JRT1

I didn’t say predominantly anywhere in my post. We have a large population of Spanish speaking adults who are first generation immigrants so the vast majority do not have any sort of degree or skill set to work in the clinics. We have some great community programs trying to change that and help build up their community but that happens with time. We do utilize a translation service when they are physically present but we were considering options for our phone service. I’m asking to see if anyone has implemented anything like a “press 1 for English 2 for Spanish type model” and how they operationalized it.

Does anyone have a call tree or process for when Spanish speaking (or I guess any other language other than English) calls your clinic? We don't currently have any Spanish options on our phone tree but have a pretty substantial population of Spanish only patients. If they call and we answer we can always call our phone translator but if they leave a message or they are unable to communicate to the person on the receiving end its tricky. Most patient will come in person but we want to be able to serve these patients conveniently for them as well.

yeah.... that sounds like a disaster waiting to happen. Its not uncommon for non-RNs to be supervisors in a outpatient setting. In fact more often than not they are not RNs. However, these MAs have been working outside their scope of practice most likely even with an anesthesia present and an MA cannot "supervise" an RN in the sense of competency. This is one of the reasons most practices partner with a hospital or bigger health care organization. The private practice offices do not always have access to what they should be doing from a compliance standpoint.

This is tough. I moved away from Inpatient pediatrics but not for this reason. I didn't have kids when I was working PICU and Peds Onc. It was hard then even without my own kids. Now that I have my own kids I don't know that I could do it every day. Its hard not to picture your own kids laying in the bed. Some people can separate it easier than others but it is definitely something you need to find balance with. If it is wearing you down too much then its time to look for something else. Thats the beauty of nursing...there is something for everyone.

I actually worked at a facility that allowed the Nurse manager to work 4 "shifts" It was actually very successful. The way we did it is one day a week you were able to work from home and have your assistant manager cover on the day you were out to help handle and day to day "stuff" on the unit. Now there were some expectations... 1. You couldn't have bad quality metrics. 2. If you were needed the day you were slated to work from home you were expected to be available. 3. Your assistant Nurse Manager had to be in house when you weren't. This was great honestly and I miss it. That day out of the office I would clean up my emails and work on projects that I could never seem to get to while being in the office. I was more productive and successful. Our VP was very supportive of this. Where I am working now I am still trying to sell it. A lot of nurse managers are "martyrs" in my experience but you don't have to live like that. Your quality of work is not measured by the number of hours you put in.

I took the exam back in 2015...my recert is this coming year. It was a challenging exam. There are so many things that you can't possibly just know. Definitely study a lot. I bought a couple of practice question books and read through the books and rationales probably at least 3 times. I made some flash cards on the few areas that I was struggling with.

It sounds like you are an awesome nurse and employee! As far as maintaining 2 jobs I don't think that is really doable if you are in a management role unless the role is very much shift work and non-salaried where you aren't taking phone calls outside of work. I think you need to consider whether or not you really want to be in management. Management is very demanding and is often not what people expect it to be. I'd say at least 50% of my time is spent in meetings. The other pieces of my time are spent putting out fires on a daily basis and trying to manage the staff. When it comes to projects and that sort of thing I tend to delegate that to people like you who want projects and are energized by it while I monitor and give direction. That said there are a lot of people in management who don't really want to be in management. They do it because they feel like that is the "next step" in their career when really nursing offers so many opportunities. If you enjoy projects and patient care maybe look into clinical nurse specialist because based on your description of what you like to do that seems like it would fit pretty well. I wouldn't let yourself be discouraged by others who are in management. However, if you believe you would like to be a CNO someday be prepared for 60+ hour work weeks. Management is demanding particularly inpatient because your employees and one ups expect responsiveness. Now there are certainly ways to manage your work life balance and some people are better at it than others. Ive been a leader for over 10 years now. I used to work 50-60 hours a week but with time I've learned its ok to protect your time a bit and set expectations for your staff (hopefully supported by leadership). Hope this helps.

Reread my first sentence.

Depends on the organization. We hire RNs, LPNs, CMAs and CCMAs. They all have the same job function and for many RNs this isn't fulfilling enough. The pay is better for the hospital and you have more autonomy. The hours aren't that much better typically as we are open holidays and evenings so RN interest is usually low. The RNs don't typically perform "RN level work" so thats why its not required in our clinics.

I think we have all had these moments haha. I think its challenging when going to different organizations in leadership roles. I have done this 3 times now. Went from being in a manager role to a director role at a new organization and then to a manager at another organization and then back to being a manager at yet another organization ( I am not a job hopper I promise haha). Every culture is different and those you report to are different. The director I work for currently doesn't really care what I do as long as my quality and tasks are completed. The last organization I worked for was very different and the director wanted to be involved in everything I do...which was exhausting by the way. As a director I was more of a "Im here if you need me" type of leader. I wouldn't let someone stop you from speaking your mind, however. Thats how we get into a group think mentality. I would recommend you seek constructive feedback though which it sounds like you did. While you want to express your opinions you want to do it in a respectful way. Its easy to get caught up in a "this is how we did it at my old facility" conversation which doesn't usually go over very well. But if you say something like, "I have done it like this in the past and it seemed to work well, what do you guys think?" that typically goes over better. Its all about how you present your thoughts to get the perception you are hoping for. Good luck!!! Communication is definitely a challenge.

I was in a pinch to finish up my CE requirement last year as well. I purchased the unlimited CE package from nurse.com. There were a lot of pediatric options and actually found some interesting ones that I wouldn't have found myself. They were all accredited. I think it was around $40 but it was worth the money to me to not have to go looking around for free ones.

Congratulations! Pediatrics can be very rewarding. Also, don't discount your skills! Its true that kids aren't just small adults BUT many of the skills that you have acquired over the last 14 years will be very applicable. In fact I bet you can share some of your knowledge to help even experienced pediatric nurses. As someone who has hired RNs for pediatric med/surg I always liked hiring the seasoned RNs without pediatric experiences. Usually these nurses are eager to learn like a new grad but have already figured out "nursing intuition". But to your question... that is a difficult one. I started as a new grad in pediatrics. Now that I have had kids, I wish I would have appreciated more what the parents were going through. Its easy to say you are empathetic but when you have children it brings it to a whole new level. At times its can be difficult to do the work as you start feeling the experience more. But dont let that get you down...its important to remember that you have the skills and knowledge to help! It is a privilege to be able to help people no matter the age.

I have managed a few pediatric units and I always like hiring adult med/surg nurses. Unfortunately (or fortunately) you don't get to practice a lot of variety in nursing skills in the pediatric environment. I don't mean that in a negative way at all but most pediatric inpatient units have fairly straightforward patients. In adult med/surg you see it all..the chest tubes, the drains, the central lines...where in peds its not always commonplace to see these things frequently unless you are in a major children's hospital or a unit that specializes in such things. The experience you will bring will be an asset to the unit. You will be surprised how many skills will transfer. Pediatric patients aren't "little adults" but they have similar anatomy that is often just smaller.

I agree with several of the other posters. MSN in leadership being "worth it" really depends on your career goals. I wouldn't let age, money or time stop you if you really want to be in leadership and advance. 40...you still have a long career ahead of you. Money...if you are open to opportunities you will have the ability to make more money. Time... its not as horrible as one might think and different programs offer different options. I completed mine over 3 years just taking 1-2 classes a semester while working full time. It is a commitment for sure but if you are willing to give up some of your free time its definitely worth it. It has opened a lot of doors for me and I don't regret it at all. Now I did have to relocate several times to reach my career goals. Also, if you haven't been in a leadership position I would advise working in one for a bit before you commit to that path. It sounds like you are in a project leadership role now so that will be a good entry level management position to see if you want to make this your career. Its not all sunshine and rainbows.

Cy Wakemen is awesome. I have used some of her strategies in my own practice. One of the things that has stuck with me is that "venting is an unhealthy exercise". I have been guilty of saying to my staff..."if you need to vent come to my office and shut the door". All this does is permit employees to complain. That trickles out into the practice environment and at the end of a venting session no one feels good at the end of the conversation and you have no solutions. I have one particular practice that has been really bad about complaining about things outside of their control and sometimes it has been silly things. At a staff meeting I just laid it out there for them and told them when they come to me with a problem whether that is my office or in a meeting I expect some sort of suggestion. This has worked sometimes...its hard to get people out of the negative place but once you start working on solutions for problems rather than complaining about them it can turn the whole culture around. It takes time and doesn't always work 100%. Low level bonding is the easiest type of bonding.