Gizmopup1

I am a nurse who is currently going for my ARNP. (But I am not a new grad - I have been around the nursing field for several years.) I don't think there is anything wrong with wanting to aspire for higher in your career, whether it be to become a nurse manager or an FNP, or any other higher job. And if someone has the time, the opportunity, the desire and the finances to continue their education, I think that should be applauded, not discouraged. Will there be a saturation point in the future? It is possible, but I doubt it. There are too few schools offering FNP degrees, FNP degrees are not cheap or easy to get, and like Salty pointed out there are not enough people wiling to be preceptors. (I posted about this yesterday.) I think there are a lot of young, ambitious people out there dreaming big. Maybe not all of them will reach their goals, but there is no harm in dreaming!

I have been nursing for many years. Like most nurses, I was given the Healthy People 2020 report, which talked about the benefits of bringing ARNPs into the forefront of healthcare as a way to reduce costs and meet the demand of the public. Like many nurses, I also wanted to expand my career opportunities and applied for an advanced degree. Because of where I live, I ended up going with an online program located out of state. (To attend a brick and mortar” university for my FNP degree would have meant a 2 hour drive each way, which would have become a barrier over time.) Over the quarters, I have been a good student. I studied hard, got good grades and did all the needed assignments. People at my work and in my community seemed excited at the idea of me assuming this new role. Then it came time to locate and secure a clinical site and preceptor. All the support and positive feedback magically went away. I started approaching locations of all kinds looking for preceptor hours that would meet the criteria. Clinics where my calls had previously been welcomed suddenly would not return my calls. Doctors and FNPs at my work found every reason why they couldn't be preceptors. Or I was shuffled though HR phone trees until finally reaching an HR manager who stated their group or organization would not consider precepting students from non-contracted schools. I would have taken this personally, but when I spoke with one HR manager at a charity clinic about the need for preceptor sites for students, she stated that she has also been approached by universities in my area who, too, are struggling to locate willing clinical sites and preceptors. And other students also talked about the difficulties they had. So apparently, even high end schools are struggling with this need and being told no.” Why? Students come with liability insurance and healthcare experience. We usually come with good credentials and references, or else we wouldn't have been accepted to school. We usually have a strong desire to excel and contribute to lightening the workload of the day. So why this resistance to helping students meet the critical need of preceptor hours? I remember the old expression of nurses eating their young, and I think we have come a long way from those days. But now we need to raise the bar. We need to also think about feeding and nurturing future ARNPs by providing willing, open doors to clinical sites if we are to truly meet the aspiring goals sited by Healthy People 2020. There is a need, and that need is now. What needs to take place to get more healthcare sites and clinics willing to take on students?

I don't think hospital nursing is dirtier, but I hated it for different reasons. After 5 years of hospital work, I also left and haven't looked back. I became a very good Home Health nurse because I can appreciate the job and I like focusing on one patient at a time. Yes, patient homes can be just as dirty if not dirtier than many hospitals, but I feel I can make a better impact with my talents and help people. Not every nurse wants to work in an ED or on a unit. And just because they don't doesn't make them less, like some of these previous comments imply. (One of the reasons I hated inpatient work was bad attitudes from coworkers) I say good job to your friend for recognizing she wasn't a good fit for her previous job. I hope she finds something she likes better. Luckily, nursing has a lot of options to chose from!

This is such as shame, and I agree there seems to be a fear and intimidation towards wounds that I would love to see regular nursing not have. A little caution is good, but fear and avoidance is not. Confident wound care is such an important piece of nursing! How do we get past this intimidation?

A big part of my job is doing wound care. I work in Home Health, and I like floating versus case managing, so I see a lot of patients in a lot of different circumstances. One thing that comes my way a lot is cellulitis wound care. In most cases, cellulitis follows a pattern: The onset stage, where the leg is swollen and red. The stage where the cellulitis is weeping and possibly blistering (usually the patient is in the middle of or completing treatment for the condition. And then at the end is the recovery stage where the legs shrink back down and scab over. Normally, in the case of someone who is able to get up and move around afterwards, the scabs will fall off on their own over time and with normal washing. But with bed bound patients, they don't get that movement and activity to cause normal slough. So these old scabs and huge chunks of dead skin stay on unless a nurse spends a little energy and attention on cleaning off the dead skin. This can be done with soaking the skin with wound wash or water and rubbing (not dabbing!) gently with a gauze or soft washcloth. Most of the time the dead skin and old scabs slide right off. What I am finding is too many nurses are afraid to do this. They believe if they cause any of this dead skin or old scabbing to come off, they are going to damage the healthy skin below. But this dogmatic approach to all skin at all stages of healing is leaving elderly patients with skin like pine tree bark, covered in layers and layers of barrier cream and gauze when they don't have to be! And we are performing ongoing wound care on wounds that healed months ago! Why are we lightly washing and treating dead, stuck scabs? Assess the skin: If the skin scales appear dry and flake off easily with intact skin underneath, this is a good indicator that some of this dead skin can be removed. Asses the chart: If the cellulitis or edema resolved weeks ago, there is a very good chance the scabs and old skin have done their job and just need a little coaxing to come off. Now does this apply universally to all patients? Of course not! But I am seeing too many nurses afraid of really cleaning and assessing wounds.

I have been working as a nurse for over 15 years. I also worked a lot of retail in my life and know how fun it can be! I see nothing wrong with holding onto your old job until you get settled into your new position completely as an RN. As a new nurse, you will not be the person management will be calling to cover extra shifts for a while. However, as you do get oriented and integrate into your floor, there will be an expectation that you will be a team player for your unit and help fill in for sick calls, high acuity and vacations now and then. This means you are going to have to make choices about how to spend your work week hours and balance your work/life. A discount isn't all that great if you are too exhausted to use it. You will also need to think about the eventual fairness to your retail family. I'm sure your retail manager will also want you to be available when they need you, and not have to play second best week after week. Luckily, you do have some time to make your choices, so enjoy your retail perks for now! You will know when the time is right to let the first job go and be a full nurse.

I can't help but think this is a big symptom right here - "No one gives a damn." This is why we are seeing honor students (and many other people) on drugs, why we have so much depression, and why we are breaking down as a community at large. Is it really such a bad/offensive thing to have something you are proud of displayed on your car bumper?

This was my thought as well. Even though the author denies this article has a negative tone towards a large population of older new nurses coming into the field late in life, why even bring it up? We aren't supposed to be assuming anything about age, race, gender anyway, so why assume older nurses would have 10+ years experience or that nursing has been their only career choice?

Something about this article smacks of age-ism. Why do we consider the desirable new nurses as only age 25 and below? I am one of those "second career" nurses who came into nursing in my 30s, and where I might have lacked in hands-on nursing experience I more than made up in customer service skills, research skills, and perspective. I don't consider myself less for not having made nursing my only job. And the amazing thing is that when I look around at my work, after having nursed for 15 years, I am still pretty average aged. And since I still have about 20 years before I plan on retiring, I am studying for my FNP. So my two cents - Instead of making stereotype assumptions about people based on their appearance (something we are trained not to do!) that we take some time to get to know the people we work with. You might be surprised at what they have to offer!

When does teamwork cross the line into craziness? I love it when people feel passion and become involved in my cases, but this past week has been a little overkill! A great example of this was my last admission into Home Health services. The patient was a middle aged woman with few financial resources who was suddenly surprised with a serious cancer diagnosis. She is probably terminal, but is not yet ready to sign into Hospice services, and so is accepting Home Health services for support until the time she is ready to accept Hospice care. The admission itself was very straightforward and revolved around starting nursing visits, sending a few DME items (she is still mostly independent but lives in a small space and doesn't want a lot of visual reminders of the decline to come), and then making initial contact with her attending and his staff. And yet….. How many people in my agency felt they needed to make it their business to send their opinions, advice and input to me on this case? Yes, I know she is more appropriate for Hospice care, but the patient doesn't want it… Yes, I know it is cheaper to send out a full orificenal of DME equipment all at the same time, but the patient doesn't want this… Yes, I know her hospital report stated she has pain but she says it is managed….. I felt I spent more of my time fielding busybody questions from staff at my agency than actual admission of the patient. And after fielding so many questions, I began to wonder if the people in my agency didn't trust me or my nursing expertise? How do you handle situations like this in your practice? Is there a nice way to let people know that there are too many well-intended chefs dipping into the pot?

I have worked in Hospice for many years in many roles. I have seen situations like this story so frequently and also feel there is huge room for improvement. There are several ways we can improve and prevent stories like this from happening. We need to have honest, open dialogues about end-of-life care and caregiver needs BEFORE family members actually start to decline. This means we need to start writing to Reader's Digest, AARP, and other visible sources read by the public and start bringing up the topics of How much does caregiving cost?” How will we afford care for Mom/Dad?” Who will care for Mom/Dad 24/7 should paid caregiving not be an option?” Hospitals could even hold monthly workshops on the topic and cover important questions like What is involved with caregiving?” How much is intermittent paid caregiving?” and What does outpatient Hospice offer and cover?” We offer this for new parents, why not families of the elderly? I would love to see more families having open conversations about decline and what the plan will be when someone does decline and need constant care. I agree with the previous posted who mentioned media portrayals of aging and death. It seems like when we do portray death, it is rare, fast and clean. And that there are way more portrayals of miracle cures and success stories than honest portrayals of dying. I think if more families had a chance to prepare, end of life could be less traumatic.