a pediatric nurse practitioner. I also have been looking into just getting my masters in nursing education. My dilemma is that I just moved to Texas and I have been offered a position in a level 3 NICU. This would be an amazing NICU to work in, and if I decided to get my Master's degree, I could eventually become a nurse educator working in the NICU and I know I would be very good at it.

    Part of me feels like I should take this opportunity, but another Part of Me is thinking about looking into other positions and possibly taking a job getting experience with adults or children. Then from there, I could apply to become a family nurse practitioner, and eventually care for patients in a practice like I have envisioned myself.

    My only fear with this is throwing away an amazing opportunity with this NICU position and regretting my decision and realizing what a great job I had. I love nursing because there are so many opportunities and experiences, but sometimes I feel like I wind up getting confused about what I want to do. I feel like I am at a Crossroads between possibly losing an amazing job opportunity, or possibly limiting myself and not stepping out of my comfort zone to see what other opportunities are out there. Any input or advice would be really appreciated. Thank you so much!

    Dear Confused,

    You are qualified and could probably succeed at any of these. You could be a NICU nurse educator, Staff Nurse Level III NICU, FNP....you are at a crossroads as you contemplate getting an advanced degree. An advanced degree forces you to choose a pathway.

    While I can't advise you on which path is best for you, I can share that in looking back in life, I found there were signs along the way when it came to big life decisions.
    Doors tend to open up when life is presenting you with opportunity.
    Conversely, roadblocks often present when something just isn't right for you, or isn't right for you at the time.

    Try not to make choices out of fear. Fear is never a good basis for decision making. The opposite of fear is taking a risk, such as moving out of your comfort zone.

    At the same time, the NICU position is not permanent. You could take the NICU position and still go on to become an FNP like you've always dreamed.

    As far as regrets, it could very well be that you'd regret never spreading your wings more than you'd regret passing up a good NICU position.

    Best wishes,

    Nurse Beth

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


  • 1
    chare likes this.

    Dear Nurse Beth,

    I'm a new grad RN on a med surg unit. I've been there about 6 months. I was wondering whether or not it would inappropriate to ask to be dropped to part-time at this time. I am interested in going part-time for a variety of reasons, however I do not want to make a mistake asking for this shift.


    Dear Wants to go Part-time,

    Without knowing your reasons for wanting to go part-time, I hope you can re-consider. Can you hold out at least 6 more months?

    At 6 months out, you are not yet experienced and it will negatively affect your learning to drop to part-time. It's highly recommended to work full time for 1 if not 2 years. Patricia Benner, in her work on how nurses learn, stages newly licensed nurses such as yourself at the Advanced Beginner level. Benner's model is Novice, Advanced Beginner, Competent, Proficient, Expert.

    You are not yet at the level of Competent, which typically includes nurses practicing at years 2 through 5. Learning builds on experience and exposure which takes time.

    It took a long time to get where you're at, but you're still on the journey towards becoming a nurse. Best wishes with your decision.



    Nurse Beth

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

  • 0

    Quote from Pixie.RN
    If you can inspire your coworkers to seek certification by doing so, then yes! Well worth it. As an experienced nurse who clearly values certification, this is a behavior you can demonstrate for the next generation, to show them that there is a lot of satisfaction in achieving a board certification and demonstrating a passion for the profession of emergency nursing. Or hey, maybe it's just 175 questions standing between you and monetary recognition from your employer, if you get something from them. Where I work, we get $1000 for any applicable board certification each time we earn it or renew it. Pretty sweet!
    I love that your facility pays $1,000! I'm taking that idea to mine!

  • 0

    Dear Nurse Beth,

    I have almost 4 years under my belt as a rehab nurse in a long term care facility. I am just about to get my BSN. I want to find a part time job that would have shorter shifts, like a 4-5 hour day. I don't even know where to search. The hospitals and affiliated offices would want full 8 hour shifts. Indeed is a pain to sort through...

    I may be going on disability, not sure if that would help me make a deal some place to only work 4-5 hours a day?

    Thanks for any help!!!


    Dear Wants Part-Time,

    Going on disability and having work restrictions does not help you make a deal- if anything, a potential employer will shy away from accomodations that benefit the employee but not necessarily the employer.

    Some facilities provide "light duty" and shorter hours for a period of time when an employee is recovering and plans to go back to their regular job. Employers are not required to create a part-time job when a full-time job is needed, however. Some progressive facilities may allow shift-sharing but that requires a colleague who is willing to work in perfect tandem with you for patient care coverage.

    Your best bet is finding a position away from direct patient care. Getting your BSN will provide options away from clinical bedside practice. You would need first need to gain skills, such as case management, or documentation specialist. Once you have experience, you are in a better position to negotiate for a part-time position, or to look for a position from home, which might be more manageable.

    The most important thing is your health, and you are wise to start planning your career around your future limitations.
    Best wishes,

    Nurse Beth

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

  • 0

    Dear Nurse Beth,

    I earned my BSN in 1980 and worked in a variety of settings over the years, mostly critical care. I've worked in the ER FOR THE LAST 10 years. I have tried testing for various certifications before, but have not ever tested well because of anxiety. I'm planning to retire at age 62, about three years from now. Would it be worthwhile to test for my CEN?

    Dear Retiring in 3 yrs,

    I guess the question is, is this on your bucket list to overcome your test anxiety and earn your certification? If so, it'd be a good idea to do it.

    As far as measurable benefits, it's probably pennies a month, and while pennies add up, there is the cost of testing.It does establish you as an expert, but so does your work history.


    I would think about what it means to you to earn your certification and then decide. It seems important to you, because you wrote in about it. It would be a wonderful accomplishment for you to succeed at this.

    Best wishes,

    Nurse Beth

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

  • 1
    scotchf likes this.

    Dear Nurse Beth,

    After I passed my NCLEX-RN, I started applying to nearby hospitals for RN Residency programs.

    I have applied to six hospitals so far, and most of the RN Residency programs will be starting soon. I have applied to ED, OR, ICU/CCU depending on hospital openings. I am still waiting to hear back from them.

    How long do I have to wait? Should I relocate to a different state if I do not hear back from the hospitals I have applied? It's hard to stay patient but I am hopeful that there is a right place for me down the road. I am looking forward to hearing from you soon. Thank you so much for your time and consideration.
    Dear Staying Patient,

    Congrats on passing your NCLEX!

    Not knowing the job market in your area- what is the demand for new grad RNs? Did most of your classmates land jobs?

    If it is a competitive market, then yes, it pays to re-locate for at least 1-2 yrs to get started. You are in your first golden year after graduating, but after 1 year, you may not be eligible for many new grad residencies. The clock is ticking.

    Staying patient is good, but be patient with a sense of urgency.

    Apply to MedSurg to get your foot in the door. Does your resume stand out from all the other equally qualified residents, and is it tailored to each organization, using keywords from the job posting? Is your resume wordy and packed with cliches, or is it succinct and punchy?
    Are you dedicating prime real estate in your resume to lengthy descriptions of your clinical rotations (guaranteed to put the recruiter to sleep)?

    Honestly, I wrote my book (below) for new grads just like you, from a hiring manager's point of view. There are multiple insider strategies, such as how to cold-call a manager, how to make your resume stand out, and what managers are really looking for in a candidate.
    Once you get just one bite- an interview- I teach you how to nail that interview and land the job.

    Sometimes you have to pull out all the stops to get hired and kick-start your career. it's worth it, because in 1-2 years you will be highly marketable.

    Best wishes,

    Nurse Beth

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

  • 4
    LadyT618, Daisy4RN, Kaisu, and 1 other like this.

    Dear Nurse Beth,

    This summer I'll have been a nurse for 3 years. I started out on a med/surg oncology unit in a hospital and burned out from that very quickly.

    I moved to home health after a year in the hospital, and now I work at a cancer clinic, in the radiation oncology department. I fear I ran away from bedside nursing too quickly and should have stuck it out long enough to feel confident in my nursing skills and critical thinking and develop a stronger foundation as a nurse.

    Now, I don't use many of my skills in my current job and I feel like I've lost all the skills I worked so hard to learn in school and during my first year as a nurse. I don't feel like a nurse most of the time. I've had 3 jobs in the last 3 years, and I've achieved my goal of working in outpatient oncology, but I feel bored, unchallenged, and that I'm not using any of my nursing skills. I don't want to find ANOTHER new job, as this is my 3rd job since I graduated in 2015. Plus, I figure staying where I'm at might increase my chances of getting hired in the infusion clinic in my building, where I'd get to use nursing skills.

    I've considered working at a hospital PRN just to keep up my skills/become confident in my skills as a nurse, but I work M-F full time so in order to do that I would have to have some weeks where I work every day plus a weekend, and I'm not willing to work more than 40 hours a week. What should I do to avoid losing my nursing skills?

    Dear Regrets,

    You've discovered that there advantages and disadvantages to every role, and consequences for every decision. You no longer have the intensity and challenge of hospital nursing but you are locked into the nicety and routine of M-F.

    You ask how to keep up your nursing skills, and it sounds like you've decided to stay where you're at, so I think you've answered your own question

    When you are in an unchallenging job, the solution is to re-frame your view. Nursing skills are more than psychomotor skills, such as IV insertions. Nursing is assessment and planning, implementing and evaluating. There is a world of knowledge to learn in oncology. You may not be losing your nursing skills as much as you think.

    If you are not feeling challenged, how can you challenge yourself? If you already have your ONS provider card, start thinking about certification. Do any policies and processes in your work area need to be changed, and can you be part of the change?

    When stuck, you need to find the passion for your job and your patients again, or make it tolerable by planning your exit. In your case, the decision to stick with it to build your work history is good.

    Best wishes,

    Nurse Beth

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

  • 2
    beckysue920 and Sour Lemon like this.

    Dear Nurse Beth,

    I have a child abuse charge, that was dropped by the State of Missouri as there was not proof of abuse. My local police dept filed charges anyway. I was not arrested (got a bondsman) and hired an attorney. He stated it wasn't worth going to trial and to do a diversion program. This program has now been completed. I was never convicted. Will I have problems getting into nursing school in Florida?

    Dear Charged,

    You have charges that will show up on a background check either by the school or the BON.

    Know that background checks conducted by the BON are FBI-level searches which reveal every documented encounter with the law- dropped charges, expunged records- everything.

    At the same time, every state is different and has different reporting requirements- you must answer applications honestly. Some will ask if you've been arrested or convicted, some will ask if you've ever been charged, some ask you to report charges that have been dropped.

    You were not convicted, but you attended a diversion program in lieu of a trial. That could be seen as admitting guilt.

    There are few absolute disqualifiers, and decisions are made on a case-by-case basis. I'm sorry that you cannot always know upfront whether you will be allowed to sit for the NCLEX . There are so many factors that are taken into consideration- the details of the charge, how long ago it happened, any priors, proof of rehabilitation, and so on.

    Child abuse charges will be taken seriously as a matter of public protection. Florida Statute section 464.018 lists child abuse conviction or entering a nolo contendere plea as grounds for refusing a license. That doesn't necessarily mean they will refuse- but they could.

    If you feel that an objective person looking at your case would decide that you are completely safe to work with children, then you might decide to apply. Even then you will face some barriers, but you have a chance.

    No one can tell you with certainty except the BON. There is no way to really know until you apply. Be prepared to change your plans if needed.

    Best wishes,

    Nurse Beth


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

  • 2
    brownbook and AJJKRN like this.

    Dear Nurse Beth,

    My hospital, that I have worked at for the past 23 years, has started a new "Flexing down for low Census" policy.

    Our new CEO's newsletters remind us repeatedly that staffing is their biggest expense. I work in a pediatric hospital and the census fluctuates greatly. Point in case, on Thursday our 21 bed ICU was almost full. Today, Sunday, we have 8 patients.

    As I have read on-line, flexing down is not a new phenomenon. The flexing down has been a huge issue. We first were being called off by reverse seniority and in 4 hour blocks. That was horrible. Some people were playing the 4hr off only game, forcing the next person in line to be sent home resulting in some patients having up to 7 RN's in a 24hr period. We can choose to take time off with pay (using our vacation time) or time off without pay. Neither option is good.

    One gives us money but no time for a real vacation. The other gives you a smaller paycheck making it more difficult to make ends meet. At the onset of the policy the pediatric hospital was having a strangely low census forcing many of us off, sometimes more than once in a pay period. It caused a panic and a ruckus among all of children's hospital.

    We had a staff meeting that I had never seen so many people attend, ever. The powers that be talked, not with staff, but with leadership of our concerns and negative impact this was having all the way around. Staff satisfaction, patient satisfaction, patient outcomes, things getting lost in the multiple reports that were being given.

    They decided to give us a cap of forced off time -16hrs in a 4 week block. The cap is not the answer. Getting called off translates to a loss of some sort for us hourly paid staff. Due to our variable census and lack of pay, from the start of this policy in November last year to current June, we have lost 11 RN's.

    We stand to lose more as this continues. There are only so many places we can float. We do not float to the adult hospital and we don't expect the adult RN's to float to peds. The adult hospital is rarely impacted by this.


    My dream question is how can we stop this? Make this policy go away? We were much more willing to take time off when it was a choice. Now that we are forced, we are afraid to use our time by choice.


    Morale is horrible, everyone is looking at the job board. This hospital won an award once upon a time as the best place to work. Now, no. Many of us don't want to leave. We enjoy what we do, we are proud of what we do. But not making a full time paycheck when you have a full time job is not sustainable.

    And, I don't understand where retention has gone. Hospitals spend upwards of $100,000 for each new RN that they orient. Where is the cost effectiveness in that? Our jobs are creating a lot of anxiety in us. We have become afraid of the phone. The dreaded phone call.


    And, we are afraid to speak up, speak out for fear of being fired.

    Upper management is not affected, they don't lose money or time off. What can we do?
    Any words of wisdom or channels to try to fix this misery?

    Dear Forced to Flex,

    More often you hear about nurses who are happy to go home due to low census, but trust me, once it goes on too long, it causes morale problems. It can quickly become dog eat dog with everyone trying to protect their PTO and worrying about getting a full paycheck.

    Nurses with more seniority feel nurses with less seniority should be sent home.
    Full time staff feel travelers and part-time staff should be sent home.
    Travelers with contractual guaranteed number of days feel regular staff should be sent home.

    Once I worked in a facility where I was sent home because I had the most accrued PTO.

    Matching staffing to census is a tough balancing act when census
    varies. Managers are held to productivity standards that are based on a ratio of nursing care hours to patient care hours. Facilities that do not have a clear process for mandatory time off create uncertainty and confusion for their staff. The fact that your facility is capping your forced time off at 16 hrs per 4 week block is more than what most do.

    Some nurses fall back on part-time jobs during low census months. Some nurses use up all of their PTO and give up any plans for vacation later in the year.


    Unfortunately, flexing to census is the nature of the business although as professionals it's not in line with most other professions. As you say, there is a cost to sacrificing the long-term goals of retention in order to meet this month's short-term budget. In an ideal world, nurses would not be called off but would be given the option of other work, which would at least give them some control.


    There is very little nurses can do in your situation except to vote with their feet, I am sorry to say. There are those who can afford to ride it out until winter or higher census, while others need a steady income.


    Best wishes to you,

    Nurse Beth

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






  • 0

    Quote from llg
    Great response, Nurse Beth. I hope lots of people read it.
    Thank you kindly

  • 2
    Wisco50 and Have Nurse like this.

    Dear Nurse Beth,

    I gave two week notice. Have two personal days available. Have 8 days of vacation available and will not be compensated for those days when I leave. Would like to take the two personal days for my last two scheduled days of work. Should I?

    Dear Leaving,

    Some states (California, New York, Wyoming, among others) stipulate that benefit time is cashed out with the final check, but apparently yours does not.

    You could request paid time off days but the company can refuse to grant it on short notice and if there is no coverage. They would have no incentive to accommodate an employee who is leaving.


    Typically personal days have to be pre-scheduled. You could call off or call in sick and be paid out of your personal days (assuming that is how your policy works). You wouldn't have gained any money, but you would have gained time off.

    Your employer will likely see this for what it is, and may even assign you a "Not eligible for re-hire" status. Depending on staffing, this move could also leave your team short-staffed.


    It feels unfair to have to forfeit your paid time off but since you have already given notice, your best option moving forward is to work the 2 weeks.


    Best wishes,

    Nurse Beth

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


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