Nurse Beth MSN

Dear Nurse Beth, I have been a med-surg nurse for two years and although I really enjoy my teammates, managers, schedule, and vacation approvals, the actual work itself I find boring, overwhelmingly busy with unimportant tasks, I feel underappreciated and overworked. A lot of my coworkers say they like med-surg because the patient's are medically stable and it is not as emotionally taxing as the ICU or ED. I am in therapy because I suffer from anxiety. My counselor said I should go into a more strenuous and "exciting" nursing environment because I find my current job tedious. But I am worried that my anxiety will be greatly triggered and that I should aim for a more calm environment. BUT I love working three 12's per week. I don't want four 10's. I don't have kids and I love the schedule because of the freedom I have. I am completely regretting becoming an RN. I followed and listened to what people told me to do instead of listening to my own heart. I am not passionate about medicine or taking care of people, although it is rewarding I do not find the stress I experience worth it. Nor is the pay worth it. I have thought about pursuing higher education such as a DNP or PHD but I am hesitant since I dislike the bedside so much. I don't want to get into informatics because of the M-F 8-5PM. I don't want to get into education because of the pay and schedule. I want to use my creative outlets more in my life. If I could go back I would go to school for something like website design, writing, photography... I am writing in hopes you have some insight to share where I could possibly incorporate my creative side with nursing. Or maybe there is a field of nursing you think I should try before I give up on the career. Please let me know, thank you for your time. Dear Dislikes Bedside, Basically all 12 hour jobs are clinical, direct-care jobs. You may have to change your expectations. In other words, consider giving up 12 hour shifts to pursue something you'd find rewarding. Don't limit your opportunities by insisting on 12 hour shifts. You could adjust to a Mon-Fri 8-5 schedule if you had to. The majority of the work force works Mon-Fri 8-5 and you learn to make it work. If you are open to a Mon-Fri schedule, then that opens up a lot of opportunity. We all want satisfaction in our careers or it's just not sustainable. I find room for a great deal of creative expression as an educator in acute care. Content development and delivery call for skills in writing and finding ways to engage adult learners. Others find their passion in supervising others, problem-solving, and managing resources. Still others love the challenge of their work in Risk Management, Quality, Infection Preventions, Revenue Integrity, Documentation Specialist. There are almost countless career paths for an RN. I wouldn't give up on nursing altogether until you've pursued something away from the bedside. Register with Indeed.com and start looking at all the different postings. See what catches your interest. Best wishes, Nurse Beth

Dear Nurse Beth, So, I recently had an interview and job shadow for a school nurse position. I received a call from the recruiter and she stated she had good & bad news. Bad news was that I did not get the job. Good news was that they really liked me. The recruiter wanted to know if I would be interested in them keeping my name for a future role for a school nurse. I stated yes and she said she would forward this information to the team. The recruiter then stated it is only a matter of time. Could this be a way for them to soften the blow or do you think they might consider me for a future role? Wonder what she meant by it is only a matter of time? What is the best way to stay in touch with the recruiter regarding the role? I just don't want them to forget about me if they are really interested in me. I'm probably just overthinking this because I really wanted the job. Dear Overthinking, I think this is more the recruiter being truthful than softening the blow. By saying "it's only a matter of time" it could suggest she has some information that she can't share, such as she knows of a position opening up, or for some reason she believes the person chosen fore the job may not stay long. At the same time, whatever information she has can also change quickly. For example, it's not uncommon for new positions to not be approved by a governing committee at the last minute. Of course this is all conjecture, and what's important is only what you have control over. Check in regularly with this recruiter. Obviously she thinks well of you. "Hi, I'm just checking in :). Any updates for me?" Good luck! I hope you get a job you love soon. Best wishes, Nurse Beth

Dear Nurse Beth, I am a 25 yr registered veterinary technician veteran contemplating switching to human nursing for a number of reasons. Those include low pay, no career respect, lack of career recognition nationwide, no job opportunities, physical wear and tear on the body, no career advancement opportunities, as well as lack of benefits. My question to you is, how much more physically taxing on the body is nursing compared to the animal wrangling I have been submitting my body to over the past 25 years? Dear Veterinary Technician, Jobs that pay well as a registered veterinary technician are rare. Wages and benefits depend on the employer unless you are in a unionized or government position, such as working in a public city zoo. Many registered technicians complete their studies only to learn that employers can often choose to hire non-credentialed and lower-paid workers, even to place IV catheters and monitor anesthesia. By comparison, nursing is taxing on the body but the career opportunities are equal to non-other in my opinion. Once you gain your basic experience you can choose to stay at the bedside or go into teaching, sales, informatics, case management, and so much more. You will have to put in the time to earn your Bachelor's degree and work at least a couple of years at the bedside, so figure that into your plan. You will probably not be able to work once you're in the nursing program. Good luck with your decision, Nurse Beth Start your job search today!

Dear Nurse Beth, I actually am not a student yet. I want to get into nursing and work at a hospital. I was thinking I would possibly start as nursing assistant and then start nursing school as soon as I can afford it and then once I am finished with school I would work as an RN. A big problem I am running into is that just about every nursing assistant job wants the candidate to be a certified nursing assistant. I am not certified so I also have been trying to look up some CNA programs to get into so I can be certified and then get a job as a CNA. The problem with that right now is finding a program. I cannot seem to find any programs right now due to COVID-19. I was wondering if you had any suggestions on how I can best go about either getting a job as a nursing assistant or getting certified. I would love to be certified I just cannot seem to find any classes anywhere right now. Any help would be greatly appreciated. Thanks so much! Dear Wants CNA certification, Many CNA programs are temporarily shut down depending on location. Even if they could manage social distancing in the classroom, they will be challenged finding clinical sites. You're right, most hospitals hire only CNAs or second semester nurses. Your best bet is to start on your pre-requisites and land whatever you are able to right now. Sorry, I know that is not what you wanted to hear. In the meantime, keep checking back with the CNA training schools as this situation is very fluid. Best wishes, Nurse Beth

Dear Nurse Beth, I was arrested in 1/17 for a DUI and had 2 charges 1 for the refusal which I went to trial and was found not guilty. The other trial for the DUI has been delayed due to the current pandemic and they are assuming trials won't start until 2021. My attorney did exhaust all appeals but they were denied. I am a nurse in FL and still working at my same job which does not know. When it first happened I contacted the BON and they told me I didn't need to self report until it was resolved. I followed up again recently and was advised the same. I have been offered a lower charge of Reckless Driving with a withhold (No immobilization, no DL suspension, no points, etc) but probation for 6 months which can be terminated early when I finish everything which is already done because I did everything in 2017 when it first happened. According to the BON website I have other steps to take if I accept the deal providing explanation letter and recommendation letters as well as court records. I have not shared my situation with many people so I'm not sure how to go about it and can't find information online. I was trying to find out how it will affect my nursing license and if I'll lose my job. Dear Arrested, If you accept the Reckless Driving plea, you must report it to the BON within 30 days. This would speed up the process for you if you think it sounds like a good deal for you. The law sees Reckless Driving as less than a DUI but the BON may or may not make that distinction. What's going for you is your offense was over 3 years ago. You have an attorney, but unless your attorney has experience with the BON, you must get one that does. Experience with DUI and experience with the BON are 2 different skill sets. When you respond to the BON, you should do so with the help of qualified counsel. Whether or not you accept a plea or are found guilty at trial, you will need to submit all court documents, proof of having met requirements, and police records. Your case will be investigated by the BON and the outcome is based a lot on your self-awareness and rehabilitation. They need to be convinced that you have taken responsibility and have changed- in other words, that you are no longer the person who would drive while intoxicated. Please read Criminal Infraction for essential tips on communicating with the BON. As far as your employer, read your employee handbook to see if you must report an arrest and/or convictions. Every organization is different but keep it to yourself unless required to divulge. Of course, if you change employers, you will be asked pre-hire and it will show up in LifeScan. Best wishes, my friend, Nurse Beth

Hi Nurse Beth, I need a career advice. I just graduated from nursing school and I have an offer as an ICU nurse at a trauma level 1 hospital that is 1 hr away from home I am a respiratory therapist and therefore has been easier to find a job in ICU, however, its a 2 year commitment and if I leave earlier I will have to pay 10k. The pay is low and I feel the training is being charged in every possible way I have another option in the IMCU at the current place of work, which is 9 miles away. The pay is better as well I am confused about what job to take because ICU is my dream job, but I didn't want to start in ICU at the facility at work so I applied for IMCU. My question is what should I do? Should I take the ICU job or the IMCU one? Dear Confused, CONGRATS on having 2 job offers! Intermediate Care Unit provides care for patients needing close monitoring and is a step down from ICU. You will get good experience but not with pressors, or continuous renal replacement therapy (CRRT), or other modalities. If you really want ICU, but don't want the ICU at your current facility, then go for it. Two years will go fairly quickly, and you won't regret good training and opportunity. Best wishes, Nurse Beth

Dear Nurse Beth. What can I do if I graduate from a nursing program and can't pass my exit program? Dear If, You need to find out your school's position on the exit exam. Typically, even if you successfully pass the program and academics, but fail the exit exam, you may not be allowed to graduate. If you don't graduate, you will not be allowed to take the NCLEX. Check your school's syllabus and all documents provided by the college. One such exit exam is the HESI exam, given in the last quarter or semester of nursing school. The HESI exam is an indicator of how well you will do on the NCLEX. It's a computer-based, multiple-choice exam. One of the reasons for exit exams is that nursing schools want to ensure high NCLEX pass rates. Nursing program pass rates are used by the BON/BRN to evaluate the program's effectiveness in preparing students for the NCLEX. State board approval is required for nursing programs. Individual nursing program pass rates are easily found on the internet. There are many study tools out there to help you prepare for the exam. Consider forming a study group with your classmates to prep for the exam. The good news is you can repeat the HESI exam. Be sure to take a look at the HESI forum here on allnurses. Best wishes, Nurse Beth

Dear Nurse Beth, I have been an RN since 12 and an NP since 2016. I had one NP job from 2016-2019. I left because I had no work life balance. I spend all my free time charting. I was overworked, burnout, and attempts to change the clinic schedules and flows weren't successful. After searching for almost a year, I found an NP job that seemed to have good balance of productivity and time to provide excellent care for the patients. Since the COVID outbreak, my company has completely made a 180 degree change. Productivity measures have been increased and they have restructured the company to a model that provides mediocre care. It seems like these changes are going to be permanent. My current job is now worse than my first NP job. I am getting depressed thinking about my options. I like nursing and being an NP but I don't like how I am forced to practice. I am debating trying to find another job or leaving nursing all together. I'm really depressed about the situation. My gut says to switch careers to something outside nursing. I hate that I am thinking of walking away from the profession I loved. Any advice on trying to apply for another position so quickly after I switched jobs? There aren't many jobs for NPs right now. I have the flexibility to live ANYWHERE in the world. Even with flexibility and submitting to multiple states, it was challenging to find this job. Should I not even try to switch jobs again and just start classes in a new profession? Dear Getting Depressed, It's such a big decision to change careers, especially one that you've invested in so much. You've had two jobs for a total of 5 years working as an NP. What if you gave it one more chance? What if the problem is 2 bad work environments, and on your next job, you found a good one? If you hated 3 jobs in a row, then you could say you gave it your best try. If you decide to look for another job, don't quit the one you're in until you've found another job. Best wishes on your decision, I know it's not an easy one. Nurse Beth Start your job search today!

Dear Nurse Beth, I'm not sure if I should be a nurse anymore? So maybe it is more of an anxiety issue or just completely want to let go of nursing. I am a 28 yr old whose got around 5 years of nursing experience. I have tried multiple areas such as LTC (6 months),complex continuing care/palliative care (maybe 2 years and half), neurosurgery (about a year), some medicine (6 months), L&D (4 months) and recently a nurse consultant at a worker's compensation insurance company (7 months). I feel like I just can't seem to find my niche or if I am interested in it, the acuity of the unit is too much for me to handle. I am a quite shy and introverted person and until now have a hard time talking to people, especially those in authoritative positions. I have tried to practice to be more assertive but my anxieties just get to me. I have been a charge nurse and even got awarded for a leadership and innovative practice award in my hospital as one of the 9 recipients which was very surprising to me. I am the last person to think of myself as a leader! I kept moving to different units and I really thought that L&D is where I would want to be at. Actually, I much rather want to do postpartum than L&D. It was going to be my plan to be in L&D for a couple months just to understand the basics then move on to postpartum. But it did not end up happening because I received a full time permanent position as a nurse consultant. It is pretty much almost every nurse's dream I guess with the consistent Monday to Friday hours, good benefits and security and no weekends or holidays. In my current role as nurse consultant, the only interaction is through a phone. So I thought with my social anxieties it would be a better option for my mental and physical health. Over time I felt like it ended up having the opposite effect. I don't feel physically healthy with the sedentary lifestyle and mentally I am even more anxious because I constantly think about what I should do next or what I should be doing the next day. I feel like treatments are often delayed because I can't make a decision whether I should cover for the treatment or not or if it is within the policy. Clients will be extremely mad at the phone conversation with me if I tell them I can't cover/pay for it or they can't be reimbursed for something. It's all about money. I feel uneasy when I think about health care and money. Even confrontations on the phone I ended up crying about later on. You would think my stress tolerance over the years would increase but I feel like I have gotten worse as a nurse. I am seeing a psychologist to help me cope but it has helped in some degree. But on top of my anxieties I seem to feel like I am just truly not enjoying it even though I know I am new and almost feel like I miss the hands on skills. I'm not the best communicator and I feel like I am able to truly show that I care for someone if I do things in a more physical manner like changing their wound dressings and giving them their medications and some teaching. I am thinking about going back to school to specialize in something but not sure on what (OB, Dialysis, palliative, OR). OR completely change my career path but still be in health care somehow like medical lab technologist but I feel like this will be a waste of time and become a disappointment to my family. Truly apologize for the rant... I just don't really know what to do and I panic when I think about work. I know nurses around the world do have it worst than me right now with the Covid because I get to work from home and I shouldn't even be complaining. But I kind of also want to be out there and helping everyone who is suffering. I definitely still have to work on my mental health and don't want to make any decisions I will regret. I have tried to be optimistic every time I choose to move to another unit and hope that this is where I want to be in only to feel even more disappointed Dear Disappointed, Your problem is not going to be solved by changing jobs, because your problem is not your job. Every time you get a new job to decrease your stress or avoid people, some other aspect of the job triggers you. This is not a career problem. It's a medical problem. You cry about work, experience anxiety, are worried and stressed. You find it hard to make decisions, avoid people and situations, and fear authority. You have loss of joy. It's good you are seeing a psychologist and it can only help you gain insight into yourself and perhaps gain some coping skills. It should give you a more realistic perspective. A psychologist cannot prescribe medications, however, and you most likely have a diagnosable and completely treatable medical condition-meaning anxiety and maybe depression. The important thing is, your medical doctor can help you. You do not have to keep suffering. I love what you said about how you show you care for others- by doing things for them in a physical manner, such as changing dressings, giving meds, and patient teaching. I think you describe the love language of nurses very well. Others see that you are a leader, and you haven't yet been the best you can be because your condition is holding you back from the best you. It's going to be amazing how much better you'll feel with the right treatment. Best wishes, Nurse Beth Related article: Confessions of an Introvert Start your job search today!

Dear Nurse Beth, Will you please recommend the best way to change nursing fields? How does one gain experience in a field that they have never practiced in and how would that information be best conveyed to a hiring department when the first step in a job application is done online? Thank you. Dear First Step, One of the many benefits of being a nurse is the vast array of options. Being a nurse can mean anything from being in hospice to being in sales to being a teacher. There's Risk Management, Case Management, and Infection Prevention. New roles are created every day. It can be challenging to get your foot in a new door when you are competing with experienced candidates. Compose a compelling cover letter and resume. Compelling because you have about 20 seconds to catch their attention. Activate your network and ask for referrals. You can join the professional organization of the new specialty and attend local meetings. You do possess transferable skills. Individualize your application to each organization, and highlight the skills, including soft skills, that solve a problem for them. Maybe they need a reliable employee, and you can highlight your outstanding attendance. Maybe they serve a Spanish-speaking population, and you can highlight your conversational Spanish. Maybe you have experience with Epic, and they use Epic. If you persist, chances are you will get the break you're looking for. Practice your interview skills and prepare for behavioral questions such as "What should we hire you?" If you need more info on answering behavioral questions, composing a resume and cover letter, employing bold strategies to land a job- I recommend my book below. Do everything you can and then trust that things often work out the way they should. Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next! Start your job search today!

Nurse Beth: Hi I have a question regarding a situation happened to me recently. I work in PACU as a staff nurse and I do phase I and II. I have only 3 months in this facility. I discharged a patient home after a procedure, this patient is taking at home a Lortab 5/325 mg. I review the chart and reconcile his medications, as part of the process we can order one dose of the medication that patient is going home, if the patient have a prescription on paper or e-script so I ordered the first dose as telephone order but I don't have to call the MD to get this first dose because is part of the protocol in this facility. I saw this medication on his reconciled medication and I printed but I did not confirmed that medication was prescribe by other physician than the surgeon that work in this facility. So I order this Lortab under the surgeon name and I gave this pill to patient. I recently received from my clinical supervisor that order was denied by the surgeon and I need to provide more detail about who order this medication because the surgeon refused to sign this order. I emailed back with the same information and I said that order was a verbal order from the same surgeon but he refused this order again. I really don't know this surgeon very well but I have a conversation just a couple times and he isn't friendly with nurses ( I hope I'm wrong!) My question is this, what is my choices regarding the order if the refuse to sign this order? And what is the consequences with DEA, hospital and my nursing license? Side note: I haven't talk to the surgeon about the order but I anticipate he will refuse this order. Thank you for you time. Dear Surgeon Refused Order, So you ordered Lortab 5/325 X 1 po under the surgeon's name and now he is refusing to sign the order, claiming he did not order it. You say your facility has a protocol that allows you to order one dose of a drug as long as the patient has a prescription for the drug at home, or is it as long as they have a prescription given at discharge (not clear)? If the patient was given a prescription for 10 Lortab on discharge, and you gave 1 pill, how is the community pharmacy to know 1 pill has been dispensed? Or is it that the pill is not dispensed under the prescription, but the fact that a prescription exists somehow allows a nurse to order the drug independently? Why not just ask the surgeon for a pain med if the patient needed it before discharge? That is an unusual protocol. If there is such a protocol, you must print it out right away and read it carefully because it could save you from discipline at your facility and on your license. If you cannot find anything to print out, then I would say, unfortunately, you do not have a protocol and the protection such a protocol would provide. Protocol My questions regarding such a protocol are: What are the criteria for the prescription? All drugs? Controlled substances? Active and current prescriptions? What is the approved process for ordering the drug? Is it to be entered as a telephone order? If so, under what physician's name? Why would the facility instruct you to enter a telephone order when there was no telephone conversation? Is there an option in your EHR when entering orders to use "per protocol" or "standing order" instead of "telephone order"? If so, that's what should have been used. This protocol allows the nurse to order a drug based solely on the fact that the patient is on the drug at home, but without consideration for possibly synergistic drugs given as part of the procedure. In other words, drugs should only be ordered as an intervention after a current medical assessment and evaluation. Such a written protocol would have to include the full process-that the physician will cosign the order within 48 hours when it arrives in their inbox. Nurses cannot order medications independently under any state's BON. This written protocol would have been approved by your facility's Pharmacy and Therapeutics, Nursing and Medical Executive committees before being posted. If you have such a document like that in your hand, then you are covered and have no worries. If you are following the facility's protocol as written, and it is a faulty protocol, the liability remains with the facility, not you, and the problem is holding the surgeon to the protocol. If there is no such document, you are potentially in trouble for practicing medicine, falsifying an order, and drug diversion, very sorry to say. When following a "protocol" make sure it is indeed a protocol and not just an unofficial nursing practice used for nursing or physician convenience. The term "protocol" is often used loosely and erroneously and puts you, the nurse, at risk unless you are very sure of your facts. An example is ordering an EKG without a doctor's order if a patient has chest pain. Does it make sense to not delay care? Yes. But many nurses think their facility has a "protocol" for independently ordering EKGs, troponin, and more. But do they, or is that just what they were told? Maybe they do, in which case, they need to pull up the policy themselves and confirm exactly what the approved process is. Typically there would be a policy approving specific standing orders to treat the patient which covers the nurse entering an order on behalf of the attending independently. Standing orders require co-signature by the attending physian, but can be initiated independently by the nurse if certain criteria are met. Inconsistency You entered the order as a telephone order based on your facility's protocol, but when asked about it later, you said it was a verbal order. If it was a verbal order, then yes, the surgeon should have entered it himself, but then the event has nothing to do with a protocol of entering orders without a doctor's order based on a prescription discovered during medication reconciliation. Unless I'm misunderstanding, your account of what happened is inconsistent and confusing. I know this is probably catastrophic to you now, and your thoughts may not be clear, but inconsistency will be used against you. Was it a telephone order based on protocol or was it a verbal order? Did you ever see the surgeon or talk to him? Verbal Orders Do not take verbal orders except in the case of an emergency, or when it would break a sterile field to do so. Verbal orders, as well as telephone orders, can become a "he said, she said". If you asked the surgeon for pain medication for your patient and he responded verbally to give Lortab 5/325 po X 1, the proper response is "Thank you, will you be entering that as an order?" You are not in trouble with the DEA but you are in trouble with your facility. You are not in trouble with the BON at this point, but if your facility chooses to report this to the Board, you could well be under investigation. If your facility reports you to the BON, you may not hear anything from the Board for some time, depending on their backlog of cases and next scheduled meetings. If you do hear from the Board, get a lawyer, and get one that has experience representing nurses to the Board. I am so sorry that you are going through this. You made some risky choices. You must be very careful about protecting your nursing license and think things through. It is just not worth it to jeopardize your career and your future. Best wishes, Nurse Beth What to do if you have a criminal infraction Start your job search today!

Dear Nurse Beth, Fair scheduling practice question. I work in a unit open Mon-Fri. The charge nurse is off every Monday because “ I have been off every Monday since I’ve worked here” we are a unit of seasoned, PT and FT RNs. We do not think it is fair for one person to have a 3 day weekend consistently and we do not have any Monday/Friday scheduling policy in place. We have asked about developing a policy for Monday/Friday requirements so that each RN would have to do a total of say 5-6 per 6 week sched. But have been told “ this will not work for our unit”(by the RN who is off every Monday and prepares the schedule.) Any thoughts how to fairly and tactfully address this? We have brought this to the plate a few times in the past as have new applicants but it’s always skirted over. Thanks! Dear Unfair, This sounds unfair on the surface, but that's assuming the charge nurse and the non-charges are interchangeable. Why is a charge nurse PT? Who serves as charge on Mondays? Playing devil's advocate, if the charge nurse position is PT and she doesn't perform the same duties as you, this is apples and oranges. On the other hand, if she is PT and performs the same duties as you and the other PTs, the non-desirable days, which include Mondays, should be shared fairly. Another question is, is this charge nurse working every Friday? If so, the other PTs are presumably not working every Friday. Are you considering both Mondays and Fridays equally undesirable? Or is it that part timers are working a split schedule, such as Mon-Wed, off Thursday, on Friday? Finally, does volume or caseload figure into staffing needs? Somewhere in the past, this charge nurse was given a cushy schedule and now she is claiming squatter's rights. The thing is, some unwise person above her is tacitly condoning this. I say unwise because favoritism breeds resentment, which affects team work, which affects patient care. Let's assume this is truly unfair. You have already been fair and tactful, and even offered a solution. I take it you do not have a union. I would not suggest initially going to HR because in my experience HR backs up the manager, and it angers managers for employees to go over their heads. Check your job description and other policies. Although they probably address weekend/holiday coverage, it's unlikely they address Mon-Fri coverage. It sounds as if you've only gone to the charge nurse herself with this, but as the scheduler, she is the fox guarding the hen house. Have you approached the manager? Go to your manager and respectfully explain that the PT RNs would like to share in the Monday coverage fairly and that you would like to present a fair solution. It is time-honored in nursing that weekends are equitably shared, and your weekends are Mondays and Fridays. Be prepared that nothing may change. In that case, all you can do is change your response, and let it go. That means you have to decide if you can appreciate the positive aspects of your job, and live with this one dissatisfier, for your own happiness. Best wishes, Nurse Beth Start your job search today!

I wouldn't worry about it. First of all, there's no need to list your clinical rotations on your resume unless there's a compelling reason to do so. It's a given that your BON/BRN required a certain number of hours and that you fulfilled them. Because new grads are all the same in terms of having passed the NCLEX and lack of experience, you want to include meaningful things that set you apart, not just words that fill the page. Do you know a second language that is spoken in your area? Have you done any community/volunteer work? Did you hold office? In previous jobs, did you receive any customer service training? Things along that line. Best wishes, Nurse Beth

Hi Nurse Beth! I've got an interesting situation going on. I was recently fired from my place of employment on 11/2019 at a major hospital system. I was salaried (non clinical position) and accused of "stealing time" from my employers despite the fact that I actually worked on the days they accuse me of stealing time. I reported them to the Dep't of Labor(DOL) because they terminated me while I was on FMLA. The DOL is supposed to arrive to a conclusion soon to show there was either a) a violation b) non violation or c) inclusive/notice to sue. I also planned on following up with the EEOC as there was harassment involved but everything has been delayed due to COVID. During the tenure of my employment I actually went back to school and graduated nursing school. I'm currently waiting to take the NCLEX. Now I'm in a position where I'd like to work for the same company as they are one the major employers in my area. There is no chance of me interacting with my previous HR representatives or managers but I am concerned about my record which is why I'm fighting so hard. My question is this: What should I expect from the recruiting process? Does this ruin my chances of finding work as an RN with this system? Any advice on how to fight this issue more effectively? Dear Concerned, If you intentionally falsified time records to get more money than you were entitled to, then that is a theft of time. It's usually not prosecuted. Employees are simply fired, as you were. It doesn't make sense to accuse you of stealing time on a day or days that you worked, because salaried employees are paid for the day (typically 8 hours) whether they worked 2 hours or 12 hours. As far as your termination status, I don't believe you have recourse. An employer can list you as a "not eligible for re-hire" as they choose. You can be right, but it may not fix anything. Even if it was a wrongful termination, it's doubtful they could be required to hire you as an RN. It wouldn't hurt to apply, but the chances of an employer hiring you after you reported them to the Department of Labor and are considering bringing suit are slim. The most you could hope for is a 'right hand doesn't know what left hand is doing' situation, and get hired by slipping between the cracks. So sorry this happened, especially as they are your main potential employer, but you may do best by cutting your losses and moving forward. Good luck on the NCLEX. Nurse Beth Start your job search today!

A 10/10 stress level, severe anxiety, sense of dread and not sleeping are all signs of a treatable medical disorder. All of these things you're experiencing are normal in some degree and at some times for new nurses. But not for 2.5 years and not all the time. The anxiety you are having will stay with you no matter what job you take to escape it. Anxiety prevents you from enjoying your job. See your doctor for uncontrolled anxiety. Even if you've been treated before, it's time for a check-in. Once you get the right treatment for you, lig gave you some great suggestions for finding the right job. You are very smart. Don't give up nursing. If ever there was a career with unlimited options, it's nursing. You can work with patients and you can work in informatics. You can teach, do case management, infection prevention, palliative care....you name it. Like you said, life is too short. You're too valuable and you do not need to suffer. Best wishes my friend

Hi Nurse Beth, My long-term goal is CRNA. I got an ICU offer from Cleveland Clinic (#2 hospital in the nation), but not main campus. It's for one of their regional hospitals. It's not a trauma hospital, but the residency would still go through main campus. I would be moving from California and was wondering if the name of the hospital system and ICU experience with good 1 year residency would be worth it enough? The pay for is 28/hr for residents and I plan to do 2 years ICU then find a job in an actual level 1 trauma center in CA. Would this also be a good name to have on my resume despite it not being main campus and overall would it be worth the move for CRNA? Dear Wondering, I say go for it! and congratulations on the offer! This can be an excellent place for you, with lots of opportunities. No matter where your career takes you in the future, and plans can change, an ICU residency at Cleveland Clinic is an amazing start. You are looking down the road and planning your career all the way through CRNA, and it's good to have a solid plan, but for now, relax into your residency. There is so much to learn in your first year. Best wishes to you in your new job, Nurse Beth Start your job search today!

Hi Nurse Beth, Are you able to offer advice on Nursing school programs? If not, can you direct me to the right contact? I am not sure, this is just a possibility, I might have had a poor experience. I am crushed. Dear Needs Advice, I'm not sure what kind of advice you are needing. I'm not able to endorse any one program, but readers can share their experiences. We do have a good forum on school programs https://allnurses.com/school-college-programs-c152/. I hope you will check it out and ask your specific question there. Best wishes, Nurse Beth

Hi Nurse Beth, I have been a nurse for 19 yrs primarily in Peds ( med/surg, PICU, pedsED, CICU, PACU adults/peds ambulatory,) I’ve been a sedations nurse in peds radiology ambulatory setting for the past 7 years. I am 44 yrs old and gave birth to my 7th baby 3 months ago. My current job is part time and is amazing in support, flexibility, no weekends/ holidays. However, I am getting extremely bored and unless I go into management there is no room for growth. I am in an ambulatory setting connected to a large children’s hospital. I am not interested in management at all. I would have to return to main hospital for any real opportunities. I am however passionate about holistic and integrative medicine. For the past 2 years I’ve been starting a Health Coaching practice for women with Diabetes. I’ve spent tons of money on marketing help to get clients as well as, getting certifications. My clients are literally trickling in so I am thinking of putting a halt on my practice for now, especially with homeschooling 5 kids with a newborn and preschooler. I am spending so much time on social media and doing other things that I don’t enjoy just to convince people that working with me would be valuable. It will be at least 5 yrs before I have all kids in school full time so I am only willing to work part time because family comes first. I’ve thought of going back to the ICU but when I think of going back to the rat race of the hospital I’m immediately turned off. A lot of us Nurses are so passionate but our work environments are so toxic and we just get burnt out. I am finding it difficult to pursue my passion, raise my family, and have life balance all in one. I don’t have the money right now to pursue a masters which would give me autonomy and an opportunity to practice what I love as an FNP. Do you have any ideas on how I can mesh the two or where I should begin my job search? I have a lot of love and compassion to give, love to educate and support, I love assessment and using my clinical skills but most of all I LOVE my family. In nursing you can pursue your passion but expect to be used and abused until your burnt out. At my age I’m not willing to do that anymore. Thanks for your help Dear Loves Family, Seven children? My hat is off to you! You are not being challenged at work, and you have an entrepreneurial spirit, as well as many talents. Your first love is your family and your primary focus is your children, at least for the next 5 years. You've already discovered that a business takes 100% effort and focus to get started. Your main challenge to finding satisfying and challenging work is working part-time. I completely agree with your choice to work part-time, having 7 children, 5 of whom are not in school. But part-time limits your career options to either shift work or some kind of job-sharing agreement, typically in a job in which you are already established. There is one job that stands out that sometimes accommodates part-timers, and it's house supervisor. This job is never boring because every shift is different. It's not management, it's high-level coordinating and trouble-shooting- much like the skills it takes to manage 7 children:). Another option is to choose to hang in there with the job you have that allows you to do what you love most- homeschool your children and spend time with your little ones -invaluable. Five years is not forever. Once your kids are all in school, you can return to school yourself and choose your future. At the same time, consider if there's any way to make your job more interesting. Do your protocols need review? Do other staff need training in rescue drugs and dosages? Best wishes, Nurse Beth

It's hard to imagine what it must feel like to work for an organization for 20yrs, and then be fired. Not only fired, but fired on allegedly trumped-up charges. According to Becker's Hospital Review, Julie Stephens, RN, an ED nurse, was fired after 20 yrs of employment for "trying to help a patient with mental health issues escape". Julie Stephens worked in the Emergency Department of Portsmouth Regional Hospital in New Hampshire. Portsmouth is owned by HCA Health Services, headquartered in Nashville, Tennessee. HCA is a for-profit organization that owns upwards of 300 healthcare facilities. Trying to help a patient with mental health issues who was being involuntarily committed to escape is an odd charge and the New Hampshire Board of Nursing did not lend it credence. In hopes of sanctioning Julie Stephens' nursing license, the complaint was reported to the New Hampshire Board Of Nursing, where it was dismissed. Julie was guilty of reporting unsafe staffing conditions and clearly the administration wanted her silenced. Portsmouth Regional ED was chronically overcrowded and understaffed, allegedly resulting in a patient death. According to Julie, a patient with cardiac symptoms presented to the ED for help. Instead of being seen immediately and screened with an EKG, the patient was not screened, was not treated, was not seen, and died after waiting more than half an hour. At Portsmouth Regional ED, lunch breaks were rare and understaffing was the norm. Julie tried repeatedly to advocate for safer staffing, making her concerns known to her Director, to no avail. In October of 2018, Julie wrote a letter to the Chief Executive Officer, Dean Carucci. Here's the timeline: In June of 2018, a new Director of Emergency Services was hired. Was Julie hopeful that things would now change? Instead, RN turnover rate increased, according to Julie.In October of 2018, Julie wrote a letter to the CEO. Did Julie believe she could appeal to his humanity? That maybe he just didn't know about the unsafe conditions in his ED? If he did know, surely he would ensure safe staffing, right? In early 2019, Julie was accused of aiding a patient with mental health issues to escape.In February 2019, days after the accusation, Julie Stephens was fired.Julie has filed a wrongful termination lawsuit. According to the New Hampshire Union Leader, "The lawsuit alleges wrongful termination, malicious prosecution and violation of a law that protects whistleblowers, according to the report." Not surprisingly, the hospital has defended its actions and denies any wrongdoing. Portsmouth hospital spokesman, Lynn Robbins, says they are "comfortable" with the firing of Julie Stephens and the hospital claims it acted in "good faith". Will other nurses at Portsmouth Regional or any HCA owned facility feel free to speak up? It's doubtful. Likewise, it's likely that managers and directors are in an environment where they are not able to advocate for patients and nurses. Was Julie terminated for good reason? That's doubtful as well. It seems if the only thing they could charge her with was the "helping a patient escape" charge, then she must have been a really good employee. What about the symptomatic cardiac patient who died after 30 minutes, untreated? Portsmouth Regional Hospital is a Chest Pain Center accredited by the Society of Chest Pain Centers. Healthcare professionals are taught "time is muscle". Heart muscle. What happened at triage to delay this patient's care? Thirty minutes is enough time to screen, get to Cath Lab, and inflate the balloon during angioplasty. There are so many questions and we don't have all the answers, but on the face of it, Julie Stephens was fired because she persistently spoke up about unsafe staffing. How is that wrong? Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, This is not really a question, but a THANK YOU! I am taking my boards in August, and read your book from first to last page. It helped me tremendously. I am happy to say that because of your book, I landed my first nursing job at Johns Hopkins in the Cardiovascular SICU!! I cannot believe it. I read your book and practiced and rehearsed my interview. I also revamped my resume and cover letter using your book, which was extremely helpful! I accepted this amazing job opportunity and have been anxiously awaiting my start date. I am starting on 10/05! Without your book, I would not have done well with the video interview. I think others are amazed that I landed this job before I even take the boards, again because I took your book's advice and applied to jobs before graduating to expand my opportunities! Thank you again! I have told my cohort about your book, and I think several of my fellow students have bought it! Wish me luck at Johns Hopkins, I am moving from Philadelphia and couldn't be more excited! Thanks again, you are really fantastic! Dear Got Amazing Job, WOW! I'll say you got an amazing job- CV SICU at Johns Hopkins!! Congratulations and I'm so honored to be a part of your success. You have such an awesome opportunity ahead of you. Even so, the first year is as challenging as it is exciting. I would love to send you my recent book, "First Year Nurse", if you'll email me your address (it will be private). Best wishes and good luck on your boards, Nurse Beth

Black PlagueRecently 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. TypesHumans 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. TransmissionPlague 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. OutbreaksWhile 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. TreatmentPeople 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.

Dear Nurse Beth, Thanks so much for your time and your advice! I have one question. I have a final interview with an ER manager at my dream job location. I was wondering if you had any examples of questions that are unit specific I could ask her. I want to leave a good impression as there are so many applicants. But since this is a new grad residency program I haven’t worked in the ER I’m kind of stumped. Thanks again nurse Beth! Dear Dream Job, The questions you ask at an interview are important, and they give you one last chance to make a memorable impression. You need to prepare several questions ahead of time. Managers typically ask "What questions do you have for us?" at the end of an interview, at which point they may have already addressed your question. So if the manager has already talked about visits per day (ED metric for volume) or throughput (getting patients up to the floor) during the course of your interview, and your questions were "How long do you typically hold patients while waiting for an inpatient bed?" or "How many visits per day do you have during the Winter months?", then you would not be able to use those questions. Also, remember, the ED manager does not expect you to know the inner workings of the ED. Experience is not what they are looking for when hiring a new grad.They are looking for someone who will fit in, be teachable, and be a safe practitioner. Here's a couple examples of questions you might ask: "I've always been told by my instructors that teamwork is one of my best strengths. What qualities do you look for in a candidate?" (tells them you're a team player). "As a new grad, I have everything to learn. If I were to get hired, what are the best ways to grow my skills in your ED?" (shows teachability and interest). One way you can use this question to your advantage is to show you have researched the hospital. "I know the mission of the hospital is to improve the health of all the patients served through excellent care. Can you tell me about the culture of the ED?" (shows you have looked up the mission statement). A couple more tips: Ask only open-ended questions that cannot be answered with a "Yes" or a "No". Do not ask questions about salary, benefits, vacation time or any perks at this stage of the process. Ask one question at a time. Avoid multi-part questions, such as "If I were to get the job, would I receive regular feedback on my performance, and is there opportunity to take more classes to improve my skills down the road?" (should be asked as 2 questions). Good luck on your interview!! P.S. Follow up with a thank-you note Nurse Beth

Hello Nurse Beth, I have a situation with which me and my coworkers need urgent help. A month ago, we got a 6 hour warning that we are now a Covid unit (we were a specialty cardiac unit before). No one got a choice, and was told if they didn't want to do it, they could quit. Fast forward a month: we were originally told that we would be taking 4 covid patients/nurse, as well as have an RN serve as "runner "- being stuff to the rooms to conserve PPE and time, since it takes a while to don and doff PPE. We also normally have a secretary, and 3 CNAs when we're full. The reality- this whole week we've been pushed to take 6 patients each, only given 2 CNAs for 24 rooms, no secretary, and as of today- no runner. These patients are sick, turn from bad to worse quickly, and most are total care bc they're so weak. In addition, RTs refuse to come to the unit "to limit exposure" so we have to do all treatments, inhalers, etc. The same excuse is used by dieticians, PTs, OTs, IV team, and Foley team. Oh- and dietary aids no longer being the trays to patients- we're expected to somehow deliver the trays for all 3 meals while struggling to give meds and provide care. We get no hazard pay or bonuses of any kind, were told we're not allowed overtime- all because our productivity is low. So, basically, we were told that until productivity improves, we won't be getting more staff. Now- the rest of the hospital- nurses are on call at home drawing unemployment. In house staffing office?- their nurses magically disappeared, but turns out they've been on call bc they refuse to work with covid patients. This is beyond unsafe, and never in my 10 years as a nurse did I think this could ever happen. The most disgusting part- this is happening not bc of shortage of nurses (there are plenty at home!!) but bc the hospital wants to make profit. This is supposedly a non-profit hospital. So me and my coworkers are stuck- other hospitals in the area aren't hiring bc of slow business, and if we quit to save our sanity, backs, and licenses we won't quality for unemployment. So far, in the last 2 weeks, 5 out of 15 RNs quit...not to mention or patients, who are going through one of the scariest ordeals or their lives are barely getting the most minimal of care no matter how fast we run- the load is simply unrealistic. In the beginning, other nurses would come and help, but lasted only a shift *some less*, before saying that they will never return bc this is the worst nightmare they've seen. So basically, the rest of the hospital gets to choose not to come help, but we're stuck there, being loaded up with more and more and more. Both of our CNAs today were crying in the break room bc they were so exhausted and felt so bad bc no matter how hard they worked, they still struggled to complete the most necessary tasks- vitals, food, water. I've talked to a couple of my friends in other states- they said this is horrible, and completely not the case at their hospitals. We're all looking for other jobs, but who's going to take care of these patients?! So, I am asking if there are ANY ways to improve this situation, or hold someone accountable for this endless abuse of staff, as well as patients not receiving care they deserve? Or is our only option is to leave, and feel terrible bc there is no one to take care of these people? They've hired 2 travel nurses, which costs way more than paying straight pay and just getting other nurses who are sitting at home to help. This is an absolute nightmare. Also, at 6 patients a piece, providing all of the other disciplines' care exposes is to crazy high exposure. The other day when I was a runner I was expected to help nurses (I was in 19! covid positive rooms), be a secretary, and at one point was sent to another unit to pull a cardiac sheath, then return, take a patient, and with that, go back to being a runner and a secretary...and the 3rd CNA. Please advice- any thoughts are deeply appreciated. Dear Worst Nightmare, Unbelievable. Actually, it is believable, because in nursing, nurses typically do not have a voice. In California, there are laws to govern nurse-patient-ratios , and nurses in every other state need to band together and do the same for themselves and their patients. A lot of times hospitals will cut staff when productivity drops. Productivity is a function of nursing care hours (staff) and patient care hours (census). If the budgeted census drops, productivity drops, so staff is decreased. At some point, though, the model makes no sense. For example, if a cardiac nursing unit is considered productive at a census of 25, staffing includes a monitor tech. If the census drops to 18, the monitor tech may be pulled. But a monitor tech, like a secretary, is needed whether the census is 25 or 5. Such positions should be fixed, outside of productivity numbers. An example of a fixed position is the nurse manager - there's a nurse manager regardless of census. In your case, you are doing others' jobs- PT, OT, Dietary, RT, secretary- and your patient load has increased by 50%. You are gowning in and out of isolation for each patient, and you are hyper-exposed to a virulent virus responsible for causing a worldwide pandemic. if you live outside of California, and if you do not have a union, there is little or no recourse outside of quitting, getting fired, or getting sick. And you are right- this kind of focus on the bottom line and disregard for nurses happens at for-profits and not-for-profits alike. CEOs at both are well compensated. Not-for-profit means a desirable tax status for the organization, but not necessarily desirable working conditions. I hope your story gets read by many, and I thank you so much for telling it. Be safe. Best wishes, Nurse Beth

Dear Nurse Beth, I got my RN license just as the Covid-19 situation took a turn for the worst. Now most, if not all, the RN residency programs in my area have been suspended. I have received an offer from a SNF but am weary of accepting it because of the things I've heard about this particular facility and their treatment of new grads. I am lucky enough to be living with my parents at the moment, so I am not pressured into needing a job, but I definitely would like to start my career as a nurse. Should I accept the job in the meantime as the future of the residency programs remain uncertain? Or would it be better to hold out for a program career-wise? Dear Lucky, It's a different time now, and unfortunately, the Covid-19 situation is affecting new grads applying for their first jobs. Many hospitals have postponed their residency programs, and decisions to reinstate programs are fluid, as the situation evolves. Some residency programs will continue, but may look different, with fewer live classes. One thing for sure, though, hospitals still need to hire nurses. I would not take a job at a SNF with a reputation for not treating new grads well. Chances are that means you would be given too much responsibility and not enough support. Not only It may take longer to land your first job, but you deserve a good start. Transitioning from school to practice is challenging and it's better to wait a bit to find the best fit for you. Best wishes, Nurse Beth Start your job search today!

Hi Nurse Beth, My name is Jean, RN. I've considered to go to a NP school next year. I have so many questions but don't know whom I ask. 1. I don't know which specialty I need to choose, either FNP, or Critical Care. I'd like to work in the hospital (I'm interested in working in Adult Cardiac area). However, I don't have any ICU experience but have only over two year tele experiences. However, I don't want to limit my work area in the hospital, either. I maybe want to work a clinic. People say with FNP I'll have a limit to work in the hospital and with Acute care NP I'll have a difficult time finding a job in a urgent care clinic. Someone even suggested to go to a PA school because PAs can work in any areas. 2. I'd like to know how I can be a Cardiac nurse (or a cardiac NP). I started nursing career in tele unit but found difficult to work in a cardiac ICU because of no experiences. I have only over two year nursing experiences but am old because this is my second career. I wish I had switched to nursing sooner.:) But I'm grateful that I found something that I'm passionate about. Working a hospital to help sick people is a privilege. Thanks for reading my questions and for helping me. Dear Jean, Choosing to become an NP is a big step in your career, and part of that decision is narrowing your focus of practice/population. When studying towards a nurse practitioner degree, it's important to consider which area of nursing you are most interested in. You have the option of many different specializations, and all areas are in demand. The U.S. Bureau of Labor Statistics expects a growth of around 19% for NPs by 2020, well above the national average. There is an increasing demand for NPs as primary care practitioners. Certified Nurse Practitioners are prepared to practice as: Primary Care NPs (FNP) Acute Care NPs (AG-ACNP) Family Nurse Practitioners (FNP) practice in primary care settings, such as clinics and offices. Adult Gerontology-Acute Care Nurse Practitioners (AG-ACNP) typically practice in hospital settings, although an AG-ACNP could also practice outside of the hospital setting. You do not necessarily need a background in ICU to become an Acute Care NP, but it would be very helpful in terms of exposure, familiarity, and helping to determine if you really are attracted to this population. Some realities of ICU include managing patients who remain on life support for very (overly?) long periods of time. RN to PA You mentioned PA, which is yet another career choice for you. It may or not be easy to find an RN to PA bridge program, but being an RN would most likely improve your chances of acceptance. As a PA, you do not have the autonomy of an NP. You are just what it says- a (highly skilled) physician's assistant. Your focus so far has been nursing, and a PA focus is medicine. PA programs are intense, and you would probably not be able to work while in a PA program. The required clinical hours for a PA are about 2X those of an NP. I'd say that, looking at everything, it would be hard to go wrong as an FNP. You will always be able to find a job, you will not have to work weekends and nights, and with the sheer selection of jobs and settings, you can find your niche. Best wished on your decision, Nurse Beth Start your job search today!