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Nurse Beth MSN

Med Surg, Tele, ICU, Ortho

Hi! Nice to meet you! I love helping new nurses in all my various roles. I work in a hospital in Staff Development, and am a blogger and author.

Posts by Nurse Beth

  1. Dear Nurse Beth,

    I want to continue to learn new things in the nursing field however I have many hard feelings about wanting to change to 12 hours shifts if I apply at the hospital. I am newly married and we have just started talking about having kids and I don't want to miss out their big events when they come along. If I worked 7 to 7 I wouldn't be able to get them to school or help them with homework. I have thought a lot about working in a clinic were i would have day time hours but I don't want to miss out on opportunities to learn if i did that. I am currently a second shift, 230 to 11, SNF nurse where I have been since I graduated in 2018.

    Dear Newly Married,

    Congrats on getting married!

    I wouldn't not work in a hospital because of kids you don't have yet.

    Once you get pregnant, you have plenty of time to take stock of your options. Once you have the baby, you still have time because all shifts work for a newborn ūüôā

    As your raise your children, you can continue to adapt to what works for you and your family. For example, before they start school, working weekends may be a good fit. But once they have soccer games and activities every weekend, you may want mostly weekends off.

    You can't control or predict everything ahead of time, but you are in a career that has more options than most.

    Best wishes, my friend

    Nurse Beth

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

  2. Dear Nurse Beth,

    I have a co-worker who constantly violates our policy on Professional Behavior. She too is an RN and we work in a clinic. This RN has befriended patients and/or their spouses on social media (Facebook, IG). She has given patients her personal cell phone and home address. And she over shares what's going on in her personal life whether it's about her or her kids and/or grandkids.

    We've told our manager about her inappropriate behavior and we did have a RN meeting so that it was addressed to all of us so that it didn't make it seem she was being singled out. But the inappropriate behavior continues to happen. When is it enough already. I'm at the point that I want to transfer out of my department and go somewhere else because it seems like management is doing nothing and this RN believes this is acceptable behavior. We do have union representation with this company.


    Dear Inappropriate,

    Managers who can't differentiate between individual performance issues and general group behavior are not effective managers. Or they're just not equipped for their job.

    Have you tried just focusing on your own job and not this other RN? It is not your problem, it's your manager's problem. It is also possible that discipline is taking place behind the scenes and you are not privy to it.

    You may be happier working in an environment where you can trust the manager to address and resolve performance issues. If so, and if this continues to cause you great stress, look for another position.

    Best wishes, my friend

    Nurse Beth

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

  3. Black Plague

    Recently it’s been in the news that two people from the Chinese province of Inner Mongolia have contracted the plague and are being treated in Bejing.

    The plague has been with us since biblical times. The Black Plague is known as being one of the most devastating pandemics in all of history. The Black Plague killed millions of men, women, and children in Europe from 1347 to 1351 and is estimated to have wiped out 30-60% of Europe’s population. The Black Plague originated in Central Asia where rodents carried it to Crimea and beyond. It’s believed black rats carried the fleas that carried the bacteria. Black rats, also called ship rats and roof rats, inhabited almost all merchant ships. 

    The plague is caused by an organism called yesinia pestis. Back when the plague was rampant it turned people’s fingers, nose, and toes black, which is why it came to be known as the Black Death and the Black Plague. It’s a swift but painful, horrifying death- victims vomit, bleed, and develop gangrene of the extremities. 

    Types

    Humans are extremely susceptible to the plague. There are 3 types: the pneumonic plague, the bubonic plague and the septicemic plague with pneumonic plague being the deadliest form. 

    Bubonic plague affects the lymph glands while septicemic plague affects the bloodstream. Symptoms appear 2-5 days after exposure. The bacteria quickly multiply in the lymph nodes closest to the flea bite and spreads to other parts of the body. Tender, painful lymph nodes, called buboes, are a hallmark of bubonic plague. Bubonic plague can lead to septicemic plague once the bacteria crosses to the bloodstream.

    In septicemic plague, patients present with fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Septicemic plague can occur as the first symptom of plague, or may develop from untreated bubonic plague. The time between being infected and developing symptoms is typically 2 to 8 days. 

    While all 3 are deadly, the pneumonic plague affects the lungs and can be contracted through infectious droplets coughing or sneezing. Anyone who inhales the droplets can become infected. The incubation period can be as short as 1 day for pneumonic plague. Victims are lucky to live more than 48 hours. Pneumonic plague can often be mistaken for the flu.

    People with pneumonic plague must be isolated. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

    Transmission

    Plague is vecxtor-borne, carried by fleas that cling to the fur of rats and other animals, and infecting humans through flea bites. Plague cannot pass from human to human, with the exception of the deadly pneumonic plague.

    Outbreaks

    While most think the plague is extinct, it has not been eliminated and is very much alive today. The bacteria lives on rodents in most all continents, but outbreaks typically occur in poverty-stricken rural areas. It is found in Africa, Asia and South America. The WHO has classified the plague as a re-emerging infectious disease.

    There was an outbreak of bubonic plague in New Orleans back in 1914. Rat containment prevented it from becoming a pandemic. In Honolulu in the early 1900s, firefighters burned the houses on either side of a plague victim's home in an attempt to stop the spread of the disease.

    In recent times in the United States, plague is rare, but not non-existent. Approximately 10 cases are still reported each year. It has been known to occur in the western states of California, Arizona, Colorado, and New Mexico. 

    Treatment

    People with the plague need to be treated right away. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin as well as supportive measures are used to treat the plague. 

    Outlook 

    While antibiotics are life-saving, some fear that if the bacteria develop resistance, another pandemic could occur. How likely are the chances of an epidemic or pandemic in the United States? Not very. 

    But because it is so deadly,  awareness is important.  Early detection is key.

  4. Dear Nurse Beth,

    Good morning.  I have reached out before in fact last month.  Your advice helped and we were not disciplined for a med error..

    My issue now is there is a resident who keeps falling out of bed.  I work on a dementia unit, locked down.  He has fallen out of bed 5 times in 7 days when he returned from the hospital.  He cannot ambulate, he is end stage CHF and acute kidney failure. We have put many interventions in place but he ends up on the mat before we can get there.  He is the closest room to nurses station.  Interventions are bariatric bed, chair alarm, recliner, mats on side of bed, bed alarm 1/2 side rails up, toileting schedule.  He is out of bed from 7am-7pm.. Cna to sit at his bedside on 11-7 when they are not in another residents room. They are not 1:1.

    The family is not on board with hospice they are very much in denial and in turmoil so they cannot help him. His anxiety is through the roof and he has no anxiety medication they just d/c his zyprexa as we are in the window for state survey.  Now they want to d/c his bed alarm for the same reason (too many restraints).  I was told we will get slammed by the state which as a nurse I am my patient advocate and believe it is not safe to take his bed alarm away.  I feel it is our only shot to possibly keep him off the floor.  My question is this correct about too many restraints and wouldn't the side rails or chair alarm be better to remove if we have to takes something away.

    Thank you

    Dear Window for State Survey,

    I would make a comfortable bed on the floor at ground level. The mats can go on either side.

    He has fallen 5 times in 7 days and he is going to keep falling out of bed. I'm surprised that a 1:1 sitter is not assigned at all times. A sitter who can only be there when they are not in another resident's room is not going to prevent his next fall.

    D/C ing the bed alarm, even though bed alarms are questionably helpful in preventing falls, is not going to help your facility do better on survey. A bed alarm is not a restraint. Side rails can harm patients even when only 2 or 3 out of 4 are up, and they don't prevent falls.

    Best wishes, my friend

    Nurse Beth

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

     

  5. Dear Nurse Beth,

    I am planning on applying to nursing school next year. What are some important things to consider when deciding between LVN and RN career pathways (besides pay, length of schooling and type of workplace desired?)


    Dear Deciding,

    LVNs and RNs both provide care. Both pass medications, change dressings, insert nasogastic tubes, and insert foley catheters.

    Depending on what state you live in, LVNs can hang blood, start IVs and give IV fluid but not IV medications.

    There are a lot of similar tasks but the responsibility is different. An RN must oversee the care provided by an LVN and retains accountability for the plan of care as well as for patient education. 

    An important consideration is career choices down the roads. As an LVN, your options are mostly limited to bedside care. As an RN with a BSN, you can stay at the bedside but you can choose to go into Infection Prevention, Case Management, and much more. A BSN prepares you to manage pt populations and effect change on a larger scale.

    Best wishes, 

    Nurse Beth

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

  6. 8 hours ago, mollynurse said:

    I volunteer a few days a week for a free medical clinic and have for almost two years now. I enjoy it and it makes me very grateful for all that I have in life since a great deal of my patients have really horrible histories. I would go back to a LTACH or SNF if in anyway that would be considered experience to get me a hospital position. Thank you for your advice. Hope you have a great day. 

    You are on the right track to consider LTACH or SNF. Your primary goal right now is to establish a good work history.

    Once you have 2yrs of history working with the same employer, it will compensate for the older employment gaps. You will show as a reliable employee with relevant and current skills, and a BSN. Best wishes ūüôā

  7. I'm looking forward to more of your articles :)! I've watched you from afar on social media and admire you!

    For me, it didn't start out as being about a business, although it is validating that others will pay you for your talent or product!  My side hustle is a blog that I started in 2014. Having a blog quickly parlayed into other paid opportunities. It's been an amazing journey that would never have happened if I hadn't listened to my inner voice saying, "Write, Beth. Write something".

    I was motivated to be a blogger at nursecode.com because I wanted to speak up about nursing conditions and speak up for nurses.

    I think that people who have a passion or a hobby should give it rein and go for it.  Yes, life is short, as another poster said, and you should nurture and develop your whole self.

    Best wishes, my friend

    Nurse Beth

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

  8. Dear Nurse Beth,

    I am an Geriatric RN for over 28 years...and was diagnosed with Pseudoexfoliative glaucoma which is hereditary with optic nerve damage from a pressure of 62 in the left eye which is under control now..but it has severely impacted my life the vision loss.....I cannot do floor work(insulin and measuring were the worst things that caused me intense anxiety and fear of giving the wrong doses)) anymore because of this and my last job was not accommodating to changing my job to something more suitable for me, like part time office work....prolonged computer work intensifies my eye pain.......so I am searching for office work now....my question is...do I tell my job interviewers that I have this vision loss? Or do I wait and get the job first and then tell them?

    Dear Searching,

    I'm sorry for what you're going through.

    You do not have to disclose your medical condition to your prospective employer as long as it doesn't affect your ability to perform the essential job functions. 

    You definitely do not have to disclose it in a resume or cover letter.

    So if the job requires occasional computer work and the essential job functions are telephone work, you would not need to tell them. If you take a job and then later disclose your condition, I would be strategic about doing so. 

    But let's say your job requires you to do computer worker for 6 hours, and you will need an accommodation to do so, you need to disclose these needs pre-hire.

    Accommodations for low vision may include magnifiers, computer text enlargers, and even contact lenses (talk to your doctor).

    Best wishes, my friend

    Nurse Beth

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

  9. 19 hours ago, cubrnjvm said:

    It does not matter and may not make a difference but I don‚Äôt agree with the advice. Unfortunately, that is one of the reasons we are mostly crushed, disrespected and our profession despite of thousands of schools, degrees and desires to stand up cannot do it. We eat each other and allow it on a daily basis. Having the opportunity to go somewhere else is fantastic and amazing but you will be ‚Äújumping‚ÄĚ places to places because mostly everywhere you may find that. There are other ways of succeeding in the work place. I hope you will find yours because there is no magic recipe.

    Thanks for your feedback. I'm not sure what part of the advice you disagree with, but I'm thinking it's to not be forthcoming when asked "Tell me why you are leaving". I also hear you saying it'd be better for the profession if we did speak up.

    You make a good point, and sadly, I'd agree if it wouldn't hurt the OP's career.

  10. Dear Nurse Beth,

    I am graduating with my BSN this summer and I am wondering how much of a hang up a misdemeanor domestic battery conviction is going to give me for getting my license and/or job. Any advice is greatly appreciated.

    Dear Wondering,

    When you successfully complete your nursing program, or very near the end, your school and you will submit paperwork to the BON or BRN for  the NCLEX. 

    After your BON/BRN declares you eligible to test, you will receive your authorization to test (ATT). You can then register with Pearson VUE and sit for your exam (NCLEX). Your school will walk you through all of this.

    This next part is very important for you- answer every question on your application truthfully. States vary in their reporting requirements. For example, some states ask if you ever had a misdemeanor, but when it comes to traffic tickets, some say you only have to report traffic tickets over a certain amount, such as $300.00.

    Many applicants believe that if their crime was expunged, they do not have to report it, and it is not discoverable by the BOB/BRN. It is discoverable as they conduct an FBI level background check.

    You will be asked to explain the circumstances in writing. The letter of explanation is highly important.

    Rehabilitation

    The BON/BRN is looking to see that you have rehabilitated, and are no longer a person who is likely to commit domestic battery. Have your values changed?

    They will want to know what steps you have taken to rehabilitate. They will ask for all court documents, and for evidence that you completed all requirements, such as anger management classes.

    Responsibility

    Take responsibility for the event, and do not cast blame. At the same time, you can describe your environment at the time to show how you've overcome negative influences in your life to go on and become a law-abiding nurse.

    Remorse

    Show remorse for your actions, and anyone you injured. The tone of your letter should reflect regret for your actions.

    Consider getting an attorney, but only one with experience in dealing with the BON/BRN. We have a nursing attorney here on site, Lorie Brown RN, MN, JD, who has a column titled Ask a Nurse Attorney   for a great resource.

    There is also a forum here titled Nursing/Licensure/Criminal. It will really help you to read about others' experiences and interact with them. You are not alone.

    Read the article How to Write a Letter for a Criminal Infraction for more helpful and important advice, such as how to include letters of reference.

    Good luck to you. Everyone deserves a second chance.

    Best wishes,

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

     

     

  11. Dear Nurse Beth,

    My job as a night shift ICU nurse is challenging to say the least. Morale is low, high stress, no breaks, difficult shifts, at least three patients many shifts, a lot of floating, and some passive-aggressive coworkers stirring the pot sometimes. I have decided to resign as I find it is negatively affecting me. I feel that if I am honest with my supervisor I will be blackballed and put on the no-rehire list which is a common tactic of the corporation I work for. What would be a good reason to tell my supervisor why I am leaving to protect my reputation and job history? I feel she will push for more details if I just say it's because morale is low which is what others have told her to avoid problems.


    Dear Decided to Resign,

    Just as it's smart of you to leave this environment for your own well being, try not to stress or use any more energy around leaving.

    There is a scripture that says "Don't throw your pearls to swine" meaning your insights will likely be wasted. You have identified low morale, high workload, floating and dysfunctional behavior- but they already know this, and so far, are not doing enough about it.

    While it's not likely you'd be marked as a "do not re-hire" unless they are extremely petty, there is some risk and little, if any, benefit to being honest. Very rarely do employers actually use exit interviews to make improvements.

    You could instead say you've chosen to broaden your working experience, or that you are leaving to spend more time with family. By making it about you, and not about the organization, your manager is less likely to push for details.

    Line up another job before you quit, and give the required notice. By doing so, you remain the professional that you are, and leave with dignity.

    Good luck to you! I hope you are valued in your next job and you land in a better spot.

    Best wishes,

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

     

     

  12. Dear Nurse Beth,

    I am an RPN, currently on maternity/parental leave. I got my RN LICENSE too recently. I don’t feel like going back to the 12-hour shift in the hospital, is there another option for shorter shifts or an alternative job for a nurse.


    Dear Another Option,

    In the States we have LVNs (licensed vocational nurses) and LPNs (licensed practical nurses). They are the same, and the title varies by state.

    I understand in Canada RPNs (registered practical nurses) are equivalent to LPNs or LVNs.

    Not everyone loves 12 hr shifts because they aren't a good fit for everyone depending on your family situation, and your stage in life. Twelve hours can easily equate to being gone from your child 13-14 hrs or longer, which is a long time for a little one and for Mom or Dad.

    Long shifts can lead to fatigue and even errors caused by fatigue. Continuity of care is more difficult with 12 hr shifts than 8 hr shifts.

    Twelve-hour shifts became very popular years ago and now are considered the norm in acute care. Hospitals believe it would be difficult to attract nurses and be competitive without them. This despite the fact that it takes more  FTEs (full-time equivalents) to run a unit with 12 hr shifts than it does with 8 hr shifts. Twelve hr shifts are expensive for employers, but overall, nurses want them.

    Typically, 8 hr shifts and 10 hr shifts can be found in procedural areas, such as Cath Lab, Surgery and Peri-operative, GI Lab, Interventional Radiology, and Infusion clinics.

    Home Health is usually 8 hrs, and many non-bedside jobs such as Case Management and Documentation Specialist are as well.

    RNs have more job options than do RPNs, and congrats on getting your RN! You are a newly licensed RN, so you will need 1-2 yrs experience at the bedside to qualify for non-bedside jobs. This makes it a little more difficult to find an 8 hr job. Not knowing your location, check on acute re-hab facilities. Some SNFs also have 8 hr shifts. 

    Best wishes,

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

     

  13. Dear Nurse Beth,


    I have questions about conflict of interest. I am offered to work as a staff nurse in a hospital. It will be my primary job. But I also want to work for a skilled nursing facility as a PRN nurse at the same time. Am I allowed to do that? I reside in Tennessee. I am not sure where to look for related information about working for multiple facilities and whether they are in conflict of interest.

    Dear Not Sure,

    The law does not prohibit you from having two jobs.

    Conflict of interest between employers usually means that your employer is concerned about you sharing trade secrets with a competitor, or setting up a competing business. This is not common in nursing, and you would have been required to sign a non-compete clause.

    Tennessee, like the majority of states, is an "at-will" state, meaning employees can be fired, suspended, or disciplined for any reason. (Read at-will employment and right-to-work article to learn more).

    Travelers sometimes run into situations where they are not allowed to hire on to an employer until a certain length of time has passed since their contract employment, but that is not your case.

    A lot of nurses have two  jobs with two different employers. Usually, like you, they consider one job their primary job, and the other one their secondary or side job. Employers do not  like to hear that your second job interferes in any way with primary job. For example, your employer may not be sympathetic if you can't make it to staff meetings because of your second job. It is wise to manage both schedules independently and never use one job as an excuse for not fulfilling your obligations at the other job.

    There's no reason you can't work both places. As long as you are not showing up for work overly tired because of your second job, you shouldn't have a problem.

    Best wishes,

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

  14. Dear Nurse Beth,
    I am agonizing over a section of an application for a new position. With each prior job there is a box titled "achievements" instead of duties or responsibilities. I am at a loss, I haven't really received any recognition or awards except one for checking my meds at the beside. Any suggestions?
    Thank you for your time,
    This Nurse

    Dear Agonizing,

    There probably is more than you realize that can fit in this box. They are giving you a chance to show your value. Above all, do not leave this field blank. Let's find something.

    Here's a few things to consider. Did you have perfect or near-perfect attendance? Have you oriented a new employee, or served as a preceptor?

    How about your unit, what performance improvement initiatives has your unit worked on? For example, have your HCAHPS scores improved in any way, such as "quiet at night", or in how "nurses explained things in a way you could understand?"

    Has your hospital achieved any disease-specific certifications, such as a stroke designated center, or a chest pain center? If so, and if it pertains to your unit, you were part of it. "Participated in stroke designation recognition". If your hospital was so designated, all appropriate staff received extra education and skills.

    Did your hospital provide any extra training, such as AIDET or LEAN, or Six Sigma Yellow Belt? How about shared governance? Are you a member of your unit council?

    Are you certified in your specialty? Have you earned any extra certifications, such as the National Institute of Health Stroke Scale (NIHSS) from the American Heart Association (AHA)? 

    Have you attended a nursing conference? If so, you invested in your professional development and obtained extra education. Have you volunteered for anything, such as a homeless clothing drive, or taking blood pressures at the local fair?

    Without knowing your specialty, I hope it's prompted you to reflect on things you have achieved. As nurses we often don't give ourselves enough credit.

    Best wishes to you,

    Nurse Beth

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

  15. 19 hours ago, DallasRN said:

    Nurse Beth, I very much do not like your reply. This situation as told may well have ended the career of this nurse.  Certainly she can go with the "not a good fit" thing but as soon as this hospital is called for a reference and it's determined she's not eligible for rehire the game is over.  Let's face it...most hiring HR people would be real skeptical of a long-time OR nurse suddenly "not eligible".  Beyond that, how horribly demeaning for this nurse.  

    Personally, I like the recommendation of legal recourse.  If nothing else, being contacted by an attorney might wake up this hospital and force their hand in terms of making all parties aware of exactly why this particular decision was reached.  Who knows...maybe surgical tech was a relative of someone?  Had a relationship with someone?  And I can't help but believe an experienced RN has more "value" than a surgical tech.  I'm disappointed.  

    Best of luck in your Job Search!

    Thanks for your point of view. While employers have to provide length of employment, rate of pay and title, disclosing re-hire status is not required.

    She could go to HR and ask them to change the status, and if that doesn't work, she could contact an attorney.

    She can also put "No" when asked if her previous employer can be contacted for a reference.

    Litigation has its drawbacks and can backfire. Suing a former employer is a red flag for potential employers. Deciding to sue is a big decision because it's emotionally and financially draining, and holds you back from moving forward. 

     She would need to be clear on what she hopes to gain, is it worth it, and how much of a chance would she really have in a "he said, she said"?

  16. Dear Nurse Beth,

    How do I demonstrate critical thinking in an interview? I was turned down for a job multiple times and have another interview coming up for the same job. I asked the manager once why I didn't get the job, and she said it was because I "did not demonstrate critical thinking" in my interview, and that I was too task oriented when discussing the position. How does one demonstrate critical thinking?

    Dear Too Task Oriented,


    Critical thinking is really a high level of thinking. It's analyzing, reasoning, and synthesizing. Intellectual curiosity is also an attribute of a critical thinker.

    For example, a nurse without critical thinking skills has knowledge of abnormal lab values. If her patient has a potassium level of 5.0, she recognizes it as abnormal and calls the provider.

    But a nurse with critical thinking skills is curious and analytical. Why is the potassium level high? Is the patient on a potassium supplement? Do they have renal insufficiency? Are they a renal patient on an ace inhibitor? 

    She, too, calls the provider but anticipates and evaluates the provider's response. She makes her own suggestions if the response is not adequate.  "I'll d/c the potassium supplement, thank you, Doctor.  Did you want a repeat potassium level in the morning?"

    In interviews, it's important for you to prepare and improve your interview skills. You must be ready for behavioral-based questions, such as "Can you tell us a time when you broke a rule at work?" In this case, they would be looking for your reasoning ability. For example, you could answer "There was a time when I was Charge Nurse and we had a patient who was dying. He was waiting for his daughter to fly in from out of state. She finally got here at midnight. There was a strict no visiting rule after 9 pm, but I decided the best choice in that situation was to let the daughter stay with her Dad. I borrowed a sleeper chair from the maternity ward and let her spend the night".

    In my book below, I give examples of how to answer several behavior based questions, including what not to say when asked "What is your greatest weakness?" and how to answer "Tell us about a time you had a conflict with a co-worker".

    That was smart of you to ask your manager why you didn't get the job. I would go further and ask for her help, specifically going over the questions you were asked and your responses. Have her explain how your answers were "task-oriented" and what a better answer might look like.

    Best wishes to you,

    Nurse Beth

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

     

     


     

     

  17. Dear Nurse Beth,

    I'm in need of advice. I have been a nurse for 16 years. I have made some poor life choices in the past that lead to being in the Diversion Program, which I completed, and now sit on the committee as a Board member.

     For the last four years, I have worked in the Preop/PACU and most recently in the OR as a circulator. Management put a lot of weight on the surgical techs judging the RN's performance. One tech, in particular, was always condescending and like to discuss personal life (partying/drinking) in the OR. This guy just rubbed me wrong, but I made up my mind to not judge, listen if he had useful information, etc.

    I had an incident recently. During a surgery, the surgeon asked me to fetch an instrument. I did, but above surgical tech happened to be in the sterile supply room. He was in the aisle I needed access to. I said, "excuse me, I need to get through". He begrudgingly moved. I went in aisle and obtained what I needed only to turn around and find him blocking my path back out. Repeatedly asked to get by to no avail. I finally placed my hand on his shoulder to redirect him. I never pushed, shoved, etc. As I left room, he yelled, "Don't ever touch me again!‚ÄĚ

    After the case finished, I went to my charge to let him know of the encounter. Eventually, the director called me to her office to explain what happened, which I did. She then mentioned talking to the surgical tech to get his side. At the end of the day, I was called back to the director's office. There I discovered I was being written up. I read what she put and in it; she stated I "shoved" him!

    I completely disagreed with what she wrote, which she stated I didn't have to sign and could write what I felt like on the back. I did this making sure to mention I disagreed with "shoving" other employees. I obtained a copy and left for the weekend.

    After work on Monday, another surgical tech caught me and asked how I was feeling, as she had heard his ranting and raving the previous Friday and that I had gotten into trouble.  I told her how unfair it was. I did say I was joking but was very upset with the write-up and felt he was weak, "expletive". To this, she agreed but said I should be careful so as not to get HR's attention.

    I said I was only venting as she had asked me how I was feeling. Not long after I had left for the day, HR did call me to say they were suspending me pending an investigation as the complaint was now elevated to "workplace violence". I was dumbfounded and also regretting venting. I was ultimately let go. Unfortunately, HR didn‚Äôt give me a ‚Äúreason for being let go‚ÄĚ, so I‚Äôm unable to complete unemployment paperwork. I took a loan out on my 401k and am living off that.

    In the end, this hospital has flagged me as ‚Äúnot eligible for rehire‚ÄĚ. I am seeing now how my past DP participation and now this is just flagging me as a ‚Äúbad employee‚ÄĚ, but I‚Äôm a good nurse and have loved this field for as long as I can remember.

    I’m feeling humiliation and shame. I’ve been searching for work, and so far have only had one interview. I did share that I was let go. First, how should I approach prospective employers? I have a lot of negative information against me right now. I did reach out to fellow coworkers and even a doctor. All of whom have written me wonderful letters of reference.

    Second, should I even bother advancing my education in nursing or leave this field completely? This is a small town, and I'm now currently barred from 3 of the 4. I feel so defeated. Any advice would be helpful.


    Dear Defeated,

    This is a "he said, she said" where they took his word over yours. There was no one there to witness the event, so there's your story and then there's his story. Somehow he was believed, or they decided he was the more valuable employee, and they were going to back him.

    It's unwise to ever touch another employee as it can escalate to exactly this. HR and risk departments nowadays are not going to look the other way when there's an allegation of "workplace violence". Meanwhile, it's ironic, because his blocking your exit is aggressive and could also be considered workplace violence.

    While this feels devastating, hang in there. This, too, shall pass. What's important is to reflect on what part you had in the conflict, so you can understand yourself moving forward and have success in the workplace. Be sure not to "vent" and manage your emotions professionally. Learn your triggers and let them be your cues that you are in danger of reacting.

    You love nursing and have 5 years of peri-op and OR experience. You are still marketable. You've overcome diversion, and you can overcome being terminated.

    When asked about previous employment, just say "it wasn't a good fit". Do not defend yourself or even explain. 

    Best wishes to you,

    Nurse Beth

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

  18. Dear Nurse Beth,

    How do I save my job when my DON is harrassing me and ordering my direct supervisors to write me up for things I either should have education on or exaggerations. I have emailed corporate and will find the number for them. I talked two of my supervisors. I put in for a transfer that was approved on 10/21/19 then denied on 10/23/19.

    The company has great potential and benefits I'd hate to lose out over being bullied. I'm a 1year nurse and working to my best abilities their expectations are unreasonable of a 10year nurse let alone myself.

    Dear Harrassed,

    You feel that you are right, and that if only the higher-ups were made aware of the situation, the DON would change her behavior towards you.

    While your tendency is to fight back and defend yourself, it will not work. Do not call corporate. If you want to save your job, it will be through your DON. You would need to meet with her, listen to her concerns about your performance, and come to an agreement about measurable performance expectations. That is what will save your job.

    It would take both of you cooperating. But it sounds like you and the DON are nowhere near this point.

    It also assumes that there are legitimate opportunities for performance improvement, but you believe the expectations are unreasonable and you are being harassed.

    If you have been written up and a request for transfer denied, these are signs your job is at risk. You don't want to be in the position of trying to land a job when you are unemployed.

    So if you believe the situation is not redeemable, look for another job now. There are other organizations with good benefits, and you do have 1 yr experience, so you are marketable, and should have other choices.

    Best wishes to you,

    Nurse Beth

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

  19. Dear Nurse Beth,

    I work in a dialysis center. We have an RN facility administrator (FA). I am the nurse manager over patient care. I had worked at the center for 8 years and followed company policies, state and federal regulations.

    The FA told me the first day that I was doing everything wrong. I needed to do things her way even if they didn't follow regulation. As time has gone on she has hired unlicensed assistive personnel (UAP) friends. After they were hired they started to criticize my decisions as a nurse. They ratted to the FA and I would be called into her office because I undermined the UAP decision. The UAP started to make clinical decisions, giving midodrine for low BP, asking physicians for orders.

    There were many patient safety issues, improper delegation. The UAP were in charge of the center. I have been to the FA supervisor and HR. Nothing has been done. What can I do?

    Dear Nurse Manager,

    In title you are the nurse manager over patient care but in reality you are subordinate to the UAPs. You are not allowed to exert your authority and do your job. It causes great moral distress when you want to do the right thing but have no ability to stop unsafe actions.

    Midodprine is a vasopressor and antihypotensive drug. UAPs should not be administering drugs, receiving orders, or making clinical decisions. 

    You have followed the chain of command, and they are backing the FA, not you. If something goes wrong, though, would you be held responsible? 

    You have not given one reason why you should continue to hang onto this job. It's clear that the situation is not going to change, and your license is at risk every day. Look for another job while you are still employed and plan your exit.

    Best wishes to you. 

    Nurse Beth

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

  20. Dear Nurse Beth,

    I’ve been a nurse for 15 years. The last five have been on the quality side as a certified clinical documentation specialist. I have always wanted to be a nurse practitioner and my job helps by collecting data, looking for clinical indicators and treatment to assist MD for diagnosis specificity. I’m great at that but still want to be an NP. I want to do more, help more, and grow. My concern is that I have not been bedside nursing for awhile and those skills are quite rusty. I wonder if it would impede my hiring abilities or my confidence as an NP? I’m thinking I would be a family NP. I don’t see many skills necessary but I don’t want to be naive either. Shots I can do all day long, give those to my brain injured hubby. Thoughts?

    Dear Wants to be Nurse Practitioner,

    Not having recent bedside experience shouldn't affect your hireability as an NP.

    Being a provider is a different role with different skill sets than nursing. Becoming a successful and skilled NP requires a steep learning curve.

    For one, you will be diagnosing. Your knowledge as a documentation specialist regarding what documentation is needed for diagnostic billing will serve you well as a provider.  In this regard, you are already ahead of the game.

    Good luck to you ūüôā

    Best wishes, 

    Nurse Beth

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

     

  21. Dear Nurse Beth,

    I have been an LPN for 5 years working in various positions, mostly Assisted Living facilities and clinics. Before becoming an LPN, I was a Computer Science major working in Web Development. I would like to get into Health IT.

    I've considered Informatics but from what I've read, those positions usually require you to do a lot of teaching to nursing staff about EHR. I'm not really interested in teaching. I currently work as a Phone Nurse for a Pain Management Clinic which is a part of a big hospital organization. Do you have any words of advice on how I can get into Health IT?

    Dear Wants IT,

    You're right, typically Information Technology (IT) hospital jobs include teaching nurses and doctors.

    But there are many IT jobs that do not include teaching. There's Clinical Documentation Specialist. 

    Clinical Documentation Specialists support appropriate clinical documentation to ensure correct coding.

    Nurse Informaticists

    According to¬†¬†the International Medical Informatics Association (IMIA) Nurse Informaticists combine the ‚Äúscience and practice (that) integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide.‚Ä̬†

    System Analyst

    A nurse Systems Analyst will support a healthcare organization's clinical documentation platform, assist with workflow, participate in design, and troubleshoot end user problems.

    While each of these titles are different and unique roles, organizations use them differently. 

    Here's the thing for you, though. If you want to get into IT as a nurse, you will need to get your RN.  All IT jobs I've seen require an RN with 1-2 yrs nursing experience. For some jobs, a BSN or an MSN in informatics is preferred. If you obtain those credentials, you will be golden in the job market.

    If you don't want to get your RN, then you may consider just applying to non-nursing IT jobs that require an education in Computer Science.

    Best wishes, 

    Nurse Beth

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

  22. There are nurses who are not a good fit for the acute care and rehab settings. It just causes them pain and disappointment to keep struggling.

    You are wise to consider¬†alternative roles and you sound well-suited to academia or research ūüôā

    Best wishes

  23.  Dear Nurse Beth,

    I work through an agency, one of the nursing homes I work for just let me go for mixing medications in pudding and letting a nursing assistant give the medication. This was my error. I learned the CNA got fired also and they told her it was reported to the board. I'm assuming they reported me also. How soon will the board notify me and my license be revolved. I have no other prior offenses?

    Dear Fired,

    What you did was not necessarily wrong, it may have been wrong in your organization.

    You do not say what state you are in, but many states allow RNs to delegate medication administration to unlicensed assistive personnel (UAP) in nursing homes. (CNAs are certified by their state agency,  but not licensed). Some believe that delegating medication administration to competent UAPs frees the RN up to meet the complex needs of nursing home residents.

    As an RN, when you delegate, you must follow the rules of delegation. You can delegate tasks within your scope of practice to a competent and trained UAP you supervise. You must also delegate within your facilities's policies, procedures, and protocols, which should align with your state's statues.

    This last part is what caused you a problem, as clearly your organization does not allow delegation of medication administration. 

    While employers may say they reported you to the board, that doesn't necessarily mean they followed through and actually did report you. Sometimes it's an idle threat. Even if you were reported, each case is handled individually by the BON/BRN and there is a good chance nothing will come of it.

    In the future, make sure you know your organization's policies because they protect your practice. I always say, you have to know the rules before you break them.

    I'm not seriously advocating breaking the rules, but it's really important in your practice to know when you're practicing in your lane and when you're practicing outside of your lane.

    Again, hopefully nothing will come of this.

    Best wishes, 

    Nurse Beth

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

  24. 12 hours ago, MunoRN said:

    There are number of criteria to be a reliable evidence based source that they fail to meet.

    I've worked at a couple of different organizations where the medical librarians refuse to have the INS recommendations on their shelves, they at least claim that their reasons are shared by medical librarians in general:

    • Their recommendations are often not based on evidence or anything accurately described as expert consensus. ¬†
    • Their recommendations are not publicly available.
    • They do not respond to feedback, criticism, clarifications requests, etc regarding their recommendations.¬† Their recommendations primarily come from a single person, and if you seek further information regarding recommendations from that person, they will only respond to those requests for a fee.
    • Their recommendations are often non-sensical and based on a poor understanding of the available evidence and terminology, their recommendation on administration set changes for instance.

    And while you're correct that many facilities adopt their policies, what's more alarming is the number of facilities that don't, which is pretty much every facility that applies any sort of critical analysis to their recommendations.

    Actually the Infusion Nurses Society (INS) Infusion Therapy Standards of Practice 2016 is considered the gold standard by Lippincott (Wolters Kluwer) and is the basis for their evidence-based procedures.

    As a Nursing Professional Development Specialist, the INS is my go-to source for infusion therapy. 

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