Nurse Beth MSN

Here is a prelude which is actually a prologue. I am writing this edit after the article below was published, based on the well -written feedback. While I pinged off a recent article and point of view written by a nursing student at Penn State, my sources, as pointed out, are old, and don't reflect the current state. As a writer, I intend to bring forward more well-researched info, and this article missed the mark. There is far less stereotyping, especially at the clinical level, where male nurses are often embraced, than at the social level. One reader did say, however, that more often that not, he is asked if he's the MD or if he's going to become an MD. I don't believe that men in nursing is a non-issue. Perhaps at the individual experience level at the bedside...but the bigger picture to me is how the slow but steady influx of males will influence the profession. I think more men will benefit the profession in many ways, and I also think gains will be made that a feminized profession was unable to accomplish. As one reader said, male privilege does exist. The comments so far have been well-thought out and respectful. I appreciate the feedback. “Caring, nurturing, comforting...healing touch. Women's work.” These are words and feminine imagery used to describe nursing, a profession so strongly identified as female that it’s odd to realize, in ancient times, nurses were men. However, since the time of Florence Nightingale, males have been a minuscule minority in nursing. What holds men back from becoming nurses, even in this modern day? One reason is the fear of almost certain stigma. Taking on a feminine role affords men an ambiguous social status. Family and friends may disapprove. As a result of stigma, role strain, and isolation, very few men join the profession. Of those that do, more than 85% as compared to 35% of women drop out or fail (Poliafico,1998). Men in nursing are at once advantaged and disadvantaged. While nurses are considered subordinate to doctors, male physicians treat male nurses better than females or at least with more respect. Ironically, male nurses command higher salaries than their female counterparts and hold proportionately more prestigious positions (Evans, J., & Frank, B. 2003). This may partially be due to the fact that males gravitate to the highest-paid specialties, such as nurse anesthetist. Stereotypes and Barriers In healthcare, men are expected to be doctors. Not only is nursing female-identified, but it is also considered by many to be gender-inappropriate for males. Hiring male nurses in labor and delivery and nursery is close to taboo in many places. Male nurses are expected to work ED and highly technical or high-acuity areas such as ICU. Men who choose nursing face questionable social status as many people do not consider nursing a respectable role for males. Some believe male nurses are misfits who aren't successful or capable in any other career. Media portrayal perpetuates the image of nurses as exclusively female. Male nurses are non-existent or ridiculed, as in the movie Meet the Parents with Ben Stiller. Male nurses may be subjected to curiosity and even suspicion as to why they are a nurse from their patients. They may feel they have to defend their masculinity and may distance from their female colleagues in order to do so. Homosexual Even though men choose nursing for career opportunity, salary, and job security, they can be categorized as homosexual based on their career choice. The excerpt below is taken from a study of men in nursing. Robin: “There’s sometimes I’ll go in and see a large male that’s used to looking after himself and he has a cardiac problem. I’m not going to go in and wash his back...it comes back to this whole homophobic thing” Evans, J., & Frank, B. (2003).p. 282 Touch Touching is an accepted form of caring, but men are stereotyped as sexual aggressors and fear being accused of sexual misconduct. Unlike female nurses, who are free to touch and show emotion, male nurses have to be careful with touch. Nursing school does not equip males to negotiate such gender conflict, and trains them from a completely female perspective. Acceptance by Female Nurses Male presence in a female-identified profession creates tension between the sexes on the job. This is partly handled by the women expecting traditional behaviors from the men- help with physical tasks such as lifting, and acknowledging them as leaders. But whether or not female nurses are ready to accept large numbers of men into the profession is unclear (O’Lynn, C. E. 2004). Would men take over the only feminine stronghold in the paternalistic field of healthcare, climbing the career ladder at a fast pace, on the backs of females? Would the nursing profession benefit from more males and do female nurses expect men to improve the status of nursing? Will it bring respect and gains that have been lacking because nursing is a female profession? And if so, is that not a sad commentary? Future of Men in Nursing The United States Census Bureau in 2016 reported 11% of the nation’s 3 million nurses to be male. While a small percent, it’s a significant increase from the 1970 statistics where only 2.7% of nurses were male. The American Assembly for Men in Nursing, together with the IOM, has set a goal of 20% male enrollment in U.S. nursing programs by the year 2020. To help encourage men into nursing, it’s important to speak up about negative media portrayals and make nursing education truly male-friendly, addressing their needs. Men need role models and mentors. High school guidance counselors have a part to play in introducing nursing to all young people. In the end, men bring a different and enriching perspective. Perceptions take a long time to change but will change by sheer numbers of males in the field as it did with female doctors. The presence of male nurses is no doubt increasing, and patients benefit from the increased balance.

Dear Nurse Beth, Hello! I am currently a nursing student going into my last semester of nursing school. I received an email from a job recruiter about an RN position. While it's not my "dream" job, I'm not opposed to working in this specific area and I do believe it would be a good fit for me starting off. I am just wondering the best way to reply to a recruiter and if it's too early to start applying to RN positions even though I won't be graduating/certified until May? Thanks for any help Dear Graduates in May, Congrats on starting your fourth semester! It is not too soon to apply for RN new grad positions. Nurse residency cohorts are offered only 2-4 X a year in any given facility, and spots are often awarded far ahead of time. You could easily be hired for a residency position starting in August, for example, with the contingency that you've passed the NCLEX by then. So, don't hesitate as there is often competition in landing a residency position. Best of luck to you. Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

At Westside Regional Medical Center in Plantation, Florida, ICU nurse Julie Griffin worked in the 12 bed cardiovascular ICU (CVICU.) Until she was fired for refusing to take a third patient. Westside Regional Medical Center is part of HCA Healthcare. HCA Healthcare is the largest for-profit hospital chain in the U.S., owning over 150 hospitals, and earning over 47 billion in 2018. Unmonitored Patients One of Julie's concerns for patient safety was that the in-room monitors provided for a split screen display. This allows for an ICU nurse to be in one of her patient's rooms, set the monitor for a 2-view display, and be able to monitor her second patient. The problem? It does not allow for a 3-way display. If the ICU nurse has 3 patients, one of those patients will not be monitored. In an interview with Hospital Watchdog, Julie Griffin explained that there is a standing order for all ICU patients to receive continuous monitoring, and nurses must electronically attest to the fact that the standard of care was met. HCA CVICU does not staff a qualified monitor tech at the nurses station where the central bank of patient monitors display. If all the nurses are away from the station providing patient care and an unmonitored patient goes into a lethal rhythm, there is no one to see it. An alarm would sound, but there are constant alarms in CVICU that compete for a nurse's attention. Alarms cannot be relied upon as a substitute for a nurse. Hospital Watchdog reports that 2 such unmonitored patients have died. Allegedly, one of the patients was discovered dead and may have been dead for up to 30 minutes. A family member went out to the nurses station to report that something was wrong. In the other case, allegedly the nurse was assigned 3 patients, was able to monitor only 2 of them, and the 3rd patient died of pulmonary problems, possible a pulmonary embolism (PE). Hospital Watchdog qualifies the above cases saying they are not substantiated with medical records or other documentation, they are reported by nurse Julie Griffin in an interview. Whistle-Blower Julie says all of her colleagues shared her concern about patient safety and lack of monitoring, but they were afraid to speak up. They needed to keep their jobs in order to support their families. Julie, previously in the Navy, believed in following the chain-of-command. She reported unsafe patient conditions to her charge nurses and manager. She believed that if corporate only knew about the practice, they would want to do the right thing and rectify the situation. Instead of rectifying the situation, nurses were frequently required to take 3, and sometimes 4, patients in the CVICU. Julie claims that untrained nurses were assigned ICU patients. Julie trusted there would not be retaliation if she complained. There was. Julie claims her Director intimidated her and at one point frightened Julie by getting physically close. Julie's schedule was changed to working every weekend. She felt harassed. Even the HR department at Westside acknowledged that the Director's actions were inappropriate. Even so, Julie was removed from duty within hours the day she refused to take a third patient. On the day she was terminated, Julie had 2 patients. One patient had orders for transfer out to the floor. One of the patients was a post-op open heart surgery, and was on a diuretic. Julie knew that a patient on a diuretic often has to urinate urgently, and was concerned that she needed to respond right away to make sure he didn't fall. Julie refused to accept the assignment of a 3rd patient. At 1700, The CVICU Director came to the unit and told Julie she had to take the 3rd patient. She again refused, was placed on investigative leave, and terminated 2 weeks later, in 2017. Julie had worked in HCA ICU since July 2016. Julie later filed 2 Florida Whistle-Blower complaints in 2018, and has filed a suit against HCA for unlawful termination. Julie's Director says that Julie was a disruptive staff member. Julie says that the standard of care required by HCA called for continuous monitoring of her patients, and she was unwilling to violate that standard. Right or Wrong? Should Julie have gone with the status quo and quietly accepted a 3rd patient, knowing that at least 1 of her patients was lower acuity? Or did she do the right thing? Is her reputation so damaged that she will have difficulty securing employment? Was she acting on principle or imminent patient endangerment? Does she have any chance of prevailing against HCA? Many of us have been in similar situations. What would you have done? Nurse Beth, Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, Hi! I am a new grad RN with 3 months of experience so far in an acute care setting. For many reasons such as unsafe nursing practices at this hospital as well as my desire to relocate ASAP, I am still trying to apply to other hospitals. My question is, when I am applying for new grad positions (6 months or less of experience), how do I address this in my cover letter? How should I go about the desire to change hospitals without speaking bad about the hospital I am currently at? Any help is appreciated! I am extremely lost at what to do. Dear Wants to Change, Some residency programs will accept you with less than 6 months experience, and some specify no hospital experience. You may not find it easy to land a residency position, but that depends a lot on your area. You don't need to address your short tenure in your cover letter. If you do land an interview, it's best to say that it wasn't a good fit. You are right to avoid saying anything negative about a previous employer. Without knowing the details of your situation, try to stick it out. The first few months of nursing are difficult, and 3 months is too soon to be sure it won't work out. If you can make it to one year, you will be far more marketable. Best wishes in your decision, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I am in a situation that I don't know how to proceed... I have been an RN in the OR for 11 years and have 3 years experience to primary care, I have started FNP school last year as it was always my calling and got so disappointed with it that I have no will to finish it. My classes are once a week and I have lots of reading materials and assignments to complete, up to here all as expected, but my professor does not seem to get it that being educated in a foreign country it is harder and it takes more effort on my part. She gets to class and talks about her day instead of actually teaching something and she is the class coordinator so when complaints were made to the nursing chair, he got really defensive and nothing changes. My 2 colleagues from class made the same complaints but all we get back is you should be dedicating yourself more. I have a student loan and I am half way through it but I don't think I am learning enough. Also all the help we were told we would get for clinicals does not even happen... so discouraging... I love being an RN and really want to be an FNP but I don't see myself passing tests or boards the way all this is right now... Any suggestions? Thanks... Dear Disappointed, Not all schools are created equal, and unfortunately, students don't always get what they paid for. There is a forum here on allnurses titled "Students" and from there, "Student Nurse Practitioner". Schools are listed by name and hopefully you can find your school and communicate with others who attended the same school, for support. Without knowing the school and the reputation of the school, it's hard to advise. If it has a dismal reputation, and a low pass rate, you might be better off to cut your losses. If it's a respected school and you just have a poor teacher, it might be worth it to try and hang in there because you've made a significant investment. If you decide to stay, take your focus off of the teacher and do everything you can to learn. Consider a tutor. Learning is a 2 way contract. While teachers should be accessible and supportive, not all are, as you discovered. Put this in the mental folder titled "things I cannot change". Many schools do not provide clinical coordinators, and it's important to start reaching out to find a doctor who will agree to supervise you. Best wishes in your decision, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I'm currently enrolled in school. Would like to do my RN. I'm a LPN 30 plus years. Am I being unrealistic about becoming an RN and being able to find a job at 60 or older? Dear Unrealistic, A lot of people will tell you to go for it and there are successful examples of people who do get their RN at a later age. But those same people may not tell you that you will have far more challenges than your classmates. Ageism in nursing is real. Two things are highly important as you make your decision. Realism First, it's important is to be realistic. By simply posing the question "Am I unrealistic about finding a job at age 60?" and because you're an LPN, you do seem to be realistic. As an LPN, you already know that bedside nursing is physically demanding and you likely have few delusions about the nature of the work, although there is a big role difference between LPN and RN. Job-wise, you will be competing for new grad positions with candidates who are decades younger than you. All things being equal, an employer will hire the younger employee who is not as likely to use as many costly insurance benefits, for example, or who is more willing to work overtime. Some employers prefer younger candidates because they are more malleable. They are not as likely to question leadership decisions and are less critical. Keep in mind that as a new grad, you will not necessarily be seen as more qualified because you have LPN experience. Some employers do not view LPN experience as an advantage. Those that do not view it as an advantage may actually view 30 yrs of LPN experience as a disadvantage. They will question if you will be able to successfully transition to the new role of RN. You will need to let go of your LPN mindset and adopt an RN role and mindset. At age 60+, you will have to try harder than others to land your first position. You may need to consider settings more undesirable and locations in outlying areas. Are you able/willing to work night shift, and are you open to skilled nursing? Would you re-locate if there are no jobs in your area? How is your stamina? Take stock of your health and estimate how long you plan to stay in the workforce. For many people, working until 70 is entirely doable. You could work a few years on the floor, then transfer to a less demanding job, such as infection prevention, or wound care consult. You say you are already in school, and that's good. You have a student mindset, and are oriented to school in general. The RN program is intense, and not easy. Once you commit, stay the course and keep your eye on the goal. Many clinical aspects will be much more comfortable for you than for your classmates, as you will not have the jitters inserting a nasogastric tube or foley catheter. Personal Importance The second consideration is to weigh how important this is to you. Choosing to get your RN means choosing not to do other things. You will spend less time with family and friends and temporarily suspend most hobbies. But ultimately, if it's your life desire to be an RN, and you will regret having not done so, do it. If you deeply want this , you will find a way to not only earn your license, but to land a job. Your personal desire outweighs your age, your finances, and most all obstacles. Along the way, you will inspire others. Key Tips During nursing school, network energetically and purposefully. Don't wait until you graduate to make connections to land a job. Make yourself seen on the floor and introduce yourself to the nurse manager. Leave a personal note thanking her/him for the clinical rotation experience on their unit, with your contact information. Let them know you will be applying for a job. Read my book below before your second year for many more such strategies . It will give you the insider tips you need to make your application stand out among others, which is needed just to land an interview. You can be amazing in person, but to impress them you have to capture their attention with a compelling resume and cover letter. It's estimated you have 3 seconds to gain the reader's attention with your resume. Once you have an interview, you must go in prepared and at the top of your game. This means knowing what questions will be asked, and what they are looking for in your responses. An example is how to answer "What's your greatest weakness?" and what not to say. Landing the right job for you will be a process, not an event. I hope you will keep us apprised of your decision, and I'm rooting for you! Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next! (on Amazon)

In general, hospitals offer residency positions to nurses who have never worked. But it's really up to the individual facility, and exceptions can be made to rules. At my hospital, 3 months ago, we put a newly licensed nurse who had worked SNF only into our residency program. It was the difference between her getting 4 weeks of orientation or 12 weeks of orientation plus year-long support. Clearly the residency was where she belongs, and we educators were very happy with the decision It will depend on how competitive the spots are, and the philosophy of the organization. Good luck to you!

Dear Nurse Beth, I am an RN-BSN with three years experience on medical-surgical. I have an interview for Emergency with another hospital. I meet with Human Resources December 4th. I have switched hospitals 3 times already with good reason (mostly due to relocation). Any advice for interview preparation specifically related to Emergency, or in general? Dear ED Interview, You have solid experience with 3 years in, and you landed the ED interview. These are both in your favor. So far, so good. The most obvious challenge is responding to the 3 hospitals in 3 years question. Re-location is a good reason, as is "it wasn't a good fit". Avoid saying anything negative about a previous employer. If you have family or close ties nearby, it would be good to let them know as you'll be seen as more likely to stay in the area. Be prepared to ask questions of them, when they invite you to. You could ask what opportunities exist for advancement, for example. Research their mission and values. Find out if they have any disease-specific certifications, such as a Chest Pain Center, or Stroke Center. Find out what computer system they are using, such as Epic or Cerner, and if you are experienced, let them know. Is there a prominent second language spoken in your area, and are you fluent? Have you had any customer service training, such as AIDET? Are you aware of which conditions are targeted to reduce re-admissions, such as heart failure? If you are given a clinical scenario, know that they are not looking for a clinical expert in emergency nursing, but for a safe practitioner. Your response should always include staying with the patient, calling for help, providing support and performing an assessment. If you are able to anticipate interventions, such as obtaining ABGs and CXR for respiratory distress, even better. Be prepared for "tell us about yourself" (short and pertinent to staying in the hospital, such as "my goal has always been to work ED"). Include a short story if able as stories are memorable. Likewise, be prepared for "what's your greatest weakness" (segue into an actual value, such as "I tend to work overtime, but am actively working on work-life balance as I feel I have more to offer my patients and the team when I make my health a priority. I just joined a yoga class." Avoid appearing timid or retiring in your interview as nurse managers look for a good fit for their units, and ED attracts strong personalities. Good luck! Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next! Read Are You Cut Out to be an ED Nurse?

Dear Nurse Beth, I'm currently working on a Telemetry floor at a [community] hospital about 50 miles east of Raleigh, NC. I'm torn between the idea of moving back home to California by the end of the year, and staying for three to six more months. I'm a foreign graduate from the Philippines, just started my endorsement/reciprocity process. One of the reasons I want to move back to California is for a better working condition. I was only trained for 8 weeks even though I asked to be trained the full 12 weeks. In my one month of being off orientation, I had to take care of six patients -- the last time I had to do that was 2 months ago. Any thoughts? If not California, what compact state would be the best to look into? Dear Wants to Move, Stay until you have completed at least 1 year of employment, and until your endorsement to California is complete. In your next job, you will not be considered a newly licensed nurse, but an experienced nurse. Newly licensed nurses are given longer orientations than experienced nurses. For example, a newly licensed nurse may be given 12 weeks of orientation and an experienced nurse, 4-8 weeks. Every facility is different in terms of what they provide. There is no doubt that the workload is better in California, and the nurse-patient ratios are protected by law. On Tele you will have only 4 patients. No other state has comprehensive mandated staffing ratios. I can't speak to working conditions in other states, including compact states, because they vary greatly from facility to facility. I'm unclear on how you are working as a nurse while just starting your endorsement/reciprocity process. Once you are eligible, apply for endorsement to California. The process can take some time, and some foreign graduates have to make up some curriculum. Just follow the steps and stick with the process. Filipino nurses have a strong presence in California and we've benefited by the diversification. Their core values include group harmony and a high regard for the elderly and authority. I personally love the sense of humor and playfulness not to mention the pancit and lumpia at every occasion. Who knows? Maybe we will work together and I can help you pass your Arrhythmia competency Best wishes, Nurse Beth (Miss Beth) Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I have over 15 years experience in all specialties of nursing with the first 8 years in ICU/step-down/oncology surgery. For the past two years it has been difficult to get a job. Recently during an interview, the recruiter told me that I have great experience, but from 2013 till now, there is no job consistency. The recruiter went on to say if someone with 3 years experience were to apply to the same position, they would get hired instead. I've had jobs that lasted for a year to a few months. I am looking for a stable full time position where I can remain for a long time. What can I do to not be judged this way? Can I be judged this way? Dear Judged, Your recruiter is not judging you, he/she is being frank about your current hireability. You want a stable, full-time position where you can remain for a long time, but your resume says otherwise. Yes, you have solid experience, but potential employers see you as a flight risk. In addition, your experience was close to 7 years ago, and the light is dimming. You could consider a nurse refresher course, although your problem is more tenure than experience. To change the perception, you need to establish 1-2 years of uninterrupted employment. You may need to do this in a setting or a specialty that is not your first choice. Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I worked on a Medical Rehab unit for 16 yrs then became disabled due to an injury at work. I had my certification in Rehab nursing but let it expire due to medical issues. How can I regain this back. I miss not having the certification on my files. Thanks I am in the process of getting more education in the medical field. Dear Misses Certification, The Certified Rehabilitation Registered Nurse (CRRN) exam is given by the Association of Rehabilitation Nurses (ARN). Rehabilitation nurses care for patients with chronic illnesses and disabilities. RNs who earn their nursing rehab certification may use the initials CRRN after their name. Since your certification expired, you must meet the eligibility requirements and re-take the exam. Eligibility includes two years of practice as a registered professional nurse in rehabilitation nursing within the last five years. Contact the ARN https://rehabnurse.org/crrn-certification/earn-your-crrn to find out more and be sure and study from their sample exam booklet. Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

I was shocked to read that you have 10-12 patients on Tele. I don't know how they justify this or how those in charge can sleep at night. In California, safe staffing laws limit the nurse-patient ratio to 1:4 on Tele. It's a reasonable number given the acuity of patients, the fact that often more than 50% of staff have less than 2 yrs experience, and the shortened length of stay. Four beds can mean 6 patients due to discharges and admits. All this to say that it's not you, it's the situation. I agree with other posters saying to hang in there 6 months if you are able. At 1 year, you are marketable and should never have to work under these conditions again. Best wishes.

Great article, thank you. I was a new nurse manager when a doctor who was a well-known bully began to berate me at the nurses station bc a lab was not resulted. It was so humiliating. He was tall, imposing, and absolutely withering in his manner. I asked him if we could speak in private and amazingly, he agreed. He followed me to my office. I said "Dr. Baker, we both want the same thing. The best for your patients. I will do everything I can to provide the best patient care on this floor, but you cannot undermine me in front of my staff. If you ever have a problem, let me know. In private". To this day I have no idea where those words came from! But it worked and he gave me nothing but respect from then on. I learned a lesson that day that I had to use later on with a nurse colleague who bullied me. Another story :).

Dear Nurse Beth, I'm in need of advice. I have been a nurse for 16 years. I have made some poor life choices in the past that lead to being in the Diversion Program, which I completed, and now sit on the committee as a Board member. For the last four years, I have worked in the Preop/PACU and most recently in the OR as a circulator. Management put a lot of weight on the surgical techs judging the RN's performance. One tech, in particular, was always condescending and like to discuss personal life (partying/drinking) in the OR. This guy just rubbed me wrong, but I made up my mind to not judge, listen if he had useful information, etc. I had an incident recently. During a surgery, the surgeon asked me to fetch an instrument. I did, but above surgical tech happened to be in the sterile supply room. He was in the aisle I needed access to. I said, "excuse me, I need to get through". He begrudgingly moved. I went in aisle and obtained what I needed only to turn around and find him blocking my path back out. Repeatedly asked to get by to no avail. I finally placed my hand on his shoulder to redirect him. I never pushed, shoved, etc. As I left room, he yelled, "Don't ever touch me again!” After the case finished, I went to my charge to let him know of the encounter. Eventually, the director called me to her office to explain what happened, which I did. She then mentioned talking to the surgical tech to get his side. At the end of the day, I was called back to the director's office. There I discovered I was being written up. I read what she put and in it; she stated I "shoved" him! I completely disagreed with what she wrote, which she stated I didn't have to sign and could write what I felt like on the back. I did this making sure to mention I disagreed with "shoving" other employees. I obtained a copy and left for the weekend. After work on Monday, another surgical tech caught me and asked how I was feeling, as she had heard his ranting and raving the previous Friday and that I had gotten into trouble. I told her how unfair it was. I did say I was joking but was very upset with the write-up and felt he was weak, "expletive". To this, she agreed but said I should be careful so as not to get HR's attention. I said I was only venting as she had asked me how I was feeling. Not long after I had left for the day, HR did call me to say they were suspending me pending an investigation as the complaint was now elevated to "workplace violence". I was dumbfounded and also regretting venting. I was ultimately let go. Unfortunately, HR didn’t give me a “reason for being let go”, so I’m unable to complete unemployment paperwork. I took a loan out on my 401k and am living off that. In the end, this hospital has flagged me as “not eligible for rehire”. I am seeing now how my past DP participation and now this is just flagging me as a “bad employee”, but I’m a good nurse and have loved this field for as long as I can remember. I’m feeling humiliation and shame. I’ve been searching for work, and so far have only had one interview. I did share that I was let go. First, how should I approach prospective employers? I have a lot of negative information against me right now. I did reach out to fellow coworkers and even a doctor. All of whom have written me wonderful letters of reference. Second, should I even bother advancing my education in nursing or leave this field completely? This is a small town, and I'm now currently barred from 3 of the 4. I feel so defeated. Any advice would be helpful. Dear Defeated, This is a "he said, she said" where they took his word over yours. There was no one there to witness the event, so there's your story and then there's his story. Somehow he was believed, or they decided he was the more valuable employee, and they were going to back him. It's unwise to ever touch another employee as it can escalate to exactly this. HR and risk departments nowadays are not going to look the other way when there's an allegation of "workplace violence". Meanwhile, it's ironic, because his blocking your exit is aggressive and could also be considered workplace violence. While this feels devastating, hang in there. This, too, shall pass. What's important is to reflect on what part you had in the conflict, so you can understand yourself moving forward and have success in the workplace. Be sure not to "vent" and manage your emotions professionally. Learn your triggers and let them be your cues that you are in danger of reacting. You love nursing and have 5 years of peri-op and OR experience. You are still marketable. You've overcome diversion, and you can overcome being terminated. When asked about previous employment, just say "it wasn't a good fit". Do not defend yourself or even explain. Best wishes to you, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

My answer would be the same, as in more details are needed. Culpable in what way for what mistake?

Dear Nurse Beth, What responsibility does the clinical nurse educator have to their student? If the student does something wrong, is the educator culpable for it if they observed it and did nothing? Dear Wondering, I'm an educator in the hospital setting, and if I or my colleagues observe a nurse doing something wrong, we have a responsibility to do something. Let's say the nurse inserted a nasogastric tube and was about to administer medications through it, but had not checked placement. Or the nurse was leaving the room with the bed in high position. Both of these scenarios involve patient safety. The educator would immediately stop the nurse from administering medications, and lower the bed. The primary responsibility is patient safety. I would do these things as naturally as possible, with the goal being neither to shame the nurse nor alarm the patient. Then I would take the nurse aside privately and coach him/her. Let's say it's not an immediate patient safety issue. If a nurse hung a secondary addit, such as an antibiotic, and left the roller ball clamped (common rookie mistake), I would just watch and say nothing. Within a short amount of time, I would encourage him/her to go in the room and check on their antibiotic. At this point they will see their mistake and correct it. The rationale is self-discovery, and active vs passive learning. Very effective. If you as a bystander were observing the antibiotic scenario, you might think I was doing nothing. Likewise, if I decided to speak to a nurse in private, you may think I had done nothing, when in fact, I had. Without knowing the details, I can't really answer your question about culpability. At a high level, though, yes. Students do not have a license, so the educator would have ultimate responsibility. However, newly licensed nurses do practice under their own license. Culpable as in a lawsuit? Perhaps. Culpable to the BON? Depends. To the organization? Most likely. Best wishes, my friend Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I'm a CNA at a nursing home, and some of my coworkers have shared resident obituaries on Facebook after they passed. I've thought about doing this a few times, especially with those residents I formed a closer bond with, but have always hesitated and decided against it in fear it would be a violation of privacy. My question is - is sharing a resident/patient's obituary on social media a violation of HIPAA? Dear CNA, It's not technically a HIPAA violation, especially if the obituary was published in the newspaper. Obituaries typically don't include protected health information (PHI). Still, it's not a wise decision. Your employer most likely would not sanction this, which could place your job in jeopardy. It could also violate the wishes of the family. While your co-workers make have been very close to the deceased person, and feel grief when they pass, it's still a business relationship, not a personal friendship. This is more of a boundary issue that a legal issue, and you are right to pay attention to your inner voice of caution. Best wishes my friend, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I want to continue to learn new things in the nursing field however I have many hard feelings about wanting to change to 12 hours shifts if I apply at the hospital. I am newly married and we have just started talking about having kids and I don't want to miss out their big events when they come along. If I worked 7 to 7 I wouldn't be able to get them to school or help them with homework. I have thought a lot about working in a clinic were i would have day time hours but I don't want to miss out on opportunities to learn if i did that. I am currently a second shift, 230 to 11, SNF nurse where I have been since I graduated in 2018. Dear Newly Married, Congrats on getting married! I wouldn't not work in a hospital because of kids you don't have yet. Once you get pregnant, you have plenty of time to take stock of your options. Once you have the baby, you still have time because all shifts work for a newborn As your raise your children, you can continue to adapt to what works for you and your family. For example, before they start school, working weekends may be a good fit. But once they have soccer games and activities every weekend, you may want mostly weekends off. You can't control or predict everything ahead of time, but you are in a career that has more options than most. Best wishes, my friend Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Black Plague Recently it’s been in the news that two people from the Chinese province of Inner Mongolia have contracted the plague and are being treated in Bejing. The plague has been with us since biblical times. The Black Plague is known as being one of the most devastating pandemics in all of history. The Black Plague killed millions of men, women, and children in Europe from 1347 to 1351 and is estimated to have wiped out 30-60% of Europe’s population. The Black Plague originated in Central Asia where rodents carried it to Crimea and beyond. It’s believed black rats carried the fleas that carried the bacteria. Black rats, also called ship rats and roof rats, inhabited almost all merchant ships. The plague is caused by an organism called yesinia pestis. Back when the plague was rampant it turned people’s fingers, nose, and toes black, which is why it came to be known as the Black Death and the Black Plague. It’s a swift but painful, horrifying death- victims vomit, bleed, and develop gangrene of the extremities. Types Humans are extremely susceptible to the plague. There are 3 types: the pneumonic plague, the bubonic plague and the septicemic plague with pneumonic plague being the deadliest form. Bubonic plague affects the lymph glands while septicemic plague affects the bloodstream. Symptoms appear 2-5 days after exposure. The bacteria quickly multiply in the lymph nodes closest to the flea bite and spreads to other parts of the body. Tender, painful lymph nodes, called buboes, are a hallmark of bubonic plague. Bubonic plague can lead to septicemic plague once the bacteria crosses to the bloodstream. In septicemic plague, patients present with fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Septicemic plague can occur as the first symptom of plague, or may develop from untreated bubonic plague. The time between being infected and developing symptoms is typically 2 to 8 days. While all 3 are deadly, the pneumonic plague affects the lungs and can be contracted through infectious droplets coughing or sneezing. Anyone who inhales the droplets can become infected. The incubation period can be as short as 1 day for pneumonic plague. Victims are lucky to live more than 48 hours. Pneumonic plague can often be mistaken for the flu. People with pneumonic plague must be isolated. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure. Transmission Plague is vecxtor-borne, carried by fleas that cling to the fur of rats and other animals, and infecting humans through flea bites. Plague cannot pass from human to human, with the exception of the deadly pneumonic plague. Outbreaks While most think the plague is extinct, it has not been eliminated and is very much alive today. The bacteria lives on rodents in most all continents, but outbreaks typically occur in poverty-stricken rural areas. It is found in Africa, Asia and South America. The WHO has classified the plague as a re-emerging infectious disease. There was an outbreak of bubonic plague in New Orleans back in 1914. Rat containment prevented it from becoming a pandemic. In Honolulu in the early 1900s, firefighters burned the houses on either side of a plague victim's home in an attempt to stop the spread of the disease. In recent times in the United States, plague is rare, but not non-existent. Approximately 10 cases are still reported each year. It has been known to occur in the western states of California, Arizona, Colorado, and New Mexico. Treatment People with the plague need to be treated right away. If treatment is not received within 24 hours of when the first symptoms occur, the risk for death increases. Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin as well as supportive measures are used to treat the plague. Outlook While antibiotics are life-saving, some fear that if the bacteria develop resistance, another pandemic could occur. How likely are the chances of an epidemic or pandemic in the United States? Not very. But because it is so deadly, awareness is important. Early detection is key.

Dear Nurse Beth, After receiving my Bachelor's degree in Psychology and Philosophy, I realized that there weren't many jobs I could do with that degree in a related field (I wanted to work in clinical field). I worked in the human services field for mentally disabled (and some physically disabled as well) people for 4 years and in the meanwhile, I took some pre-requisite courses to enter an accelerated BSN program. I tried two schools last year and got rejected by both. I'm re-taking two classes on-line that I did not get great grades in, of course, I cannot fix my undergrad GPA, which is barely 3.0. I will then be applying to more schools this year, which will start next summer/fall. During this time, I actually applied to 10-month LPN program in local community college and got accepted, and they've been calling me and asking me to come in and try even after I missed all mandatory orientation and registration period. My goal is to be a RN. Should I take the opportunity to go through LPN program in case I don't get into ABSN this time, and maybe find other (and slower) ways to become RN, or should I just focus on getting into ABSN now and try to start it next year? I'm just tempted to take LPN just because I'm not confident enough that I will get accepted by those competitive programs. Dear Tempted, It might not be a bad idea to take the position in the LPN program. It gives you the advantage of immediacy. You've had 2 rejections, and now you have been offered an opportunity. It's community college, so the tuition is low. It could be a way to get started in nursing while you find your path to becoming an RN. Best wishes in your decision, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next

Dear Nurse Beth, My job as a night shift ICU nurse is challenging to say the least. Morale is low, high stress, no breaks, difficult shifts, at least three patients many shifts, a lot of floating, and some passive-aggressive coworkers stirring the pot sometimes. I have decided to resign as I find it is negatively affecting me. I feel that if I am honest with my supervisor I will be blackballed and put on the no-rehire list which is a common tactic of the corporation I work for. What would be a good reason to tell my supervisor why I am leaving to protect my reputation and job history? I feel she will push for more details if I just say it's because morale is low which is what others have told her to avoid problems. Dear Decided to Resign, Just as it's smart of you to leave this environment for your own well being, try not to stress or use any more energy around leaving. There is a scripture that says "Don't throw your pearls to swine" meaning your insights will likely be wasted. You have identified low morale, high workload, floating and dysfunctional behavior- but they already know this, and so far, are not doing enough about it. While it's not likely you'd be marked as a "do not re-hire" unless they are extremely petty, there is some risk and little, if any, benefit to being honest. Very rarely do employers actually use exit interviews to make improvements. You could instead say you've chosen to broaden your working experience, or that you are leaving to spend more time with family. By making it about you, and not about the organization, your manager is less likely to push for details. Line up another job before you quit, and give the required notice. By doing so, you remain the professional that you are, and leave with dignity. Good luck to you! I hope you are valued in your next job and you land in a better spot. Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I have a co-worker who constantly violates our policy on Professional Behavior. She too is an RN and we work in a clinic. This RN has befriended patients and/or their spouses on social media (Facebook, IG). She has given patients her personal cell phone and home address. And she over shares what's going on in her personal life whether it's about her or her kids and/or grandkids. We've told our manager about her inappropriate behavior and we did have a RN meeting so that it was addressed to all of us so that it didn't make it seem she was being singled out. But the inappropriate behavior continues to happen. When is it enough already. I'm at the point that I want to transfer out of my department and go somewhere else because it seems like management is doing nothing and this RN believes this is acceptable behavior. We do have union representation with this company. Dear Inappropriate, Managers who can't differentiate between individual performance issues and general group behavior are not effective managers. Or they're just not equipped for their job. Have you tried just focusing on your own job and not this other RN? It is not your problem, it's your manager's problem. It is also possible that discipline is taking place behind the scenes and you are not privvy to it. You may be happier working in an environment where you can trust the manager to address and resolve performance issues. If so, and if this continues to cause you great stress, look for another position. Best wishes, my friend Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, Good morning. I have reached out before in fact last month. Your advice helped and we were not disciplined for a med error.. My issue now is there is a resident who keeps falling out of bed. I work on a dementia unit, locked down. He has fallen out of bed 5 times in 7 days when he returned from the hospital. He cannot ambulate, he is end stage CHF and acute kidney failure. We have put many interventions in place but he ends up on the mat before we can get there. He is the closest room to nurses station. Interventions are bariatric bed, chair alarm, recliner, mats on side of bed, bed alarm 1/2 side rails up, toileting schedule. He is out of bed from 7am-7pm.. Cna to sit at his bedside on 11-7 when they are not in another residents room. They are not 1:1. The family is not on board with hospice they are very much in denial and in turmoil so they cannot help him. His anxiety is through the roof and he has no anxiety medication they just d/c his zyprexa as we are in the window for state survey. Now they want to d/c his bed alarm for the same reason (too many restraints). I was told we will get slammed by the state which as a nurse I am my patient advocate and believe it is not safe to take his bed alarm away. I feel it is our only shot to possibly keep him off the floor. My question is this correct about too many restraints and wouldn't the side rails or chair alarm be better to remove if we have to takes something away. Thank you Dear Window for State Survey, I would make a comfortable bed on the floor at ground level. The mats can go on either side. He has fallen 5 times in 7 days and he is going to keep falling out of bed. I'm surprised that a 1:1 sitter is not assigned at all times. A sitter who can only be there when they are not in another resident's room is not going to prevent his next fall. D/C ing the bed alarm, even though bed alarms are questionably helpful in preventing falls, is not going to help your facility do better on survey. A bed alarm is not a restraint. Side rails can harm patients even when only 2 or 3 out of 4 are up, and they don't prevent falls. Best wishes, my friend Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Nicole was by all accounts a competent, caring Nurse Practitioner. Her patients loved her and her coworkers spoke highly of her. She was also the proud mother of Remy, short for Remington. Nicole and her husband had tried for 15 years to conceive and they were overjoyed when they had Remy, now 21 months old. Coworkers said she loved to show them photos of little Remy. By all accounts, Nicole was a loving, responsible parent. In the morning of June of 2018, Nicole was working at Evergreen Family Medicine in Roseburg, Oregon. That morning, she drove into the clinic’s parking lot as usual. She got out, locked her car, and went to work her shift at the very busy clinic- as usual. In doing so, she left her 21 month old baby, Remy, in the car where Remy remained for hours until Nicole returned at 4:30, when her shift was over. Nicole discovered Remy unconscious and blue. Nicole screamed for help and attempts were made to revive the toddler, but she was pronounced dead. Supporters and Haters The community quickly divided into supporters and haters. What happened to little Remy is almost too horrific to contemplate. Sides were taken. Both sides felt empathy- empathy for the mother and the suffering she would never escape from. Empathy for Remy, a vulnerable child who suffered a horrible death. The supporters felt ‘This could happen to me”. An understanding that “There, but for the grace of God, go I.” They found room for forgiveness and compassion. The haters responded with “She isn’t competent to be a mother”. Some called for Nicole to be punished. Initially charges of second degree manslaughter were filed but they were dropped. How could this happen? As we understand more how the brain works, we understand better how mistakes can happen. To anyone. She Was Out of Routine Usually Nicole’s husband dropped Remy off at daycare, but he had worked night shift as an EMT and Nicole wanted him to sleep. Thankfully, being out of routine usually results in errors such as remembering to bring in a journal to work but forgetting to take your lunch. I forgot to lock my car! I always lock my car. Oh, right, I was waving at my neighbor when I got out and walked across the street to talk to her. She Was Distracted Nicole no doubt was thinking of her shift ahead of her at the clinic. There was a lapse in temporal memory. Her brain was filled and looking forward. Maybe she was wondering who the medical assistant would be on duty that day, or if the antibiotics she prescribed the day before had helped her patient. She had to remember to ask her boss if she could order large size disposable BP cuffs and she had to renew her license soon. Did she have enough CEs? There was no trigger to cause her to look in the back-facing car seat, where Remy was soundly asleep. No visual reminder. No audible alarm. I was interrupted by my phone during med pass and thought I unclamped the secondary tubing for the antibiotic. She Was on Autopilot In the police affidavit, Nicole said “I thought I dropped her off at daycare this morning”. I thought I took my birth control pill this morning. Or was that yesterday? Called inattentional blindness, we all have operated on autopilot. Memory experts tell us that the basal ganglia takes over and suppresses the prefrontal cortex for many reasons, including when we are tired, as in the case of new parents. Kids in Heated Cars Kids do not do well in heated cars. Approximately 30-40 children each year succumb to death in overheated vehicles. Some were forgotten in cars, others accidentally locked themselves in. Babies and young children are particularly sensitive to the heat as they have larger surface areas and less efficient cooling mechanisms. A child’s temperature rises faster than an adult’s, up to 3-5 times faster. The temperature in a car can rise to 125 degrees in just a few minutes. The prevalence of back facing car seats accounts for the young age, as infants and small children can easily be asleep or not able to communicate. Rear-facing car seats look no different whether or not there is a baby or toddler inside. Conclusion What happened to Nicole can happen to anyone. It will happen again this summer, when the death toll from kids in cars typically rises. What would prevent this? Jailing Nicole would not prevent this. Maybe educating parents similar to education around infant co-sleeping and the use of seat belts. Public service announcements. Supporting initiatives to increase awareness such as Look Before you Lock and occupant detection systems. Perhaps placing a necessary item in the back seat next to the child, such as a purse or cell phone. Kids and cars.org even suggests placing your left shoe in the back seat. Most of these suggestions are to trick the brain out of autopilot and the brain state that allows these accidents in the first place. Mistakes are not intentional but prevention and compassion are. Related Articles When Nurses Make Fatal Mistakes Nurse Gives Lethal Dose of Vecuronium Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

Dear Nurse Beth, I am planning on applying to nursing school next year. What are some important things to consider when deciding between LVN and RN career pathways (besides pay, length of schooling and type of workplace desired?) Dear Deciding, LVNs and RNs both provide care. Both pass medications, change dressings, insert nasogastic tubes, and insert foley catheters. Depending on what state you live in, LVNs can hang blood, start IVs and give IV fluid but not IV medications. There are a lot of similar tasks but the responsibility is different. An RN must oversee the care provided by an LVN and retains accountability for the plan of care as well as for patient education. An important consideration is career choices down the roads. As an LVN, your options are mostly limited to bedside care. As an RN with a BSN, you can stay at the bedside but you can choose to go into Infection Prevention, Case Management, and much more. A BSN prepares you to manage pt populations and effect change on a larger scale. Best wishes, Nurse Beth Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!