Nurse Beth

How long do nurses typically stay on night shift before going to days?

For a definitive answer, consult your legal counsel and individual state's nurse practice acts (which vary). I'm not an attorney, but I can share some thoughts. This is a critical and nuanced question, and you're right to be cautious. Here's how it breaks down: Licensure and Scope of Practice In the U.S., nursing practice is regulated at the state level by each state's Board of Nursing (BON) and Nurse Practice Act. Patient location is paramount. Generally, nurses must hold an active license in the state where the patient/member is located at the time of service. This applies whether the service is in person, by phone, or virtual. Having a compact license (eNLC) allows a nurse to practice (telehealth included) in all compact states legally. Nurses licensed only in their home state (non-compact) would typically need additional licenses to serve members residing in other states. Does a Physician's License Cover Nurses? o. A physician's license does not "umbrella" over nursing practice. Each nurse is personally accountable to their own state BON. Even if tasks are administrative (gathering documentation, relaying determinations), if you're functioning as a nurse (using your RN or LPN title), the state may consider that nursing practice, and therefore, subject to licensure requirements. Gray Zone: Clinical vs. Nonclinical Work Some of the work you describe—like relaying pre-authorization decisions, sending determination letters, and making process calls—could arguably be done by nonclinical staff. However, because nurses are practicing under their license/title, it could still be interpreted as the practice of nursing, depending on the state law. After all, there is a reason your company has nurses making these calls, and not nonclinical staff. Although nurses are not responsible for decision-making, they may still need to interpret decisions using their nursing knowledge, which could make them liable. The employer's position (“everything falls under the physician's license”) is risky. Boards of Nursing typically do not accept that rationale—nurses remain individually responsible for knowing and practicing within their scope and licensure. Risks to Nurses Practicing nursing across state lines without a license in that jurisdiction could be considered unlicensed practice of nursing, which is grounds for disciplinary action. Even if no harm occurs, a complaint could lead to an investigation, fines, or license restrictions. It's not enough that the employer "says it's fine”—Boards of Nursing enforce the law, not the employer. Resources for Proof You can use these to show your employer (and to protect yourself): National Council of State Boards of Nursing (NCSBN) " A nurse must be licensed or have the privilege to practice in the state where the patient is located at the time care is directed or service is provided. This pertains to in-person or telehealth practice." Your Nursing Insurance Carrier State Nurse Practice Acts & Boards of Nursing Each state BON website spells out whether telenursing or remote services are considered practice in their state. Example wording: "Nursing care provided to a patient in this state, even when delivered electronically or telephonically, constitutes the practice of nursing in this state and requires a license issued by this Board.” Bottom line It depends on each state's nurse practice act, and in most cases, nurses must be licensed in the state where the patient resides. A physician's license does not shield nurses from their own licensure obligations. Your employer's stance could expose nurses to regulatory risk. Best wishes, Nurse Beth

I'm so glad you didn't pay $2,000 for a nurse coaching course that awards a certificate, but not board certification. Nurse Coach Certification The American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), does not administer a board certification exam for Nurse Coach. However, ANCC recognizes the credential provided by the International Nurse Coach Association (INCA), which administers the Nurse Coach Certification Exam. So, in other words, the Nurse Coach certification offered by INCA is legit, although not provided by ANCC directly. The course offered by INCA costs approximately $4,000 and can result in ANCC-recognized certification. While certification would definitely add to your credibility, that's a lot to invest and may not be neccessary for landing a job or guaranteeing a job, just something to think about. Many nurse coach jobs listed on indeed.com (job board) do not require certification or list it as "preferable". Nurse Coaching Jobs Start by building your brand and network. Create an online presence: Build a professional website or social media profiles (LinkedIn, Instagram, Facebook) where you can showcase your expertise, certifications (if applicable), and services. Even if you're just getting started, sharing tips, articles, and your journey can attract potential clients or employers. Network within nursing and wellness communities: Join relevant groups on LinkedIn, Facebook, or professional forums. Engaging with other nurse coaches or holistic nurses can help you find job opportunities and gather recommendations. Use your current contacts: Reach out to colleagues from your nursing career, as well as friends, family, and other professionals. Let them know you're looking for coaching roles or clients, as word-of-mouth can be powerful in the wellness space. Research Nurse Coaching Platforms and Companies Some companies and online platforms are looking for nurse coaches to work directly with clients, especially in wellness, chronic disease management, or health coaching. Telehealth and health coaching companies: Companies like Noom, Health Coach Institute, Teladoc Health, and TrestleTree may hire nurses for virtual coaching roles. Some health insurance companies or healthcare systems might have coaching programs, especially for chronic disease management, mental health, or wellness. Explore positions through major healthcare systems or organizations such as: American Holistic Nurses Association (AHNA) International Nurse Coach Association (INCA) Health and wellness companies (e.g., Fitbit Health Coach, Aetna, UnitedHealth Group) Check Job Boards and Career Websites While nurse coaching is a niche, there are job boards and websites where healthcare jobs, including coaching roles, are listed. Indeed: Look for "Nurse Coach" or "Health Coach" positions. FlexJobs: It's a great place to find remote or part-time nursing jobs, including wellness coaching. LinkedIn: Use LinkedIn's job search feature to look for Nurse Coach positions or Wellness Coach roles. SimplyHired: Another platform where you can search for nurse coaching roles. Free-lance If you're entrepreneurial-minded, you could consider free-lancing, and build your own coaching business. Be prepared to market yourself. Since nurse coaching is still a growing field, you may need to actively promote yourself and your services. Share success stories, write blog posts, create videos or webinars, or even offer free initial consultations to build your practice and get testimonials or experience. Once you get a few clients, ask for referrals. Also check out Nurse Keith, who is a successful nurse coach, and could definitely help guide you to your career goal. I wish you the very best, and good luck! Nurse Beth

I agree it's a lot to ask you to produce documents from 1984 and before there was electronic record-keeping. Here's a couple of thoughts that may help: National Council of State Boards of Nursing (NCSBN) The NCSBN is the organization that oversees the NCLEX exams. They may have a record of your results, even from that long ago. You can contact them directly for information on how to obtain your NCLEX results. Contact NCSBN: Visit their website and look for information about historic records or reissuing exam results. You may need to submit a formal request, and they might charge a fee, but it could be more reasonable than what New York State is asking for. NCSBN Website: www.NCSBN.org Florida Board of Nursing (BON) Since Florida is asking for the results, you could contact them directly and explain that your NCLEX results are from 1984. Sometimes, other forms of documentation may be accepted if retrieving the original exam results is difficult. Since Florida is requesting these results, you should check if there is a special process for applicants who took the NCLEX decades ago. Some state nursing boards are more flexible regarding older records and may allow you to submit alternative proof, such as your original license number, employment records, name badge, or other relevant documentation, instead of the exact exam results. Florida BON Contact Information Phone: (850) 488-0595 Website: floridasnursing.gov New York State Board of Nursing (NYS BON) If the NYS BON still has your records (which they may), you could also request a copy of your results directly from them. Keep in mind that the $200 fee seems quite high, but it could be the fee for retrieving archived records. You could inquire if there's a more affordable option for older records or if they can waive part of the fee, given the age of your exam results. NYS BON Contact Information: Phone: (518) 474-3817 ext. 120 Website: https://www.op.nysed.gov/registered-professional-nursing Your Nursing School or Previous Employers If you attended nursing school in 1984, they might still have a record of your exam completion or licensure status, and they could provide documentation confirming you passed the NCLEX at that time. Similarly, if you worked in a state or facility that has kept your employment records, they might have a copy of your initial license or proof of passing the NCLEX. Recommendations Contact NCSBN first: They are the official organization that handles NCLEX records and may be able to provide guidance. Communicate with Florida BON: Explain your situation and ask if there's flexibility in submitting alternate documentation. They may be able to work with you. Good luck!

I highly doubt you are unreliable (or seen as unreliable) because you are concerned about being reliable. Acknowledging burnout is the first step towards addressing it, and seeking a solution demonstrates professionalism. You can only control your own approach, and not your manager's response. Keep in mind that seasoned managers are accustomed to these conversations and situations. Managers understand the need for growth, and they will also appreciate the opportunity to collaborate on a solution that respects both your professional development and the unit's needs. Your honesty and transparency will be appreciated. Focus on your approach and embrace the conversation with confidence! First, schedule an appointment with your manager, as befits a serious conversation. Prepare for the appointment by having your key thoughts/talking points prepared. You want to be appreciative, concise, and professional. Your key thoughts will include: You are burned out, but frame it as something you're actively working to address. "I've been reflecting on my current role, and I've realized that I'm feeling burned out, which has been affecting my energy and focus. I want to be upfront about this because I believe acknowledging it is the first step in addressing it. I've been thinking about ways to manage it, such as exploring different roles within the hospital that might reinvigorate my passion. My goal is to thrive and contribute at my full potential, both for myself and the team." You are committed to the organization. "I'm not looking to leave the hospital, but I want to be sure I'm doing everything I can to keep my passion and energy for the work I do." You're interested in shadowing opportunities. "I'm interested in shadowing other units to explore where I might be best suited to contribute more effectively while rejuvenating my passion." Instead of asking for a transfer outright, you're showing an interest in exploring other areas first, which feels less like a decision and more like a discovery process. You acknowledge and respect the one-year transfer policy. You can either leave it as it is or request flexibility. "I'm aware of the one-year transfer policy, but I'd like to know if there's any possibility for flexibility in special cases. If not, I'm still open to exploring other options or solutions." You are seeking a solution together. End on a collaborative note, asking for your manager's feedback and suggestions."I'd love to hear your feedback and suggestions." Follow these guidelines for the conversation while using your own words. Keep focused on the goal, which is a collaborative relationship with your manager and working together towards a solution. Best wishes, Nurse Beth

To fulfill the written and oral communication requirement for RN license endorsement, you generally need to prove that you are proficient in English. The specifics vary depending on the state to which you're applying for endorsement. Here's an overview of common requirements: Written Communication Many states require you to take a written English proficiency exam, especially if you were educated outside of the U.S. or in a non-English-speaking country. The most common exam for this purpose is the TOEFL (Test of English as a Foreign Language). Many states accept this to demonstrate your written English skills. Oral Communication Some states may also require an oral communication exam. The TOEFL iBT may cover this. State-Specific Requirements States differ in their specific requirements, and some states do not require an English proficiency exam, so it's essential to check with the State Board of Nursing (BON) where you're applying for endorsement. If you let me know which state you are applying to, I can provide you with specific steps. Best wishes, Nurse Beth

First, inquire with your MSN program to see if they provide preceptor matching services or have a database of potential preceptors, or even past students. There are preceptor matchinh services online, but they are mostly for NP students. Cold call. Try calling the Staff and Development department of a local hospital and tell them you're looking for a preceptor. They may be able to put you in touch with someone in their Informatics department. Here are the likely requirements: Preceptor Requirements A master's degree in nursing and an unencumbered, current nursing license are typically required. A minimum of two years of work experience in a relevant nursing informatics setting, such as EHR enhancement, data management, or workflow mapping, is often necessary. The preceptor must be willing and have the time available to mentor you through your practicum and help you meet your learning objectives. Best wishes, Nurse Beth

Yes, you can apply to take the NCLEX exam while on your H1B visa, as long as you meet the licensing requirements for the state where you plan to practice. The NCLEX is required to become a licensed RN in the U.S. You don't need to wait for your resident visa to apply, but there are a few things you should consider: State-Specific Requirements: Each state has its own specific licensing requiremeYou'llou'll need to check with the Board of Nursing for the state where you plan to practice to see what specific requirements they have for foreign-educated nurses. This may include verifying your credentials, completing any required courses or exams, and meeting language proficiency standards. This could involve taking an English proficiency test. Common exams include: TOEFL (Test of English as a Foreign Language) IELTS (International English Language Testing System) Credential Evaluation: Since you were educated as a nurse in the Philippines, you will likely need to have your nursing education you'retials evaluated by a recognized agency (like CGFNS or another state-approved evaluator). They will assess whether your education meets U.S. standards. Work Authorization: Since you're on an H1B visa, you should confirm that you have the legal authorization state'stice as an RN once you pass the NCLEX. Some employou'llay be able to sponsor you for a nursing position that aligns with your visa status. NCLEX Eligibility: After meeting the state's requirements (including credential evaluation), you'll be able to apply to take the NCLEX exam. Once you pass, you can apply for your nursing license in that state. Make sure you research the requirements in your state and consider consulting with an immigration lawyer or a licensing expert to help navigate both the visa and nursing licensure processes. Best wishes, Nurse Beth

So the concentration was 20 mg/mL? Is that a common concentration for oral administration in nursing homes?

Excellent! Thank you @NRSKarenRN

"It may help you to know that feeling like you did something wrong is a common reaction to being assaulted. It may come from a need to feel like the world makes sense or that everything happens for a reason. It may be your brain trying to figure out how to keep it from happening again." So wise and helpful ?

I started nursing as an LVN in CA. Authorized Practices IV-certified LVNs can initiate and manage IV fluids. Under specific hospital policies, LVNs are authorized to administer blood and blood products. Prohibited Practices Administration of IV pushes and IV antibiotics is not authorized. LVNs require clinical supervision for these procedures.

That's a real and challenging situation. Based on what you described, there are several concerns and potential approaches to address them. Key points to consider Scope of practice: In most jurisdictions, school nurses provide clinical care, health assessments, management of medications, and emergency response. Routine, ongoing clothing changes for students without a medical diagnosis or clear medical need fall into custodial care. Assigning this duty to a nurse could divert time from medically necessary care. Paraprofessional support: Many districts employ health clerks, health assistants, or patient care technicians to handle non-clinical tasks (changing clothes, toileting assistance, basic hygiene) under supervision, freeing the nurse to focus on clinical care and emergencies. This arrangement is usually defined by policy and job descriptions. Who changes clothes when you are not there? Practical steps and questions to discuss with the district What is the official job description for the school nurse(s) and any paraprofessionals? Clarify the role and policies about custodial duties vs. clinical duties for nurses. Assess patient care needs and safety Are there students with medical diagnoses (e.g., incontinence, mobility impairment) requiring nursing involvement? Is there a plan for those students that minimizes unnecessary nurse time for routine tasks (e.g., assistive care provided by trained assistants under nurse supervision)? Staffing and logistics Can the district hire or designate enough health aides/paras to handle non-clinical tasks (diapering, toileting, cleanup) with clear boundaries and training? Are there contingency plans for medical emergencies when a nurse is tied up with non-clinical tasks? Training and protocols Implement infection control procedures for spills, including PPE, cleaning products, disposal, and hand hygiene. Create clear criteria for when a staff member (not the nurse) should handle routine toileting or clothing changes, and when the nurse's involvement is medically necessary. Training should be grounded in policy and include safeguards for staff against sexual allegations, clear guidelines on when to contact parents, and procedures for obtaining any necessary witnesses when touching a child is involved. Legal and regulatory review Confirm compliance with state or country nurse practice acts, school health policies, and child protection/privacy laws. Check worker safety guidelines for staff performing assistive care tasks. Possible interim recommendations Reallocate non-clinical duties: Move routine clothing-change and cleaning tasks to trained health aides/paraprofessionals under nurse supervision, not to the nurse as a primary duty. Develop a triage system: Use standard screening to determine which issues require nurse involvement (e.g., acute illness, injury, medication administration) and which can be handled by trained staff. Build a resource pool: Hire or designate a pool of per-diem health aides to cover peak times or multiple sites, so the nurse can focus on clinical care. Also check out the School Nurse Forum for reference and reality check. They are an active, helpful group. Best wishes, Nurse Beth

I'm so sorry you had to go through that. It sounds frightening, and it's normal to feel unsettled after a violent situation. You were assaulted, and you should not blame yourself for protecting yourself or for seeking help. Calling 911 and alerting the Director of Nursing was the right course of action. The CNA's behavior appears to have been problematic well before the assault. Your calm, professional response shows you were trying to handle things thoughtfully. The CNA is responsible for her actions. You did not provoke her, and even if you had, her behavior would still be her own responsibility. Misplaced guilt is common when multiple stressors are present (e.g., a vacation request, tension with the DON). It's understandable to second-guess yourself or question your feelings under these circumstances. If guilt is weighing on you: Talk with a trusted colleague or a therapist to help process your emotions. Document everything about the incident and your interactions with the CNA and DON. Keep a clear record in case the situation escalates or you need to explain it later. Note concrete details: dates/times, what happened, who witnessed it, any injuries, and communications you've had. Actionable Steps Consider requesting a formal incident report or review meeting with HR or a union rep. Request safety planning training (e.g., identifiable de-escalation strategies, leaving the area when unsafe, buddy system for shifts). Give yourself space to rest and recharge. You deserve a vacation and grace as you recover. When you're ready, you can approach the situation with a clear mind and advocate for your well-being. Best wishes, Nurse Beth

Do I put the second facility on my resume at all? Background checks Here's some info on background checks to help make your decision: So here's what a standard background check can entail: Criminal record Identity verification Education verification Credit check Confirmation of dates/roles with previous employers Omitting a job from your resume is less likely to be discovered during a standard background check, often used for entry-level or non-sensitive roles. Here's what a more in-depth background check entails: SSN trace and broader employment history Omitting a job from your resume is more likely to be discovered during a more in-depth background check, often used for roles requiring regulatory/licensing checks. What does this mean for you? When considering whether to include your second facility job on your resume, it's helpful to weigh the advantages and disadvantages of both inclusion and omission. Pros and cons of inclusion Pros of inclusion: Demonstrates honesty Fills employment gaps Allows positive framing (skills learned, resilience Cons of inclusion: Potential questions about short tenure Requires careful, professional explanation Pros and cons of omission Pros of omission: Avoids delicate conversations Keeps narrative focused on strengths Preserves privacy Cons of omission: Creates a resume gap Risk of discovery in deeper background checks May raise questions about credibility How to present if included Use concise, neutral bullets focused on transferable skills Maintain a professional tone; avoid negative framing of the prior environment. What's the right choice for you? It depends on what you're most comfortable with and what aligns with your long-term goals: If you value complete transparency and want to minimize the risk of later questions, or if you anticipate a more in-depth background check, include the job. Just be ready to explain the short tenure. If you feel that including it on your resume would lead to unwanted scrutiny, or you anticipate a standard background check, omitting the job could be a valid choice. Just be ready to explain the gap. Either way, you control the narrative. Best wishes on your decision, Nurse Beth