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

Communicating past disciplinary actions to a potential employer I'm not a lawyer, but I can offer general guidance to help you communicate effectively and stay compliant. Here's some key points to consider: Privacy and reporting requirements Many nurses are required to self-report investigations or disciplinary actions to state boards. You've already disclosed the matter to the California Board of Nursing (CA BRN), and the Nevada Board of Nursing (NV BON) is aware of the issue from three years ago. California's licensing board (and your employer) may weigh the seriousness, remediation, and time since the incident when assessing risk and suitability to practice. Impact on current employment Outcomes depend on whether you were asked to disclose the past incident and whether you disclosed it. Common questions employers can ask: "Have you ever been the subject of a disciplinary action by any licensing or regulatory board?" "Have you ever had any adverse actions, sanctions, or complaints filed against you with any professional licensing board?" "Are you currently under investigation by any licensing board?" Some employers value honesty and proactive disclosure, while others may react negatively, especially if they maintain zero-tolerance policies or have heightened patient safety concerns. If you disclose, be prepared to discuss what you learned, changes you've made to prevent recurrence, and evidence of ongoing licensure compliance (e.g., continuing education, practice improvements). Risk assessment and mitigation Gather documentation: docket numbers, board correspondence, orders or sanctions, letters of reprimand, timelines, and proof of remediation. Document current practice standards: record quality-improvement steps and patient-safety measures since the incident. Consider consulting with a nurse-licensing attorney: they can help review disclosures and assist with communications to boards and employers. How to approach disclosure to your employer Plan your message: a brief, factual disclosure that you were reprimanded by a state nursing board three years ago, that you disclosed it to CA BRN for licensure, and that you have complied with all post-disciplinary obligations (if true). Highlight current competence: emphasize recent experience, ongoing practice, and steps taken to improve patient safety. Consult HR/compliance: they may have a standard disclosure process; consider coordinating with them. Practical steps you might take now Consult a nurse-licensing attorney for a confidential review of disclosure obligations, potential exposure, and messaging strategies. Ask: "How should I communicate past disciplinary actions to a potential employer to minimize risk while staying compliant?" Compile a concise timeline of events, actions taken, and current CA licensing status. If you disclose, do so in writing (brief and factual) and offer to discuss the matter with HR or compliance. Protect privacy: share information only with authorized parties (e.g., HR, licensing boards) and avoid unnecessary disclosures. What to avoid Avoid including excessive narrative or emotional content. Don't imply guilt beyond what records show. Don't disclose more than you can substantiate with records. Don't present it as a "defense"; frame it as professional learning and growth. Important caveat Each case is fact-specific, and outcomes vary depending on the employer, jurisdiction, and the specific terms of the disciplinary action. A licensed attorney can tailor guidance to your circumstances. As a former nurse manager, I believe that any nurse who learns from her mistakes and takes responsibility is a safe practitioner. Everyone makes mistakes; the important thing is to grow from them. Best wishes, Nurse Beth

Importance of Patient-Care ExperienceTwo to three years of patient-care experience is important for developing the core judgment and operational fluency that employers highly value. This experience: Builds clinical judgment, confidence, and autonomy in handling complex cases. Demonstrates proficiency in core nursing skills and practical procedures, even for non-bedside roles. Fosters autonomy, problem-solving, and independent decision-making. Establishes familiarity with essential systems and workflows (e.g., EHRs, interdisciplinary communication). Provides broad exposure to diverse patient populations, enhancing education, care coordination, and decision-making. Prepares for leadership and mentoring by demonstrating potential in crisis management and mentorship. Are you willing to dedicate another year or two to patient care to enhance your qualifications for your desired role? Strategic Return to the WorkforceSecuring a job now, even if it's not your dream role, is a vital step back into the workforce. View it as a temporary position while you continue your search for a long-term fit. Minimizes employment gaps: It's generally easier to secure a new position when currently employed. Always be prepared to explain any employment gaps on your resume. Strategic stepping stone: This positions you as an internal candidate for future non-patient-care roles. Skill development: You gain valuable experience while continuing to build your skills. Immediate Job SuggestionsIdentify comfortable patient care roles. Consider what types of patient care you can tolerate. Is your dissatisfaction with bedside nursing a universal issue, or is it specific to high-acuity settings, such as the ICU? Would you be more comfortable with less acute patients, such as those in MedSurg? Explore non-bedside patient care. Consider roles such as ambulatory positions in the PACU or Diagnostics. Strategic Career Planning Intentional selection: Thoughtfully choose a nursing specialty that aligns with your interests and strengths. Self-Reflection: Consider your skills, passions, and original vision for becoming a nurse. Explore areas like administration, education, community health, or informatics. Explore Diverse Nursing RolesBeyond the bedside: Numerous nursing roles extend beyond direct patient care. Examples include: Documentation Specialist Palliative Care Case Management Educator Discharge Planning Infection Prevention Clinical Research Strategic Career DevelopmentPlan your career strategically to achieve your goals. This may involve: Gaining years of experience. Acquiring essential skills. Pursuing specialized training or certifications. Continue Your Job SearchApply broadly: Don't hesitate to apply for jobs that require 2-3 years of experience; employers may be more flexible, especially if positions are challenging to fill. Utilize Job Boards: Register on platforms like Indeed.com and filter for non-bedside jobs requiring 1 year of experience. Focus on reputable organizations. By following these steps, you can significantly increase your chances of a rewarding nursing career. Best wishes, Nurse Beth

This is challenging, and the difficulty lies in the fact that you are soon transitioning from being a new graduate to being a new nurse without acute care experience. You will encounter job postings for: new grad residencies experienced nurses And you may not know exactly where you fit. Jobs for new grad residencies In the remaining 1-2 months of potential eligibility, apply full-out to any and every residency you possibly can. I say potential eligibility, because, as you know, working in home health potentially disqualifies you from many residencies. However, every residency has its own guidelines, and it doesn't hurt to try. Consider reaching out to the coordinators of new grad programs directly, if possible, and asking if they would consider applicants with 6 months or more of experience. Be honest about your situation and express your strong interest in the opportunity. Sometimes flexibility in these programs depends on the facility. A side note on working in home health as a new grad: This is not recommended because you do not have the experience to practice autonomously and could even pose safety concerns. Jobs for experienced nurses What you can do is search for jobs that say "experience preferred," which indicates they may consider an applicant without experience. Please note that they will not be offering an extended-residency type orientation, but rather a standard-length orientation typically provided to experienced nurses. What to apply for Speciality areas are typically more competitive than MedSurg, so overall, you'd have a better chance on MedSurg. You may be able to leverage your pediatric home health experience and apply to Pediatrics. Likewise, leverage your paramedic background and apply to the ED. Alternative trajectory Consider sub-acute care, which can serve as a viable stepping stone to acute care once you have gained 1-2 years of experience. From there, you can gain the critical skills needed to be a Flight Nurse. Additionally, attend job fairs and activate your network. Contact your classmates and instructors to inform them that you are seeking a position. By maximizing your efforts, you'll be doing everything possible to secure the job you want. Best wishes, Nurse Beth

I hope one of our onsite home health experts weigh in on this. This is such an urgent and challenging situation, and I'd really value insights from someone in the field regarding what actions the agency should be taking to support both you and the client. Shouldn't infection control/prevention already be involved? Social services? Adult Protective Services? Is it an expectation that visits are paused in such conditions? If there is potential risk of neglect or abuse (including self-neglect), are there mandatory reporting guidelines in your jurisdiction and your agency's policy? Your supervisor should be able to provide clarification. What I can say with certainty is you must absolutely protect yourself. Immediate safety and PPE Do not enter an environment with visible soiling without appropriate PPE. At minimum, wear gloves, a disposable isolation gown, and eye protection if there is a risk of splatter or contact with feces. If you are unsure about PPE requirements, check your agency's Infection Prevention and Control policy or contact the on-call infection preventionist. It's better to err on the side of caution. Pathogen testing and clinical considerations Orders for pathogen testing would have to come from the supervising clinician or an established protocol. I'm unsure how a provider would code lab tests without clear medical necessity or which specific organisms to target, especially in asymptomatic patients. Perhaps the risk of environmental fecal contamination alone is enough. However, it seems obtaining orders to protect caregivers is ultimately the agency's responsibility, not the visiting nurse's. Assess and document Upon arrival, document the environment neutrally (without judgments about the client). Note the condition of the home, presence of hazards (slippery floors, strong odors, soiled areas), and the client's abilities and supports. Note the client's functional status, stool continence management routines, and any use of incontinence products or assistive devices. If there is fecal matter on floors or surfaces, document risks and the need for cleaning. A photograph is generally not appropriate in home health without consent and policy; check your agency's guidance before taking photos. Escalate and involve colleagues Immediately inform your supervisor about the environmental hazards and your safety concerns. If there is suspected behavior that is intentional or due to cognitive or /behavioral issues, involve the supervising clinician to determine if a behavioral assessment, social work consultation, or care plan adjustment is needed. Best wishes and be safe, Nurse Beth

Congrats on passing the NCLEX-PN! That's a huge accomplishment. And congrats on two job offers! It's great that you're already considering where you can gain the most experience as you begin your career. Both the long-term care (LTC)/rehabilitation settings, as well as the clinic setting, offer unique benefits. The best choice for you depends on the type of experience you want to gain and your comfort level with the workload and mental demands while you are still in nursing school. Here's a breakdown of both: Long-Term Care/Rehab Setting In LTC and rehab, you'll typically work with older adult populations or patients with chronic conditions, including those recovering from surgeries or injuries. This environment offers the opportunity to develop your foundational nursing skills, including medication administration, wound care, blood sugar management, and patient monitoring, over an extended period. You'll also have the opportunity to build your critical thinking in terms of patient care, as you'll often be dealing with a variety of comorbidities and patients with different levels of acuity. Challenges The workload in long-term care can be pretty demanding, and you may not always have as much direct supervision or interaction with registered nurses (RNs) and doctors. While this environment can feel like a leap into the deep end, it also provides an opportunity to develop independence in your practice. LTC often involves higher patient-to-nurse ratios, which can foster independence but may limit real-time mentorship and support. Since you're still in nursing school, the responsibilities in LTC/rehab may feel overwhelming at times, especially if you're balancing your studies. However, this setting provides you with a significant amount of hands-on practice in daily patient care. Clinic Setting In a clinic, you'll work with outpatient populations, so you'll be exposed to a variety of patient conditions, but they may not be as complex as in the LTC setting. You can gain hands-on experience with skills such as vital signs, administering injections, performing lab draws, and basic triage. Supervision levels vary by setting and by facility. The clinic setting often offers more opportunities to learn from RNs and doctors, as you mentioned. Since you'll likely have a team-based environment, you can observe their interactions with patients and get more guidance as you build your own skills. Challenges While a clinic may offer more structured learning, the volume of patients can sometimes be fast-paced, if it's a busy facility. If you're trying to balance nursing school, the pace could be overwhelming. However, it might be easier to manage because the workload might not be as intense as in long-term care. The clinical skills you gain here may be more narrow compared to the LTC setting (e.g., no tube feedings, foley cath insertions, wound care). Would that concern you? Which setting is better for learning? Clinic setting. If you believe you would benefit from direct supervision and a team-based environment, the clinic setting may be the better option for you. You'll have the opportunity to observe and learn from experienced RNs and providers, and the pace may be more manageable, allowing you to learn without feeling overwhelmed. LTC/Rehab Setting. If you feel confident in your ability to work independently and want to develop your critical thinking skills and nursing competencies in a more autonomous setting, then LTC could offer more opportunities to build foundational skills and practice under less supervision. Recommended approach for a student in school Since you're still in school, your continued education takes priority. You mentioned not wanting to be overwhelmed, and it's wise to manage your stress proactively. Both settings have their merits, but I would lean toward the clinic setting as less stressful. It's likely to offer more structured learning, less physical strain, and a better opportunity to build your skills and confidence at a manageable pace. Plus, you'll have more exposure to a variety of healthcare professionals, which will enrich your overall learning experience. And keep in mind that, as your first nursing job, you will learn a lot in either setting. Also, it's not a permanent decision, right? You could always try a few months in the clinic first, with a plan to add LTC exposure if you want broader bedside skills. I hope this helps you decide! Best wishes, Nurse Beth

Hello again, and thank you for reaching out. I understand the intense workload and intensity of practice in pediatric oncology and bone marrow transplant nursing. I'm glad you're prioritizing your health as you plan your NCLEX, English study, and future move to the US. Here's a focused take tailored to your context (Turkey, an American-affiliated hospital, ICU/ER pathways, and CRNA goals): Burnout first: health as the foundation Your sleep, nutrition, and stress symptoms are signals that need attention now. Practical steps: Schedule a medical/psychological check-in if sleep or appetite issues persist for more than a few weeks. Implement a concrete burnout plan: establish a consistent sleep schedule, plan meals and meal prep, take micro-breaks during shifts, maintain hydration, and set boundaries to protect your rest. ER now vs ICU later: how it affects your CRNA path ER experience can develop acute-care decision-making skills and tolerance for high-stakes situations, which CRNA programs highly value. However, most CRNA pathways emphasize solid critical care experience (ICU). If you move to ER, plan a clear bridge to ICU exposure in the near term (e.g., post-NCLEX ICU shift, a critical care internship, or a targeted critical care role in a U.S.-affiliated setting after licensure). Realistic framing: ER can be a stepping-stone, not a detour. The key is to document how you sustain or build ICU-relevant competencies alongside ER duties. You can pivot back to a more ICU-focused role when you're ready, or pursue specialized critical care positions. In the US, the ER experience typically continues to provide valuable skills relevant to advanced practice. Concrete trajectory considerations Licensure and timing: In Turkey, ensure you understand how ER vs. ICU rotations map onto US licensure and visa processes, and how your American-affiliated institution can support your transition. Bridge to US pathways: Map a plan that includes a defined ICU exposure (perhaps post-licensure) within a reasonable timeframe, and document critical care responsibilities that programs recognize (airway and ventilation management, organ support, hemodynamic monitoring, etc.) Start a portfolio for a CRNA application to capture and include critical care competencies and experiences. English and NCLEX alignment: Coordinate your study plans with clinical experiences so you can translate your practice into U.S.-practice narratives. Final takeaway Your health comes first. If moving to ER provides meaningful burnout relief, it can be a smart interim step—as long as you commit to obtaining robust ICU exposure afterward and align it with your NCLEX and visa timelines. Your goal-oriented mindset is a strong asset. With a concrete, staged plan, you can preserve momentum toward ICU experience and CRNA entry without compromising well-being. At the same time, don't overthink things. Transitioning to the ER won't prevent you from becoming a CRNA; there are many paths to acceptance—this move isn't a take-or-break situation. Yes, ICU experience is essential, but again, you can gain a year or two of it in the US after obtaining your license. Best wishes, Nurse Beth

I'm sorry you're having this experience. Without rehashing the narrative that led to your being blacklisted, let's focus on some options for a clear path forward. Know what you're aiming for: Are you seeking job reinstatement, removal from the list, a fair settlement, or accountability? What would make this right for you? Options for moving forward. First and foremost, do you have a case? What this could involve: I'm not an attorney, but consulting with a labor law or employment attorney to review your specific facts, state laws, and potential claims (such as pregnancy/medical-leave discrimination, retaliation, improper no-rehire actions, or violations of relevant employment records rules) is your best bet. An attorney who specializes in labor law or discrimination can assess whether the company's actions were legal and whether you have grounds for a claim related to wrongful termination or discrimination. Given the circumstances (pregnancy, medical emergency), there could be legal protections in place depending on your state's laws. If a viable case exists, pursue formal remedies through state agencies (such as the state civil rights or labor department). An attorney can help you navigate which agency to approach with your case. If needed, look for free or low-cost attorney services available to qualifying individuals based on their income and the type of case. If you're unsure about eligibility, start by contacting a legal aid office or a local bar association's referral service for an assessment. Examples: State and local legal aid offices Public-interest or nonprofit law firms may offer low-fee or sliding-scale referral services. Firms specializing in workers' rights, employment law, or discrimination offer reduced-fee or pro bono services. Bar associations connecting low-income clients with volunteer attorneys. Some attorneys take cases at low or no cost if they believe the case has merit and public interest value. Some states offer attorney standby programs or clinics where you can get initial advice at a reduced rate or for free. Contingency or limited-scope representation. For certain claims, some lawyers may take cases on a contingency basis (they're paid if you win) or offer limited-scope representation (help with specific tasks for an hourly rate). Wage-claim or employment-rights hotlines. Some states run hotlines that provide legal information and can refer you to affordable resources. Helpful tips to maximize your chances of getting help: Be prepared with documentation, including a timeline of events, copies of notices, hospital records, communications with the employer, and any relevant policies cited. Explain your income and assets upfront to determine eligibility for aid programs. Ask about fees and payment options upfront: consider a sliding scale, fixed fees for specific services, or pro bono availability. Since you've been informed that you're on a no-rehire list, and if you're not ready to hire an attorney, consider contacting the Department of Labor in your state (or in the state where the facility operates) directly. Ask if your situation violates any labor laws. In some cases, an employer cannot unfairly blacklist you or do so for legitimate reasons, such as medical emergencies. What to expect: This path can be time-consuming and may involve emotional and financial costs, as well as aggravation. There's no guaranteed outcome or quick fix. Outcomes vary by state regulations, the specifics of your evidence, and the employer's policies. How to prepare: Gather and organize documentation: hospital/ER records showing dehydration and pregnancy-related illness, all communications with the employer about reporting the emergency, the written statement you provided, the hospital proof, and any policy language you were told about. Proof of medical emergency: Make sure you have clear documentation from the hospital (ER records, doctor's notes, etc.) that explicitly states your condition at the time—being pregnant, severely dehydrated, and needing IV fluids—so that you have the proper backup for your side of the story. Avoid emotional language Create a concise timeline: dates, what was said/done, and what you're seeking (e.g., removal from no-rehire list, reinstatement of eligibility, or a written explanation). Seek employment elsewhere (peaceful/productive alternative) What this could involve: Exploring roles outside the affected employer in CNAs, home health, assisted living, private duty, or agencies that hire CNAs. Considering staffing agencies or travel/per-diem positions to gain entry with more flexible/no‑rehire concerns. How to prepare: Update your resume to highlight your CNA experience, pregnancy-accommodation awareness, and any additional certifications. Prepare a brief explanation you can use in interviews that emphasizes reliability, patient care, and current readiness to work. What to expect: You may find new employers with clear policies and a supportive onboarding process. A mixed approach: Begin pursuing new opportunities now while you evaluate your legal options. This keeps income flowing and preserves leverage if you later pursue formal remedies. Two years on a no-rehire list is a long time, and it shouldn't define your career. Redirecting your energy towards job searching may help lift this burden and create new opportunities. Best wishes, Nurse Beth

Holding a non-nursing bachelor's degree makes you eligible for a direct entry Master of Science in Nursing (MSN) or a Master's Entry Program in Nursing (MEPN). A direct-entry MSN program enables students to earn both a Bachelor of Science in Nursing (BSN) and a Master of Science in Nursing (MSN) simultaneously through an accelerated, combined curriculum. Some MEPN programs are structured to allow you to earn your RN, pass the licensing boards, and begin working while still enrolled in the program. However, you need to confirm this directly with the specific program. In terms of gaining experience while in school: BSN: A BSN route generally provides more direct, hands-on patient care through clinical rotations during the program. MEPN: You will also gain experience while studying. The challenge is that the intensity of a master 's-level program might leave less time for traditional bedside care, depending on the structure. If you're more interested in gaining extensive experience at the bedside, a BSN might be the better choice. However, if you're eager to dive into more advanced roles while accelerating your education, an MEPN could be a good fit, especially if the program allows for hands-on RN experience along the way. Have you considered what specialty you're aiming for in the future? That could also influence your choice. Best wishes, Nurse Beth

Great advice from @CookieRoo9413 It sounds like you're in good standing to pursue home health nursing. Key questions to tailor next steps Do you have any recent hands-on clinical refreshers you've done (within the last year or two), even if not full-time? Do you have an Oklahoma home health employer in mind, or are you exploring options like visiting nurse associations, Hospice/Home Health agencies, or independent case management? Are you comfortable with driving and performing home visits, including travel time and on-call expectations? Are you interested in a part-time or transitional role (e.g., per diem, float pool, case manager, patient education) versus a full-time return to work? Do you have any certifications relevant to home health you'd like to leverage (e.g., Wound Care, IV therapy, Basic Life Support, Pediatric/Antenatal training)? Are you willing to pursue any brief re-entry or refresher coursework? Suggested plan of action Refresh and validate credentials Consider a nursing refresher course Short refresher options: CPR/BLS, NICU/neonatal nursing review, wound care basics, infection control in home settings, and assessment techniques for homebound patients. Confirm current licensure status and any specific re-entry requirements with the Oklahoma Board of Nursing. If you haven't checked recently, a quick call or email to the OBN or their website can confirm if any re-entry steps are recommended. Update your resume with your most recent clinical practice and your neonatal/mother-baby experience. Assess home health options in your area. Given your newborn/mother-baby background, a perinatal/home-based role or neonatal home visiting could align well with your experience. Consider the following agencies: certified Home Health/Hospice providers, visiting nurse associations, hospital-affiliated home health programs, or private duty nursing services. Logistics and practicalities Scheduling: Determine ideal days/hours, patient load expectations, driving radius, and on-call requirements. Documentation and technology: Most home health jobs require electronic charting; ensure you're comfortable with the standard platforms (eMAR, visit documentation, etc.). Compensation and benefits: Research typical pay scales for Oklahoma Home Health RNs (per diem vs. full-time) and any benefits if you're seeking part-time stability. Create a personalized plan for outreach Draft a concise resume update highlighting: 1984–2019 Saint Francis tenure, newborn nursery, mother/baby care, perinatal competencies, CEUs, and your BA in Social Science. Prepare a summary statement: your nursing strengths, your interest in home health, and your readiness to re-enter. Activate your network. Often, this is how you hear about a job lead. Attend professional meetings in your area, and consider attending any job fairs to expand your network of contacts. Identify 5–8 target employers and plan outreach (applications, LinkedIn updates, network connections). Hopefully, this provides a good starting point. You bring a lot to the table, and I hope you find the job that's right for you. Best wishes, Nurse Beth

Intubating a patient with DNR status? I don't follow.