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Showing posts from 2012


Remember your first code?  That time when you see that first patient under your care go into respiratory or cardiac arrest?  Haven't had one yet?  It will come, soon enough.

Responding to a code takes some training.  Simulation has gone a long way in helping new healthcare providers respond better to that first emergency.  It doesn't mean that first time doesn't make you freeze up; make you cold with fear that whatever you do will not be enough; of having to talk to the family, comfort them if things do not go well.

Any emergency response requires training.  Anyone who thinks that in the face of danger, they will respond heroically and with a clear head has never actually been in that kind of situation.  Ask any soldier who has gone through battle and many will tell you the first time in the face of real danger did not necessarily go as they had been told in training.  They did not necessarily respond as they thought they would, as they would have wished.

It is the fallacy…

Did you hear? Nurses are the most trustworthy profession in the US AGAIN!

Update Your Ethics

The International Council of Nurses is the international representative body for nurses worldwide.  They work with professional nursing organizations and countries to help create supportive policies for nurses and their clinical practice.

Their most recent addition to the policy world is their revised code of ethics.  "The 2012 revised edition includes the nurse’s role in developing and sustaining a core of professional values, creating a positive practice environment, maintaining safe, equitable social and economic working conditions, sustaining and protecting the natural environment and contributing to an ethical organizational environment."

You can access the Code here for free in PDF format:

And while you're there, take a look around to see what ICN has to offer.  Get to know your global representative!

Where the Jobs Are: 2012 Report

The American Association of Colleges of Nursing (AACN) published their most recent report about employment rates for new graduate nurses at the bachelor's and masters levels.

The good news:

Employers prefer BSN graduates these days and those preferences are reflected in hiring numbers.Job offers at the time of graduation for BSN nurses doubled between 2011 and 2012 to 57%.There is no variation between public or private nursing schools in terms of job offer rates.Four to six months after graduation, 88% of new graduate BSNs had jobs.MSN graduate were the most likely group to have jobs at graduation and within four months of graduation. The bad news:

Geography matters for job placement. There are more jobs in the Midwest and South.  The West has the fewest.New associate degree and diploma program graduates are facing more barriers to hiring in hospital settings.  Slowly, their job options are becoming limited to long term care facilities and other non-acute care settings.Major urban …

Unhelpful Legislation

"Unhelpful" is about as nice as I can phrase it.  In the US state of Georgia, a state dominated by Republicans who extol the virtues of small government and less regulation, the party voted in legislation that has made the licensure renewal process for healthcare professionals extra burdensome and requiring additional paperwork.  Of course, since government spending also had to be cut, they reduced the staff that processes licenses.

What's going on?  Georgia now requires healthcare professionals to submit proof of legal residence, legal work permit, or citizenship to get their license renewed.  That is ALL healthcare professionals, even those born in the US.The initiative is supposed to "weed out" anyone who might not actually be qualified to practice and got a "false" license.

NPR reportson the consequences to healthcare professionals, especially those who received their education outside the US or who were international students when they completed t…

The 32 Hour Work Week for Nurses

Sometimes it's nice to see research that confirms a hunch you've had for a few years.  A recent study in Health Affairs, one of the most influential health policy journals in the United States, looked at the effects of 12 hour shifts on patient satisfaction and nurse burnout rates.

Turns out, results are not good.  The longer nurses worked in a day, the less satisfied patients were with the quality of care.  In addition, nurses working 12 hour shifts were more likely to become burnt out than those working fewer hours.

On the overtime policy front, that's good news for nurses.  The study adds just one more reason why mandatory overtime is bad policy.  It should create incentive for staffing units appropriately and closer to the California standards.

From another perspective, we know why nurses like 12 hour shifts.  Let's face it, 3 days a week of work and then a bunch of days off in a row, so many sometimes that you don't have to use vacation days if you can set y…

Global Health: Critical Worker Shortages

The UK's Guardian provides a useful infographic for understanding global critical health worker shortages.  You can get a nice visualization of how severe health worker shortages are and the consequences to infant and maternal mortality.  
The countries listed in the infographic are places where recruiters should not actively recruit healthcare professionals because of the devastating consequences those practices have on low and middle income country health systems.  You can read more about fair and ethical recruitment practices here.
If you're a Nurse Executive and your facility is considering hiring internationally educated nurses to fill staffing shortages, check this list in the infographic first before entering into agreements with recruitment companies domestically or abroad.  Sustainable recruitment is only possible if it is done ethically.
For more information about fair and ethical international recruitment practices, check out the Alliance for Fair and Ethical Recrui…

US Nurses: Vote Today!

Nurses: There is no excuse not to vote.

There is too much at stake this year that affects the health of our patients.

Be a smart voter and choose five major issues that affect your job and your patients' ability to get care and services.  Take those five issues and make sure you study how candidates at all levels, from local representation through the president, match up with your perspectives.

Voting because of a single issue or stance by a candidate is not good critical thinking.  The world is too complex for your vote to come down to one single thing.

Finally, if you experience any voting issues, or are the subject of intimidation from other voters, poll watchers, or election site workers, please call1-866-OUR -VOTEfor legal assistance at no charge.

More Great Nurse Stories from the Storm!

Have you wondered how elderly and ill individuals who are stuck in their apartments are doing?  The Visiting Nurse Services of New York City and related agencies are still on the job, even in the midst of the storm!  The New York Times article linked above covers their dedication to their patients, even when it meant climbing the same distance as halfway up the Empire State Building.

And special thanks to Stephen Colbert for the kudos to NICU nurses at NYU Medical Center.

The Colbert Report
Get More: Colbert Report Full Episodes,Political Humor & Satire Blog,Video Archive

Disasters & Teamwork

The New York Times (photo from the article) details how challenging it may be for coastal hospitals to deal with the new realities brought on by natural disasters.  Bellevue Hospital, the nation's oldest public hospital, had to evacuate yesterday when its generators failed. Hospital staff had been sending fuel up 13 flights of stairs through bucket brigades to keep them running.

For all the craziness that happens during disasters, they are also some of the times when teamwork happens at its best.  It would be great if that kind of teamwork could happen all the time, albeit without moving patients down stairs due to non-working elevators and hand pumping respirators.  One of the biggest challenges I hear about from former students is navigating the complexities of teamwork between staff members.  Depending on the institution, in some places it is the nurses; others the nursing assistants.  Physician dynamics vary so much between teaching and community hospitals that you never know…

More Reasons to Love Your Chosen Field

Seventy-five stories to sustain you in your work and on those bad days, remind you.

Nurses & Disasters

Read about the amazing nurses and hospital staff at NYU Langone Medical Center who had to evacuate hundreds of patients when the back up generator blew out on this story on NPR:
This is one of those times when things like disaster drills and JCAHO inspections really matter.  Even the best prepared places can face devastating consequences.  
BRAVO to all the nurses and so glad you all are getting the recognition you deserve!

Global Health: A New Kind of Capacity Building

Capacity building for healthcare human resources comes in many forms.  This seven year program in Rwanda puts a new spin on it by having a public-private, international partnership funded through redirected international aid dollars.

I am the first to admit this is a shameless plug for a great program my employer, NYU College of Nursing, is participating in through a university consortium.  I'm involved with the team studying the impact the program will have on patient care, nursing education, and health systems outcomes.

If you're thinking about a career in global health, its good to learn about these types of partnerships.  They can mean great opportunities for field experience, the chance to learn about designing and conducting research, and most importantly, that real impact on people's lives requires a long term investment.  If you want to work in global health, you have to be willing to wait to see results and know that the changes you help to make might not be evid…

And we're back

My apologies for the long hiatus.  Although I am funded to have a semester free of teaching, grant writing has taken up all of my time recently.  Yet once again, students are inspiring me to write so here's what to expect in the next few weeks.

How to be a smart nurse voterWhy I'm voting for...Choosing the right masters programTransitioning in your first year in the hospital Here's hoping your semester goes well and you had one of those great nursing moments with a patient recently.

Mighty Nurse!

Mighty Nurse: A good all in one resource site for finding US nursing jobs and sharing frontline stories.  No matter where you are from, those frontline stories happen in your town, state, and country too.  Good nursing cartoons too for when you've had THAT kind of day.

Global Health: Did you ever wonder why....?

Students who begin studying global health issues start to realize how complex health challenges are in many countries.  Sometimes a combined history lesson in economics, sociology, and politics provides a lot of helpful explanations for "why things are the way they are."  The Center for Global Development (who does a great global health blog) has an excellent presentation about the complexity behind social and economic development.  When you have some time, click here to watch the 45 minute presentation.

X Degree to BSN: The Next Step

You have an AD, Diploma, LPN, possibly even an NA degree.  Ladies and gentlemen, it is time to go back to school.  For 500 reasons I am sure you can name as to why you should not, I'm going to provide a few as to why you should..

To start,a BSN provides you with more job security than you currently have.  Whether it is a hospital or community setting, most non-clinical positions who like to hire nurses require a BSN.  That degree is more security for you in the long run than your current degree.  More income?  Depends on which level you're coming from.  In the long run, however, a BSN provides you with the most flexibility.
It doesn't matter if you do it online, in a classroom, or in some other format.  A BSN means more money, more job security, more career options in the long run than you can possibly imagine without it.  You become an example to your children with a college degree.  You say that no matter what, you can go on at any age, under any circumstance and get a c…

Global Health Careers: Volunteering

Volunteering is a great way to test out if a global health career is in you future or not.  In the majority of cases, that first volunteer trip you'll have to pay for yourself.  I would encourage you to do your own fundraising for the trip and not take out additional student loans whenever possible;
So, that first trip.  It can be life changing or reinforce that you really like working in your home country.  In my case, I volunteered while on study abroad through my university.  While I was mostly doing observations, it was enough for me to realize that global health was the way I wanted to go.  In particular, after observing nurses in Mexico and where they worked, I knew I wanted to study human resources development.  
For other students I've had, however, the trip abroad made them realize how important it was for them to work in their own country.  They realized that the problems at home were enough for them to tackle and they felt more comfortable working domestically.  It …

Surviving Spinning Plates: You Must Eat

In my 17 years as a nurse, the most common phrase I have heard from new graduates, even experienced nurses, is "I didn't have time to eat."

That's crazy.  Not eating when you're working is not only not good for  you, it's not good for your patients.  Here's why.

We're back to pathophysiology again.  When blood sugar drops, so does your energy, your short term memory, and your general ability to think clearly.  Think about what that does to your patient care skills.  You might miss important details, forget to check something, be late with a medication, any number of possibilities. That puts your patient at risk.

When you're working in a good place, your co-workers, the charge nurse, and the manager should make sure you get a chance to take a break and eat something when your working your shift.  In fact, they have to; it's the law (at least in the US).  Sure, nurses don't get long breaks for meals and can rarely go off site, but they do ge…

Global Health Careers: Getting Started as a Nurse

One of the most frequent questions I get asked by nurses and students alike is about building a global health career.  This is always music to my ears because more nurses need to work in global health at every level, from the frontline to the policymakers at international health organizations.  
The good news: There is no single, "correct" path to take.  The bad news: There is no single, "correct" path take.  In light of that, let's focus on a few basics first.
If any of the following freaks you out, a global health career is probably not for you:  Working with few resourcesClinical practice that can, at times, be a bit fly by the seat of your pantsManaging systems that have little or no structure to them, or so much structure that even the people who live and work with them can't figure them outDealing with poverty so extreme it's in your face all the timePeople speaking other languages around you makes you uncomfortableYou live life certain …

Surviving Spinning Plates: You Must Drink

It's 11:00am.  The shift started at 7:00am, maybe even 6:00am.  You've gotten through administering medications, assessing patients, are still working on helping people bathe, and maybe putting out a fire or two.  Breakfast involved a nutrition bar that you ate in three minutes because hey, eating that early in the morning doesn't always agree with you.  Physicians have finished rounds and you know a stream of orders is going to come your way sooner rather than later.

So, did you drink anything yet?  Anything besides your morning wake up beverage, whatever it might be?

If you haven't, it's time to start carrying a water bottle with you.  Yes, water is great for hydration, your skin looks great when you drink it regularly, but it has a more important function for a nurse.  It forces you to urinate.

Nurses are really good at ignoring when they have to go to the bathroom.  Dig back in your brain, however, to your pathophysiology course.  Ignoring the urge to urinate…

Coming Soon - Regular Features

I've received a lot of positive feedback about the blog so, thank you!  In light of that, I've decided to do some regular posts on specific topics.  You can sign up to receive emails of the posts above.   
Here are the working titles and suggestions are welcome.  
Surviving Spinning Plates For new graduate nurses, these posts will include survival tips for getting through the first year.  Evidence-based, of course!  The NPR post about nurses and their working conditions inspired the title.For experienced nurses, share your stories from the frontlines and what you do to get through the day and make sure your patients get excellent care.Global Health Careers A frequent question from my students is how to build a career in global health.  Posts here will offer some case examples and advice from experienced nurses who work around the world on the frontlines, making policy, and conducting research.Conversations with M&J Veterans from the recent wars in Iraq and Afghanistan need eff…

Spinning Plates

Once again, NPR comes through with a really good story and quotes one of my mentors, Linda Aiken, at the University of Pennsylvania.  The story describes what nurses in the United States are managing in hospital roles.

If you're an experienced RN, the story probably sounds pretty familiar.  With Baby Boomers aging, hospital admissions are rising even though the state of the economy causes people to delay care to save money.  That means sicker patients.  But this isn't a new story.  Since health reform in the 1990s, patients who enter hospitals are sicker than ever before.  New evidence, technology, and modes of care ensure that more people survive conditions they wouldn't have even a decade ago.  But the price means busier nurses.

What does this mean for new graduates entering the field?  First, it means you can expect to feel totally overwhelmed for the first six months on the job.  Your practice becomes focused on task completion and trying to organize yourself.  You ma…

Job Background Checks

NPR had a great story today about how much any company, including healthcare facilities and organizations, can ask about you in a background check.  From their post:
Hiring Do's And Don'tsEvery state has different regulations regarding which types of information employers can solicit from job applicants, but here are some general guidelines. Generally OK To Ask About:
Aliases/previous identitiesProof of age if hires must be at least 18Legal status to workCriminal convictions or pending chargesEducational attainmentMilitary serviceNot OK:
Questions that lead to disclosure of ages above 40Citizenship/national originalRaceReligionSexual orientationMarital statusSometimes OK
ArrestsDisability — questions can be asked about ability to perform specific required task but not about general level of disability, treatment or time missed in previous jobs.Source: Les Rosen, Safe Hiring Manual

Report from the Job Search Frontlines

With most Spring graduations now finished, new nurses everywhere move forward with studying for the NCLEX-RN exam as their next step.  Maybe there's a little time off in there too that at least involves a few days of sleeping late after the intensity of nursing school!
For non-nurses reading this blog, the NCLEX-RN is the professional licensure exam diploma, associate degree, and bachelor's prepared nurse take to ensure they are safe to practice and deliver patient care.  Yes, all three levels of education take the same exam.  Why it works that way is a longer story for another day.
Meanwhile, anecdotal and utterly unscientific reports are coming in from former students of mine.  Here's what they're saying about the 2012 nursing job search.
1) Time: It's taking between four and six months to find an entry level job.  That time frame includes the time spent studying for NCLEX and waiting for permission to test to be processed.
2) Locations: Cities are still slower t…

Thank You, Sheila Davis

It's not often a major news outlet puts up statistics like these for the world to see.  Thank you Sheila Davis, Partners in Health, and the Huffington Post for getting this information out there.

Networking & the New Job Search in Nursing

Greetings!  Am back from the end of semester hiatus where my teaching team and I had to deal with 4,700 grades for my course this semester that had 289 students.  No, I'm not exaggerating.  Of course, there was a flurry of emails (mostly polite) about grades and points etc..  My experiences the last couple weeks inspired this post.

Like it or not, new graduate nurse or experienced one, who you know will help you get a job.  Every job search book says the same thing.  Now, you might not want to work for a parent's really good friend, like my student in the previous post was contemplating, because that will add other challenges to your first year as a nurse or other employment situation.  Nonetheless, networking is key to the job hunt.  So where do you begin?

First stop: Your Professors & Clinical Instructors

Sometimes you just find a professor or clinical instructor that you really click with and learn more from than you ever thought possible.  Most of the time, those people…

The New Graduate Job Search - Part II

A random encounter with a student on the street outside my office inspired this one.

After usual greetings, the conversation went something like this:

Student: I have a job offer on a med-surg floor at the hospital where I've been voluteering.

Me: Great!  That's fantastic.

Student: Yeah, but I'm not sure I want to take it.

[Inside my head, there are two scenarios going on:

Scene 1 - Twenty something me who had a job offer in a market similar to this one yet turned it down, went elsewhere, then spent 8 months looking for a staff nursing job wants to say: "Dude, don't do it.  TAKE the JOB!"  Now, I have no regrets about my past choice but it would have made some things easier in the long run, like my student loans would be closer to being paid off...

Scene 2 - Echoing in my ears are howls of dozens of other students who graduated in December and have spent months looking for work.  They'd love to be in the same position.]

[Back to the street]

Me: So why don'…

The New Graduate Job Search

My RA, Andi, recently decided to take a job in a rural part of the US.  It was not an easy decision. She currently lives in New York City, where so many want to live and work.  It is the place where most of my students want to stay working, but it is among one of the 4 hardest markets to try and find a job in the US.  The others include anywhere in California, Denver, Boston, and Philadelphia.  Aside from the excellent nursing schools in those places, they are also top choices for living.  Andi even wanted to work in a public hospital where she could work with under-served populations and practice her Spanish.  With the economic crisis and healthcare reform on hold, however, public hospitals have a hard time hiring.

Andi is a great example of taking an unconventional chance when it comes to the new graduate nurse job search.  By choosing to go to a rural area, she's getting to work in her first choice area: step-down ICU.  She found a wonderful hospital with a culture that is supp…


Welcome!  Here's a site that might prove useful to you as the nursing student, practicing bedside nurse, and nurse seeking a career transition. My students were the inspiration for this blog as I discovered I was having the same conversation over and over: Nurses need mentors and there are too few out there.  Hopefully, this site will lead you to some helpful insights, essential humor, and support for those challenges and high moments that involve being a nurse.  I will try to post regularly (I think weekly might be feasible) with exceptions made at the end of the semester when grading for large classes takes a lot of time.

You can email me with questions about (también en español y mais u menos em portugués): Surviving nursing school, the job search (AD, BSN, MSN, PhD, Post-Doc), career progression (to grad school, or not to grad school, that is the question!), and working in global health.  Am sure other topics might come up and I hope I can help there too.  Meanwhile, in the in…