Archive for July, 2008

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Nursing Specialties

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Specialty Nursing at Ultimate Nurse

Welcome to the Nursing Specialty section of UltimateNurse.Com!

If you are a Nurse – an RN or LPN interested in learning about a Nursing Specialty, or just researching Specialty Nursing, then you have found the right place!

Below is a list of Specialty Nursing resources offered by Ultimate Nurse.

We hope you find these to be quality nursing specialty resources. We work hard so we can say that Ultimate Nurse is:

“The Ultimate Destination for Nursing Information!”

If you would like to see additional information about Specialty Nursing, please feel free to contact us any time. We are more than happy to help you find the information you need.

While you’re here, please visit one of our Travel Nursing site sponsors:

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Our Specialty Nursing Guarantee — At Ultimate Nurse we pride ourselves in providing only the best Specialty Nurse information. We have fully researched these Nursing Specialties and are 100% confident that they are relevant and useful resources for Nurses. If you feel like any of our Specialty Nurse pages do not meet the highest of standards please do not hesitate to contact us or leave feedback in our Specialty Nurse Forums.

-Ultimate Nurse Staff

Nurses Don’t Need to Feel Stuck

Posted in Nursing, Travel Nursing

Nurses Don’t Need to Feel Stuck

Historically, workers hired on after high school or college at the plant, the office, the mill, the mines. etc. and worked there until they retired. This loyalty was expected and those who didn’t follow this rule were scrutinized. Typically a gold watch was the prize for years of service upon retirement.

A couple of decades ago, workers began to figure out that the power to negotiate better benefits and higher salaries was to change jobs every few years. Slowly, nurses have begun to learn this as well.

It’s still easier for many nurses to hire on at the local community hospital and work there until they retire. And no doubt, there are some perks and advantages to longevity and seniority. However, there are still far too many nurses who are unhappy in their job and underpaid because they have worked there too long.

When there is only one community hospital in your hometown and you’re a nurse, that’s generally where you work. That comfort zone is hard to break out of. But nursing offers so many more options.

Nurses often love being nurses, but they don’t like their jobs. They don’t like their boss or some co-worker(s). They don’t like the days and shifts they have to work. They always get stuck working holidays and weekends. They miss out on their children’s activities. They never seem to get a full thirty-minute meal break, much less have two-hour power lunches.

Too many nurses feel stuck. They have worked on the same unit for so long they don’t think they can do anything else. The only option is to quit; and all too often that happens.

This has created a tremendous problem in the nursing profession and it is finally beginning to be explored. A significant number of nurses are not working as nurses, and yet we are approaching a critical shortage of nurses.

Unhappy nurses and those who are burned out, present a significant patient risk. Health care has no room for apathy. Burn out is stress taken to the nth degree. Stressed out workers make mistakes.

Continuing education providers and many employers are beginning to implement better programs to assist nurses to transition to other roles and fields. Nurses who have spent their career working with adults often pine for pediatrics, but feel completely incompetent and vice versa.

ICU nurses finding themselves completely depleted of adrenalin may be looking for something a little less stressful and yet need a mentor to help them slow down in the world of med/surg nursing or even home health care.

Home health agencies have begun to discover a gold mine in bringing retired nurses back into the field. Many of these nurses retired from nursing to raise families and now in their late forties and fifties, are ready to return to the workforce, but reticent to return to the hospital floor. Agencies have developed return to nursing programs to retrain these nurses and are finding them to be terrific employees.

Travel nursing can be a great option as well. It doesn’t always mean leaving home. If you live in or close to a large metropolitan area, you can explore the assignment opportunities at a hospital across town. Certain mileage restrictions apply, and high prices of gasoline can be an issue. However, living in your own home, you may receive a stipend for housing that you can apply to you gasoline costs.

If it’s time for a change in your career, don’t burn out. Move on!

By Kathy Quan RN BSN
Kathy is the author of The Everything New Nurse Book, and the owner/author of TheNursingSite.com.

The Nurse Practice Act

Posted in Nursing, Travel Nursing, Uncategorized

The Nurse Practice Act

Have you read your Nurse Practice Act lately? Do you understand your Scope of Practice? The Nurse Practice Act is a set of laws which protect the public from harm. It defines the formal education needed for a particular level of nurse and sets the regulations for licensure.

Click here for info on YOUR STATE’S nurse practice act.

The NPA defines the nurse’s scope of practice based on the content of the formal education and level of nurse. It is different for an RN and an LPN/LVN. It is also different for a Nurse Pratitioner.

Know Your Scope of Practice
The Scope of Practice defines your role as a nurse for the locality where you are presently practicing. This can vary from one state or province to another. If you are a travel nurse, or are moving to a new state, you need to read and familiarize yourself with the NPA and Scope of Practice for that state or province before you begin work.

You may not use the excuse that you aren’t familiar with your scope of practice as it is part of your role as a nurse to know and understand it. The NPA and scope of practice can be changed as education requirements change. Read your NPA often and stay abreast of changes in your state or province.

Take note that just because you acquire a set of skills or knowledge base from experience or observation in the course of your job, it does not mean you may perform them without certain limitations. In addition to your NPA you also need to be familiar with your present job description and the rules of your facility.

For example, the NPA may state that RNs can give IV push medications, but if your facility says that all IV push medications are to be given only by a certain level RN or even a physician, then you are not allowed to give that medication if you don’t meet the criteria set by the facility.

Each state board of nursing in the U.S. develops the NPA for that state. You can find a link to each state’s board of nursing here.

Don’t Overstep Your Scope
You are also responsible not to overstep your scope of practice regardless of what your employer may ask of you. This can be especially important if you don’t work in a traditional healthcare setting. Even within a healthcare setting, employers are notorious for asking nurses to stretch beyond their scope of practice to perform duties which can be questionable. Your responsibility as a nurse is to protect the safety of your patients.

DO NO HARM
New nurses in particular can often be intimidated into performing skills that they have not performed before, or not been checked off on, because the unit is short staffed and there isn’t time to find a preceptor or supervisor to help you with the procedure. This is really unacceptable and nurses need to remember the first rule of all healthcare, DO NO HARM. Don’t perform something you have never done before without appropriate supervision!

If you are a travel nurse and your skills need to be checked off before you are able to perform a procedure independently be sure you do so.

By Kathy Quan RN BSN
Kathy is the author of The Everything New Nurse Book and author/owner of TheNursingSite.com.

Do You Love Nursing and Hate Your Job?

Posted in Nursing, Nursing Jobs, Uncategorized

Do you love nursing and hate your job?

Most nurses will tell you that they love being a nurse, but they don’t like their job. Being a nurse is never easy. No one ever said it was going to be. It can be one of the most rewarding and yet physically and emotionally draining professions.

Then add in the fact that there is shortage of nurses so you’re bound to be overworked and inevitably underpaid. So what can you do if you don’t like your job? Try a new one, or change something about your job that makes it better for you.

Change is never an easy thing to live through. The degree of change will directly affect the degree of difficulty. So sometimes just a little change is all you can handle. However, sometimes a big change is what you really need. Avoiding change is not the answer.

Deciding what and how to change things can be frustrating and all too often, nurses just give up all together and leave the nursing profession. This happens most often when the nurse is completely burned out. S/he has nothing more to give and has no energy to focus on what to do and how to make things better.

Before you get to this point, stop and take care of you! Nurses are great at teaching others how to care for themselves, but they don’t listen to their own advise. You have to put yourself first and take care of you so that you can continue to take care of others.

You must do something everyday to replenish yourself. Take fifteen minutes to do something just for you. If that means locking yourself in the bathroom with a good book, a piece of chocolate cake, some knitting, crochet or other needlework, or just a few minutes of piece and quiet; just do it. Soak in the tub, or give yourself a facial. Or just sit and take deep cleansing breaths.

Men seem to be natural at doing this regularly. They often burn off their frustrations shooting some hoops or lifting weights. Exercise is a great way to leave your frustrations behind you. A run or a brisk walk can do wonders for anyone’s spirit. Whatever you do to make a little time for yourself, do it regularly and look forward to it each day. Reward yourself.

You may find that you like your job after all. If not, you’ll be better able to focus on what you need to do about it. Begin by making a list of the things you like about your job (if anything) and then the things you don’t like.

See if you can focus in on what it is that you need to change. Look at the things on your list. Is it the people you don’t like? Or one person in particular? Is it the days or the hours? Is it the kind of patients? Is it the setting? Is it the money?

All of these things you can change. Some you may be able to change more readily than you think. But do something about it. The longer you stick it out, the more unhappy and frustrated you’re going to be.

The nursing shortage works in your favor because you have options. A transfer to another department may not be easy because your boss will probably try to block it and not lose your warm body. But talk to him/her and explain your frustrations. Perhaps a trade can be made with another unit for someone who’s unhappy there.

If the main problem is your boss, you can always say that you’re burned out and you need a change. You don’t have to point fingers. That’s not going to change things. You are the one who needs a change and you’re asking for his/her help to do it.

Sometimes you may have to quit the job outright and find another. The beauty of the nursing profession is that it offers so many choices. Don’t let yourself believe that you’re stuck! Try something new. Browse choices here.

By Kathy Quan RN BSN
Kathy is the author of The Everything New Nurse Book and author/owner of TheNursingSite.com.

The New Kid on the Block

Posted in Nursing, Travel Nursing

Are you the new kid on the block?

Whether you’re a travel nurse starting your first or a new assignment, a new nurse grad, a float nurse, or you’re starting a new job, being the newest nurse on a unit can be intimidating.

A smile and a positive attitude go a long way in breaking the ice and starting off with a good impression. Take the lead and introduce yourself. Shake hands if appropriate. Remember this is not always acceptable for cultural reasons, for the germaphobe and for those who don’t like having their space invaded. But offering a hand even when not taken can be seen as a warm gesture.

There will almost always be at least one nurse who is cold and indifferent. The one who resents you being there for whatever the reason. Typically this is because the travel nurse makes more money, a new grad knows nothing, a float nurse will take no responsibility, or a new nurse threatens her territory. Sometimes you can melt the ice and other times you just have to let this person be and stay out of her way.

Your presence on this unit represents a double-edged sword. They obviously need your warm body, but they fear being burdened by a newbie who needs extra help. You can help to ease this situation by first recognizing this dilemma and then dispelling their fears by showing that you are here to help and not to be a burden.

Arrive early and be prepared. Bring your lunch, snack foods and a water bottle. Don’t bring all of your valuables and expect to have a safe place to put them. Lock them in the trunk of your car or leave them at home. Your essential licenses, ID and a few dollars can fit easily in a small pouch or wallet that fits in your pocket.

Make sure you have pens and your own stethoscope. A small notebook or PDA will show that you’re organized and ready to take a few notes. Ask for a quick tour of the unit and make note of where things are such as the linens, the kitchen, the med carts, the crash cart, the charts, and general layout of the unit. Then as you have time, explore these areas and familiarize yourself with the unit.

Hospitals sometimes divide floors into units with no clear delineation. Patients and visitors are often confused and go to the wrong nurse’s station. If you have a list of room numbers that belong to your unit, you’ll be able to sort it out more easily.

Observe the staff and learn about the “culture” of this group. Do they work together as a team? Do they all get along? Or do they all just do their job and not interact unless absolutely necessary? Who are the natural leaders? Who are the trouble makers?

Get your own work done and if you have time, offer to help others. If you have to ask for help with something, come prepared to return the favor. Remember that when a nurse has to stop and help you, his own assignment will be impacted.

Finally, don’t engage in gossip. You will hear plenty. Listen politely and go about your business. If co-workers pressure you to comment or take sides, just say you understand their positions, but you’re too new to have an opinion and get back to work.

By Kathy Quan RN BSN.
Kathy is the author of The Everything New Nurse Book and the author/owner of TheNursingSite.com.

Is Organization on Your Skills List?

Posted in Nursing, Travel Nursing

Is organization on your skills list?

Organization is an essential skill for nurses. Whether you are planning out your day, providing patient education or preparing to call a physician about a patient, having “all your ducks in a row” is of extreme importance.

Yes, many nurses are not organized and somehow they do manage to get through the day, but their stress levels are usually quite high. Taking the time to make sure you have dotted all the i’s and crossed all the t’s the first time around can save you a lot of heartache and frustration.

For example, you know that whenever you have to call a physician, he’s going to want more information. If all you can say is that your patient is still having pain after one dose of Tylenol #3 (acetaminophen with 30 mg. codeine), you’re going to be bombarded with questions.

If you’re prepared and provide the physician with a complete report of recent vital signs and a list of other pain measures you’ve tried along with a complete pain assessment, you’re likely to have an easier time requesting a repeat dose or additional medication.

When completing your charting, if you have a list of notes to review, chances are that your documentation will go faster and be complete and accurate.

In addition to your daily routine, keeping track of your professional information is important too. Learn to organize these items. A small file box or even a shoe box can be an easy way to keep track of this information. Make copies of your license(s). Put reminders on your calendar about renewals. Create a file for your ceu information and certificates. Keep a copy of your skills list and resume in a file and review/update them quarterly. Include any new skills, education, and experience you have gained.

You can and should also have electronic copies of all of this information. Scan paper copies such as licenses and certificates. Keep this information updated and accessible on your computer. Add a password to the file if necessary. You can also copy these files onto a CD which can be password protected as well. Put a copy in a safe deposit box or other safe place.

If you are a travel nurse, you will need access to this information often. Keeping it all together in one place will assist you in applying for new assignments efficiently. If you have access to both hard copies as well as electronic copies (i.e. .pdf or .doc files) of your information you will have options for emailing or FAXING the information quickly.

Keeping your CV or resume updated can be very rewarding. You never know when someone will ask for it and offer you an exciting opportunity. If you have to stop and create one, you might lose out.

While you’re at it, be sure to include organization to your skills list as well as your computer skills and proficiency with various software.

By Kathy Quan RN BSN.
Kathy is the author of The Everything New Nurse Book and author/owner of TheNursingSite.com

Tips and Tricks for Travel Nurses

Posted in Nursing, Travel Nursing, Uncategorized

Tips and Tricks for Travel Nurses

Make the most of your travel nurse opportunities. Here are a few tips and tricks to assist you.

One of the best tips any travel nurse will give you is to do your homework. Read travel nurse blogs and nursing forums where travelers share their experiences both good and bad.

Another important tip is to understand an assignment fully before you accept it. Ask questions.

Be super organized. Know where all of your documents are and have them up to date.

Have a current resume and a list of all your skills and talents. Be ready to send it as a Word or .pdf attachment to an Email or to FAX it to your recruiter or hospital.

Have copies of your license(s) and lists of all recent CEUs. Know which states are part of the Nurse Licensure Compact. There are 22 states which accept each other’s nursing licenses. Rhode Island has signed the agreement and will implement it in July 2008.

Make a list of states where you would eventually like to travel. If they are not member of the Nurse Licensure Compact, know how to contact the state’s board of nursing to obtain a nursing license if needed.

Keep all licenses up to date. Let the ones you don’t intend to use again become inactive.

Have an open mind and be flexible about assignments. Some agencies refuse to let nurses be too picky about which units they will or will not work. However, make your career goals known to your recruiter.

Take care not to burn bridges. The health care world is small and mobile. You never know when you may cross paths with someone again.

If something sounds too good to be true, it probably is. Always read the small print and ask questions. Never make assumptions.

Be professional at all times; even when you’re not on duty.

Accept responsibility for any mistakes you make, learn from them and move forward.

Be careful how you word and share any bad experiences. State facts, not opinions. If you had a bad experience, say simply that you “would not recommend” an agency, hospital, unit etc. If someone wants details, do it privately over the phone.

If you have to get out of an assignment, discuss it with your recruiter and agency first. Give them as much notice as possible. If there’s a problem that they can try to fix, let them try.

Life happens and there may be a time when you have to get out or refuse an assignment last minute, but be sure your situation is legitimate. And make it be a rare occurrence.

Express your goals and needs in writing to your recruiter so that there is not a possibility of errors. When they change, update your recruiter. Important things to include would be who travels with you (family, friends, pets), any special needs you have such as handicapped access, close in parking, security arrangements, etc.

Travel nursing can be an exciting career option. Make the most of your experiences. Be organized, prepared and professional.

By Kathy Quan RN BSN

Kathy is the author of The Everything New Nurse Book, and author/owner of TheNursingSite.com.

More About Travel Nursing

Posted in Nursing, Travel Nursing, Uncategorized

More About Travel Nursing

Travel nursing offers nurses the opportunity to see the country while working at various hospitals on a short term contract basis. There are even some opportunities to travel to other countries.

If you live in a large metropolitan area such as Los Angeles, you can even live in your own home and be a travel nurse. Your commute has to be at least 50 miles one way, but in large cities and counties that is quite possible. And there are probably several hospitals you can rotate through.

Even in a rural community, if you live at least 50 miles from the local hospital you can contract through a travel nursing agency to work as a travel nurse in that facility. Some restrictions may apply and can vary from agency to agency and hospital to hospital.

Most travel nurses want to see the country, meet new people and learn about the cultures in the various regions of the U.S. They sign on with a travel nursing agency and accept an assignment in the region they want to explore for the next few weeks or months.

A travel nurse may reside in the northeast, and want to get away for the winter. Travel nursing positions are plentiful in California, Arizona and Florida. But they are available in all 50 states as well as a few foreign countries such as Spain.

The travel agency will negotiate the contract, help you with licensure in the state you wish to travel to and assist in finding housing nearby. They may also assist in your travel arrangements and in finding means of transportation in your new city.

Some travel nurses may choose to drive to their new location to ensure they have a familiar car. Some travel nurses have RVs which they take on the road with them. This minimizes the need to pack and unpack frequently. The agency will then assist you to find RV hookups for the duration of your contract.

Any special needs should be discussed well in advance with the travel agency such as pets or family or friends who will accompany you to ensure appropriate housing can be arranged.

Many travel nurses are married and/or have children. Sometimes the couple may both be nurses or one is a nurse and the other a physical or occupational therapist. Therapists can also find travel assignments and the same agency may be able to place both of you. Or they may work in cooperation with a travel therapist agency.

Children usually need school and after school care arrangements made. The travel nursing agency may or may not be prepared to assist you with these arrangements. Be sure to discuss this option when deciding on an agency to represent you.
Always be sure you understand an assignment before accepting it. Hospitals depend on these agencies for staffing and there may be serious penalties for failing to carry out a contract.

By Kathy Quan RN BSN
Kathy is the author of The Everything New Nurse Book, and author/owner of TheNursingSite.com.

Negotiating a Travel Nursing Contract

Posted in Travel Nursing, Uncategorized

Negotiating a Travel Nursing Contract

There are a few essential points to consider about travel nursing contracts. When interviewing a potential travel nursing agency, ask for a blank contract to get a feel for the things they typically include and negotiate.

Next, ALWAYS read each contract before you sign it. Don’t ever assume they are all the same, no matter how long you’ve been with this agency. Know what you’re agreeing to. So take a few minutes of quiet time to read it through carefully.

Before you ever accept an assignment, be sure you understand exactly what the assignment is. What type/size hospital is it? Which unit will you be assigned to? Who’s the nurse manager? What shift you’re expected to work; how many days/hours, which holidays, weekends, etc. What kind of orientation is included? What’s the dress code? Do you need scrubs, uniforms, or any special equipment? Will you be expected to draw your own labs? What is the float policy? What are the nurse-to-patient ratios? How many RNs, LPNs, and CNAs or unlicensed assistants will you be working with?

What is the actual pay? Are you salaried or hourly? What benefits are included and when do they start? What is the cost? Do they cover your family? What about liability insurance? Who pays for your travel expenses? Who arranges your itinerary? Can you work more hours?

Then you’ll need to do some research about the city and the hospital. What’s the population? What’s the median: age, level of education and income? What do local nurses make? What’s the cost of living? What’s the crime rate in this community? What kind of weather conditions can you expect?

You’ll also want to know all the details of the housing arrangements. Sometimes you’ll have a small apartment. Will it be furnished? Sometimes it will be an extended stay residence hotel. Sometimes it will be a standard motel or hotel room. Is there a per diem for meals? Will you have a kitchen and is it equipped? Are you expected to have a roommate? Who actually pays for this? Are you expected to pay and be reimbursed? What amenities are available or nearby? Will you have a rental car? What about security issues? Where do you park? Is it a secure or gated building or community?

Other considerations include any family or pets you may have and expect to accompany you on this assignment. Make sure the agency knows about them and makes necessary arrangements. You don’t want to find yourself in a strange city with your Labrador only to find out you’re not allowed to have him in your new apartment or hotel.

Discuss your own arrangements that may save the travel company money. Occasionally, you may have some of your own plans in a location. You may have a relative to stay with and don’t need housing. Sometimes your spouse carries the medical/dental benefits and you don’t need those. Perhaps you have an RV and won’t need housing, but will need RV hookups which cost considerably less than an apartment or hotel room. You should receive a stipend or an increase in your salary or hourly wages to cover these cost savings to the travel agency.

Make a list of all the things you need want and expect in your travel assignment and make sure they are all included in the contract. Don’t rely on an oral agreement.

Don’t ever accept an assignment until you understand it fully and are seriously ready to live up to the agreement. Hospitals depend on these agencies to provide quality nurses. The agencies depend on the nurses to fulfill their obligations. Life happens and there will be times when a travel nurse has to back out of a commitment, but these should be rare.

By Kathy Quan RN BSN

Kathy is the author of The Everything New Nurse Book, and author/owner of TheNursingSite.com.

Finding the Right Travel Nurse Company

Posted in Travel Nursing, Uncategorized

Finding the Right Travel Nurse Company

There are many travel nursing agencies to choose from and not all are the same. You will have to do some homework to find the right travel nurse agency for you. Guaranteed there will be travel agencies advertising on nurse Websites all over the Internet. Click on the ads and start researching.

The first thing to be aware of is that some agencies entice nurses with ads promoting huge salaries for travel nurses. Take this with a grain of salt as most of the time these figures represent much more than just your take home pay. They include such items as benefit packages, sign-on or completion bonuses, and moving and housing allowances in addition to the actual gross pay.

The nursing shortage has created and helped to sustain the travel nursing field for over twenty years. Hospitals are willing to pay huge sums of money to fill voids and vacancies. Travel nursing agencies make money off of having nurses to fulfill these contracts. So another important factor to consider in finding the right travel nurse company is where are their priorities and loyalties.

Without nurses, these agencies have nothing to offer. Nurses need to remember this and demand an agency treat them well. The agency needs to negotiate in their favor and go to bat for them should the need arise.

In finding the right travel nurse company, you need to do your homework, and you need to learn about other’s experiences and then to interview prospective companies to determine a good fit for your specific needs. Seek out information on travel nurse blogs, websites and forums. Network with travel nurses and find out what they know about travel nurse companies.

For the new travel nurse, some agencies are just better prepared to help than others. Some depend largely on experienced travel nurses to fill their contracts and others are more willing to work with novices and mold them to fit their needs.

You will need to consider YOUR needs first.

  • Where are you thinking about working? What state and what type of facility?
  • What kind of experience do you have? (ER, ICU, psych, peds, OR, etc.?)
  • Are you traveling alone or with a spouse, children, friends, pets?
  • How much help or support do you need?
  • Are you able to figure things out on your own with minimal guidance?
  • What are Your needs in regards to finances, benefits, housing, career goals?

Some of the specific questions to ask of an agency include:

  • How long they have been in business?
  • Are managers and recruiters nurses or health care professionals?
  • Where do they place travel nurses? (What states or countries?)
  • What kinds hospitals do they work with? Teaching hospitals, community, rural, and what trauma level?
  • How long are their typical assignments?
  • Do they pay travel expenses?
  • Do they offer hourly or salary assignments? Are they flexible with this?
  • What kind of benefits do they offer, the cost and how soon do they start?
  • What is their typical housing arrangement? (Apartments, extended stay hotels?)
  • Is someone available 24/7 to assist with problems?
  • Can you expect personal service and assistance?
  • Do they have any nurses willing to speak about their experiences with the agency?
  • Why are they the best choice in a travel nursing company?

Remember that you are in charge of your career and always have the freedom to change agencies. Do your homework and find a travel nurse company that best fits your needs. After some careful consideration of the assignment, you should be ready to try travel nursing.

By Kathy Quan RN BSN the author of The Everything New Nurse Book, and author/owner of TheNursingSite.com.

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