42pines

I became an RN (ADN) at age 52, did Med/surg then Adult ICU then found Occupational Health Nursing which I've excelled at for ~12 years. The problem is that I'm 69 and have had 8 really, positive interviews over the past 6 months, all for which I am eminently suitable (I have the experience/certs, etc.) but have not been hired. I have heard the words "we'd like someone who will stay with us for a long time." I also realize that hospital wage models will not hire a RN with 17 years experience (too much $) when one with 2-3 years will do. I suspect I'm being "priced out of the market." I'm doing an ADN>BSN currently and very near the end. "Not" nursing for a long time (an employment gap of even 6 months) is bad. So I applied to an agency and was accepted as a flu clinic/wellness clinic (BP, BMI, Lipid profile, etc.) PRN nurse at about 70% of what I usually pull in. So I go in for orientation/training (which I could teach) finish that in two hours then get a question: "Would you consider being the nurse for a "small," nursing home? The home just happened to be a short drive from where I live--that's nice. Then I thought, "I know nothing about geriatrics/LTC (excepting that I am geriatric). My company had me do a LTC "exam." OMG, it was like taking the NCLEX again--it was difficult, but I achieved an 89, so I guess I did remember some of what I learned 19 years ago. At any rate, I took the job. I really liked the "director" who is an LPN and liked all of the current "residents," and the CNA's seemed quite happy too. It is obvious that this small (19 bed) facility has had issues with state inspectors, so there is a lot of learning to do to come into 100% (if that is possible) compliance. It's not a "skilled nursing facility," it's more an "assisted living facility," but being responsible for 19 residents is scary. Don't get me wrong, at my last job I was sole "practitioner" (agreed--RN's are not Practitioner) for a industrial site with over 700 employees. Cardiac incidents occurred about 2x a year, I do have a clue--but how well will this translate to elderly/frail elderly, I'm not quite sure. This house's acuity is very, very low, so I'm as concerned with compliance. I'll take each resident and learn meds/conditions in turn. Any suggestions for a newbie to LTC? Top 5 tips? Any good books out there? It's likely that I'll be back here picking your experience. What do you think about a 69 yo RN newly moving into geriatrics? I'm finishing a BSN and will try to find a decent but cheap ANP degree in adult/geriatric. Btw I intend to continue nursing until someone tells me "go home and retire." Dr. Leila Denmark is my role model, she was an active pediatrician until she retired at age 103. Google her, what a remarkable lady.

I haven't a clue as to why the "not using your real name, picture, city of residence" perpetuates. Allnurses has links to Linkedin. Many, including myself pretty much have everything, photo, where I work, and email contact. I think that the "not use real name" is a thing of the past. As for preceptors, though it's been over a decade, I've had two. One, named Rene was absolutely wonderful, a real gem who often held me close to the fire but pulled me out before I got burned and in ICU that's a real skill. The second caused me to leave ICU and no it wasn't me. On the very first night that I had this preceptor the Senior male ICU nurse said to me: "Oh, you're working with xxxxxxx now?" I said "Yup." He said: "how long." I looked down at my watch and smiled and said: "Oh, about 15 minutes." He responded: "Has she made you cry yet?" Well, she never made me cry, cringe yes, but the short of it was that after a week I gave notice and quit that ICU though I loved the job. I've never met a person so mean and one night coming home I was so stressed I took my BP, it was 220/160. The next day I gave notice. A preceptor can make or break a new nurse, it's as simple as that. And hat's off to those preceptors who give so much of themselves to help a new nurse. And be careful of preceptors where not one single penny is given to the preceptor for the extra work involved--and there IS extra work. Some places demand nurses do precepting and then do nothing to lighten that preceptor's load, and perhaps in some cases those forced into precepting do not make good ones.

Bravo for doing the Advanced Trauma care certification. You'll never know, perhaps all the training in the world might still not have saved that boy, but then, every bit of learning that we do just might give us that edge that saves a life. American nurses really cannot understand the differences between what is available in other countries unless they spend time overseas. If Maylasia is like Thailand, where I've lived, few that run ambulances really have any adequate training and depending on where you live, there simply may be no trauma center. Here in America the nurse that wouldn't help would likely face "abandonment" charges and at a minimum would likely have her license revoked by the Board of Nursing. In Thailand, that would not be the case, and it may not be in Maylasia. Thanks for sharing and keep up the good work.

I hear about nurses strikes, groups protesting about forced over time, poor pay, no raises, overstaffing... As the years pass it just seems to get worse. An interesting article entitled: "The U.S.: Where Europe Comes to Slum" puts America's job situation into perspective. (If I'm allowed to post links, if not search using the title): http://www.informationclearinghouse.info/article28173.htm It tells how " companies — not banks, primarily, but such gold-plated European manufacturers as BMW, Daimler, Volkswagen and Siemens, and retailers such as IKEA — increasingly come to America (the South particularly) because labor is cheap and workers have no rights. In their eyes, we're becoming the new China. Our labor costs may be a little higher, but we offer stronger intellectual property protections and far fewer strikes than our unruly Chinese comrades." It tells how far America has already fallen, for instance: "German manufacturing workers, making the world's most sophisticated products and machinery, earn on average $1.50 for every dollar that American manufacturing workers make." In 1982 at a party I commented to someone that America was going to face hard times and that it would not end until wage parity occurred. I referred it to the "Third Worlding of America" Well, it's been happening. "Boston Consulting Group, concludes that when you compare China's soaring wages and still-low levels of productivity with our stagnating wages and rising levels of productivity, the price advantage of manufacturing in China instead of the U.S. will shrink to insignificance by 2015. Investment in the U.S., says the group, "will accelerate as it becomes one of the cheapest locations for manufacturing in the developed world." So the good news is that Occupational Health Nurse jobs will increase in a few years, and I'm one. But it paints a picture of how it is not just the working environment nurses but eventually the effect will be felt by all workers. Yet when this sort of abuse occurs, and so many of us see it in Nursing today, eventually there will be reaction. I predict that by 2018, even contract, temp and part-time workers will become unionized. This will be so because more and more of us will be forced into contract, temp and part-time work, and if you are there, many of you already know how this can be with reduction of wages, no or worthless benefits, no job security and ill treatment. Sure this will not affects some, ER nurses, CICU, NICU, CNRA's will be exempt but if you are a rank and file nurse--watch out. Though so many of my nursing compatriots think ill (and rightly so) of Unions because of their overzealous actions and demands in the past two decades, most Unions have lost tremendous powers. But as the Unions came to be because of worker abuse, it seems that likely the pendulum will swing again, and the reaction will be increased unionization, including the nurses who once thought ill of Unions. As an American I feel saddened to read this article, but it makes a lot of sense and the problem extends beyond Ikea, T-Mobile, Siemans and BMW; as our entire country's standard of living falls (if only by stagnation) we are already included. Perhaps 7 years in the future once again I will suggest nursing as a career to young people--I used to, but stopped about 3 years ago. That would be nice.

"Written in a Carefree Mood": Old man pushing seventy, In truth he acts like a little boy, Whooping with delight when he spies some mountain fruits, Laughing with joy, tagging after village mummers; With the others having fun stacking tiles to make a pagoda, Standing alone staring at his image in the jardinière pool. Tucked under his arm, a battered book to read, Just like the time he first set out to school. Written by Yu Lu around 1300 Attitude helps and so does physical exercise and practicing on yourself what you would recommend to others.

"The" nursing shortage came about in the late 2000's. (1988-2002 and on). It had a dual cause that fit together nicely. From '83-86 there was a wave of consolidations. Big hospitals ate up little ones, Nursing homes consolidated, on and on, Managed care and Insurance changed, greater efficiency came about with less staffing because things became consolidated and as such less staff were needed. At the virtual height of this marked change, the Pew Charitable Trust, the largest philanthropic organization in the world did a "blue ribbon panel" investigation into the future of nursing. The prior 5-8 years showed increasing efficiency and decreasing staffing needs. The stats were there, accepted fact: "fewer nurses were going to be needed." Unfortunately the report did not look closely enough at two items: First the age of nurses working, and second: the tsunami of baby boomers about to hit the osteopathic wards. But who listened to the Pew Charitable Trust's report? Well, schools did, by the hundreds, after all schools are (in case you didn't know) simple business profit centers. And a poor outlook made many schools reduce and often close nursing programs. Why try to sell education when the market will not be there. Many schools closed, and some reduced their output by 1/2 or even 3/4. Then the tsunami hit, and we had a huge shortage in the late 2000's and especially the early years of the next decade. But around 2005 schools "saw the light." My college over the next three years tripled the output of RN's opening satellite locations. The fact is there is a glut in many areas, and a shortage in others. It is not uniform by any means. But I cringe to think that someone earlier said there was a shortage because nurses were unwilling to work for $5 and I'm inclined to nod my head. No it's not really $5 but the point is well made. Today you are far more likely to get a job as "contract" with no or lousy benefits. I think you are far more likely to find your unit understaffed. And sadly, with the economy dying, I suspect it'll only get worse. And for those who say "Oh the economy is getting better," please go to Yahoo and look at a USD/CAD, or USD/AUS or the US$ versus any other major currency. In 2008, $1000 US dollars got you $1,600 Australian dollars. Today $1,000 US dollars gets you $930 Australian dollars. That means that the US$ has dropped a whopping 42% against the Australian dollar. And don't think it will only affect SE Australia wines, which by the way, have gone from a low in 2008 of about $4 to a current ~$13. Eventually since this is a global economy, it will effect us everywhere. Today you only see it in oil, gold and other commodities. But I'll bet that everyone "feels" the ground swell, your wallet just doesn't seem to be as efficient as it was a few years ago. What does this mean for nursing--a lot. Our country's currency IS crashing and burning. It is losing purchasing power left and right. The result is there will be less and less money that will need to go farther and farther and guess who is expected to take up the slack? Hint: You. Fact 'o life--batten the hatches and full steam ahead fellow nurses. Get tough, make do, and do the best you can with what you have--and if you get stepped on, walk--you have experience and experience sells. And for the newbies, realize that you are at a very, very harsh place in nursing history, do the best you can.

Go and ask the Nursing Director. Often even when there is a waiting list, the Director rules, and will occasionally fit someone in. Done that, been there. I became a nurse accidentally--I was in a MT course (Medical Technologist--a lab rat) but my classmates were soooooo boring that all my friends were nurses. They kept trying to get me to apply (I didn't even know there was a waiting list). Eventually I happened to talk to the Nursing Director and she said: "Well, we happen to have an opening." She didn't, and I had no clue until after a year went by. I have no doubt that she looked at my grades first though. Volunteering might hold big points at one school and nada at another. What universally hold true though, and I cringe to say this, is that Nursing Directors loathe having someone "not make the grade." "C's" do not make the grade I hate to say. Often a B or even a B- does. What I'd suggest is talking to the Director, and explaining that you intend (if you in fact will do this) taking the A&P courses over again. Act embarrassed, they want competitive. You will find it easy since you've done it once, and if you come out with an A- or A it will make nursing life a lot easier! After 8 years of nursing, if I get the chance I'll take them again and I got a B+. Every day I realize how little I know about A&P. I'm not trying to be overly critical, they are tough! coures. This holds doubly true at a competitive college where a drop-out or knock-out (failed to make minimum grade) is often seen as an embarrassment. My best friend was "knocked-out" by one single point on a final exam! Really. Just my harsh reality two cents.... feel free to flame me anyone.

Personally, I'd think twice about an MPH. They are a dime a dozen with little opportunity. This is not true with a PhD of Public Health. I'd suggest looking into a school that has a dedicated Occ Health Nursing Practitioner degree, going there, and finishing your BS. By doing that at the same school you may be able to breeze through the NP program. University of Alabama, UNC, Simmonds College/Harvard, comes to mind. Search for NIOSH research center colleges.

Odd, are you asking for yourself or for another? You say: "What would you recommend to a new grad planning an OH career? How do we claw back our professional credibility? Or do we bother?" In America for a new grad I'd recommend at least six months in Med/Surg, then transfer to ED or ICU (via a fast-track course of study) and spend a year there. Then I'd recommend, or while still working at the above if possible, accruing the 1000 hours of Occ-Med work necessary to sit for the COHN-S exam. Then I'd work for a year or two in an environment where you can get some quality exposure to Occ-Med stuff. Then, because let's face it RN's are NOT in shortage at all, and I think that will get worse since schools have doubled or quadrupled their RN output over the past 4 years, (My alma mater has) I suggest quitting and becoming an Advanced Nurse Practitioner in Occ-Med via a NIOSH Research college. Now you have the necessary background to make $70 to 90,000 US$/year. Four years ago I'd see a dozen ads for Occ-Med RN's, today I see a dozen ads for Advanced Nurse Practitioners and maybe one for a RN part-time. You of course have an MSN, but the ANP especially from an Occ-Med program is highly saleable. As for global, since you're from Oz, I certainly hope that Occ-Med improves. After all, though not in Oz, but in Asia, all the jobs that caused all the RSI's, Ergo, and toxic exposures have simply been shipped from the US (and maybe from Oz too) to China, Malaysia and so on. It saddens me to read that there seems to be little interest internationally because the price tag in 20 years will be monumental.

Being in Houston and with your background I'd suspect a low of $60k to a high of $75k annually with decent bennies.

Yes, it is too much to ask for names--sorry... Try this agency, I hear they mean what they say, and say what they mean: Brnuemup & Queec Nursing Agency: 1) Not one of our contract nurses have expressed a single complaint, we have 100% satisfaction. 2) Every nurse is guaranteed to become permanently hired by the company that they work for within a reasonable amount of time. 3) We give you loads of opportunities so that you can become highly educated in your field. 4) Compensation is guaranteed to be adjusted annually. 5) We've heard of your quality work and we need you, come join us. 6) Generous benefit plan: Physicals, and eye care are free. We have a quality medical insurance plan. Of course reading between the lines: 1) They know better than complain. A hint of complaining and *poof* bye, bye. 2) Reasonable amount of time = 60 years. Wel, it's reasonable in a geological scale! 3) You've got a local library--dummy, use it! 4) Who said compensation was to be adjusted "up" doh! Be real. 5) Ho hum, you sound naive, and of course we need you, too many of our nurses have died from stress already. 6) Of course physicals and eye care are free, gosh--you do that for all employees, why not help yourself? Yes, we do have an annual medical insurance plan, and you only pay $100 per month, but what you don't know is that TOTAL maximal benefits combined is $1000 per year. And yes it does say unlimited emergency room visits and the plan will pay up to the maximum allowed each time, but what you don't know is that the maximum allowed is $20 per visit. (This insurance policy is very real--not imaginary! It was the last one I had). Oh, if you did not "get it" at the start, go back and read the name of the agency slowwwwwwwwly.... I predict that within 5 years there will naturally form a new Union called the Grand Union of Contract and Part-time workers. The Unions (which ultimately became too powerful and a problem in themselves) were formed by abuse. Unfortunately, today, almost all of us are faced with abuse in our work.

Hmmm....that's sort of like saying: "I'm going on a trip, what shall I bring?" Are you going across town? Or perhaps Thailand, or Nepal, or maybe Alaska? I'm not trying to be mean here, but the question is nebulous because you haven't given us a clue as to how big the place is, and what they do. > I've held 3 Occ RN positions and about a dozen part-time ones. At a paper mill I responded to things like 5 workers exposed to poison gas. At a major gun factory my biggest issue was sound issues in firing ranges, lacerations due to machinery, and safety consulting. At a 700 person hi-tech factory my biggest issues were annual mammograms (setting up a program); vision checks (we used a lot of lasers) entrance physicals; workers' comp, and headaches. At GM my biggest issue was splinters, lots and lots of splinters, believe it or not. But at many of the small jobs I had my biggest issues were anxiety, support for unexpected pregnancies; fixing boo boos, and at some, where permitted, doing CEU work on the computer. > My advice is that if you are interested in Occ Med, grab it! If no experience is needed, all you might have to do is "be there." And you can become pro-active, go sit in the cafeteria once a week over in the corner and in a bit of privacy do BP checks. That will start a chain reaction and people will come to you about everything and anything. If your place of work has motorized vehicles, machinery and situations where you could run into trauma--enroll in a local EMT class. Audiometry is not always required, if it is, let your company send you to become COHC (Cert. Occ. Hearing Conservationist), if they want you to do spirometry, let them send you to school for it. You may not even have to do much regarding Workers' Comp. At some places you will be expected to be the person who contacts the state and runs the program, if so, learn, the state can give you what you need. The hardest thing in Occ Med is getting experience. Becoming COHN used to require 2000 hours of experience, now they have reduced it to 1000. Look into AAOHN, get their books and read them, and then eventually become COHN by taking the exam. Then you are (were) golden. ("were" because industry has been so badly hit in this economy) > Remember, the worst that can probably happen in a place where "no experience is required" is a person comes in, sweaty, clutching their chest, having difficulty breathing--in that case, you know CPR already, you call 911, or security, get your AED, lay the person down and try to keep them calm. Every nurse is faced with that scenario. Practice that scenario (in your mind, or play-act) weekly. If you need to use the AED, heck, they're dead already--all you can do is help. Also practice using an epi-pen, and make sure that is the one thing that they have on hand! (besides the AED) > *lol* In my first job I had a fellow that had been stung by a bee--no prior allergies. But he started looking not so good, I called my boss on the phone and started to say: "How do I know when to give someone epi..." and then "added, forget it, call you back." It became obvious real fast--and it was nice that I had play-acted that scene because all I had was a vial of epi. It was remarkable at how fast that epi worked! (yes I 911'd him also).

There was a fellow who went through the UAB NP Program that used to post here, but I cannot (looking back) find who he is. He didn't do the distance option though. It's a highly rated program and I'll be applying myself (but not for distance) in the next month or three. I suspect that it's realistic as you'll end up doing clinical with someone in your own area. The book learning can be done anyplace and it really doesn't make any difference where the clinical work is done. I prefer being there, it's just my style. I thrive on the energy of others with similar interests.

Sounds like you'll be wearing a lot of hats. It won't be so easy for them to simply give your job to another... For me much would depend upon benefits. If it came with good medical, matching 401k, etc. I'll be willing to work for perhaps $29@hour. But then I have no idea how expensive it is to live in the Houston area and you'll need to adjust for that. MA where I had my last job had an income tax, NH where my former job didn't, so just to break even I had to get 5.3% more than I would in NH. I wouldn't think you'd take less than $30/hour, and I wouldn't think you'd get more than $35--maybe that helps, but again, I really don't know pay rates in Texas. (Edit:) Oops... I just saw the words "staffing agency." Evil words if ever any existed...good luck. I hope it doesn't begin with "A". Contract agencies, for the most part (from my experiences) are to be feared....

Personally I cannot overemphasize the value of doing some CNA or LNA work. You get a first hand experience, from the inside, of what it's like to be a CNA, so in your future life you'll probably appreciate them and know how to deal with them. But more importantly, even spending four months as a CNA gives you amazingly invaluable experience in "handling people." Nursing school, be it LPN, ADN, or BSN often throws you into clinical with little preparation and you are faced with two major factors. You are faced with anything from assessment to catheterizing someone, in short the "procedures." But you are also faced with bathing, moving, and interacting with your patient. As a CNA bathing, moving, and a lot of person-to-person skills will become so second hand that you no longer really notice them. Then while others are fretting at how to wipe butts properly AND do an assessment, you got to simply assess--since the personal care is so ingrained it involves no stress. You are free to enjoy the learning experience of the procedure at hand. The trick to enjoy nursing, be it in school, in the Med/Surg ward, ICU, or wherever is to be able to minimize stress. If you can afford to, take your time. Moving like SuperNurse may fatten your wallet, but I guarantee it will increase your stress level.