Permanent Placement

Accelerated Programs Offer a Fast Track to Nursing

Posted in Independent Contractor, Nursing Jobs, Nursing Specialties, Per Diem, Permanent Placement, Travel Nursing, Uncategorized

If you are reading this and you are considering a career in nursing, an accelerated or fast track nursing program may be the answer for you, especially if you already have a bachelor’s or master’s degree in a non-nursing discipline. An accelerated nursing program allows you obtain your BSN in as little as a year or your MSN in as little as three years. How can this be accomplished?

Accelerated nursing programs utilize the coursework you have already taken such as biology, anatomy, and the social sciences. In addition, accelerated nursing programs do not take breaks between semesters or courses, and usually require that you carry a heavier course load, while at the same time participating in an intense clinical training process. (more…)

Fostering Effective Communication in Nursing

Posted in Independent Contractor, Nursing, Nursing Jobs, Nursing Specialties, Per Diem, Permanent Placement, Travel Nursing, Travel Nursing, Travel Nursing Company Reviews, Uncategorized

Effective and clear communication is critical during the countless interactions that occur between health care professionals on a daily basis. The staff should know how to communicate effectively with one another so that appropriate information is shared in a timely manner. When effective communication does not occur, the patient’s care is compromised.

The Joint Commission, which accredits and certifies more than 19,000 health care organizations and programs in the U.S., states that communication problems have long been cited as a root cause in the majority of the cases studied. The Joint Commission’s Sentinel Event Database reports that hierarchy differences, conflicting roles and power struggles can all lead to communication breakdowns which ultimately compromise patient safety and the quality of care.

Communication, at its most basic level, is the exchange of information between people, groups or entities. (more…)

Travel Nursing in a Faltering Economy

Posted in Nursing, Nursing Jobs, Permanent Placement, Travel Nursing, Travel Nursing

A couple of weeks ago, I spoke with a friend who works for a travel nursing company in southern California. He got into this field because he felt that the nursing field was going to be a sure bet in this faltering economy. Now he’s nervous and not so sure about the security of his job.

Many hospitals in southern California have apparently cut way back on their need for travel nurses at the present time. This is especially true for general med/surg nurses. Many specialty areas such as ICU, NICU, telemetry, etc., are still looking to fill positions, but too many of the applicants only want med/surg and are still demanding high salaries. They aren’t finding too many options here.

With the current economic downturn, nursing will remain more recession proof than most careers, but nurses have to be realistic in their goals today. Hospitals are looking at every possible way to cut costs. Paying high salaries for med/surg nurses is one place they have cut back, whereas they may still be willing to pay for specialty nurses they cannot recruit from their own local community.

In many communities, nurses who had left nursing to raise families or to retire early, have returned to work. Retirement funds such as 401Ks have been lost or significantly impacted, spouses may have lost jobs, and extended family members may be in dire need of financial assistance. For a nurse returning to work after a long hiatus, med/surg is probably the best place to start out and rebuild confidence and skills, so these jobs are scarcer.

One factor that is somewhat beyond the realm of economics is affecting hospitals. This has been a very slow flu season in most of the country. The flu shot for 2008-9 seems to have been effective, and cases are more widespread this year.

In recent days however, the news seems to indicate that this may change. There has been a mutation in the flu specimens of late that appear to be resistant to the Tamiflu antiviral medication. This may result in more complications as patients find that their symptoms are not weakened by this medication.

In a bad flu season, hospitals can become inundated with the elderly and chronically ill as well as the very young. In a slow flu season, censuses remain low and the need for nurses diminishes.

With few elective procedures being performed these days, hospital censuses are also lower as well. On the other hand, as more people put off health care for lack of insurance or funds to pay for medications or rising co-pays, patients who do need hospitalization are generally sicker and need more specialized care.

The need for nurses continues to vary across the country. Some areas will continue to have a strong demand while others may diminish somewhat. Travel nurses will continue to find work, but they may need to change their expectations about locale, perks and salaries. Those who have or attain more specialized experience and skills will have a better chance of being in demand.

By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book and the recently published 150 Tips and Tricks for New Nurses. She is the author/owner of

© 2009 by All Rights Reserved.

Great Recession is Temporarily Slowing the Nursing Shortage

Posted in Nursing, Nursing Jobs, Nursing Specialties, Permanent Placement, Travel Nursing

The nursing shortage has always been a cyclic issue. For instance, consider the fact that just about 25 years ago there were actually too many nurses and it was quit difficult to find a job. Many of those who became nurses then are now in their 50’s and seriously thinking about retiring today, but for now the economy has slowed them down.

Nursing is one of the most physically and emotionally challenging professions and consequently many nurses are quite ready to retire in their 50’s. When the economy really began to sour last fall, and retirement plans such as 401Ks took a nose dive, many nurses decided to delay their retirement.

In addition, many nurses found themselves returning to the profession because their spouses had been laid off. As a result of these two factors coupled with lower hospital censuses, the shortage of nurses has actually begun to shrink.

This may be a fix to the nursing shortage right now, but it’s quite temporary. When the economy recovers, there may be an even larger mass exodus of nurses than previously expected.

Take for example the fact that the average age of nurses in California is 47, and 45% of those nurses are actually over the age of 50. Potentially 45% of the nurses in California could be retiring very soon.

California is near the bottom of the number of nurses per capita at 647 RNs for every 100,000 persons. The national number is 825 per 100,000. Only Utah, Arizona, Nevada, and New Mexico rank lower than California. California is also one of the states with a mandatory nurse-to-patient ratio. Arizona is considering this type of legislation as well.

The number of new nurses cannot keep up with the number leaving the profession, even with the slower pace of retirement. It’s certainly not for lack of potential students as many thousands are turned away each year because of the lack of nurse educators. Schools just cannot compete with the salaries nurses can earn working in a hospital versus teaching.

Some hospital groups have invested in nursing programs to help them expand and accept more students in an effort to forestall the shortage which will be presented by a mass exodus of nurses. This has helped, but it’s going to take a lot more to make a dent in the potential crisis.

As health care reform efforts make progress, the potential for an additional 46 million currently uninsured Americans to have improved access to health care will also make a dramatic impact on the nursing shortage as demands for care increase.

So for those nurses who are having some difficulty finding jobs right now, don’t get too discouraged. As the economy begins to recover, there will soon be no shortage of jobs for nurses.

Opportunities for travel nurses should begin to pick up again and those nurses who have a large repertoire of skills and experiences will be able to command offers like never before.

Nurses should take advantage of these times and expand their knowledge base and skills set to prepare for the future.

©2009 by All Rights Reserved. By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book. She is also the owner/author of

An Interesting Time to be a Nurse

Posted in Nursing, Nursing Jobs, Permanent Placement

The nursing profession is certainly never boring. Nurses are always expected to work miracles in the face of any and all obstacles, and most times we do.

Currently the Great Recession and the move to reform health care in the U.S. have impacted the nursing profession in many ways and will continue to do so for quite some time.

Hospitals and other health care facilities have long been impacted by the shortage of nurses, and now the economic factors are causing administrators to cut back on staffing.

Most nurses have weathered the seasonal call offs due to a low patient census and sometimes it’s nice to have a few unexpected days off, but when you’ve used up all of your personal time for these furloughs and face even more time off because of cutbacks, it isn’t fun anymore.

When you do work and are expected to give quality patient care to twice as many patients as you should have, that isn’t fun either. But administrators seem to expect nurses to work miracles under the worst of circumstances, and never ask nurses for an opinion on how to improve conditions and make the care more cost effective.

At the same time the nurses are expected to provide the quality of care needed to ensure reimbursement isn’t affected such as preventing decubs, pneumonia, UTIs and DVTs that are on Medicare’s Do Not Pay list.

A recent study of infection-control specialists published June 9 on Modern pointed out that education about hospital-acquired infections has been significantly reduced due to budget cuts.

The Association for Professionals in Infection Control and Epidemiology (APIC) surveyed 1943 members in March 2009. Forty four percent of the responders said that they attend fewer meetings at their hospitals now because of cutbacks, and 42% said they no longer conduct as many walking rounds in their facilities. Hiring freezes and staffing cuts have caused them to spend more time on other duties than focusing on prevention.

In the long run, APIC thinks that hospitals will spend more money treating these infections than they would have in preventing them in the first place, but administrators haven’t figured that out yet. Again they don’t talk to or listen to the nurses.

Meanwhile health care reform measures will (hopefully) make it possible for many more Americans to have health insurance coverage and to afford health care. On the other hand, there is a serious shortage of health care workers, most notably nurses. This shortage is growing and will reach crisis levels in the next few years. Increasing the number of potential patients who can afford health care is going to make the demand for nurses even greater.

Anne Zieger from said a few weeks ago that from her observations, “nursing unions are on the verge of revolution.” Two of the most powerful nursing unions, CNA/NNOC and SEIU have even set aside their fierce rivalry to work together on the issue of health care reform. The two issues at the forefront are mandated nurse-to-patient ratios and required overtime.

It certainly is an interesting time to be a nurse.

©2009 by All Rights Reserved. By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book. She is also the owner/author of

Nurse Jackie

Posted in Permanent Placement, Uncategorized

Showtime has a new series out called “Nurse Jackie”.

Here is the synopsis:

Nurse Jackie is a half-hour dark comedy that is at turns wicked, heartbreaking and funny. Edie Falco stars as the title character Jackie Peyton, a strong-willed and brilliant — but very flawed — emergency room nurse working in the complicated and frenzied environment of a New York City hospital. A lapsed Catholic with a weakness for painkillers to get her through the days, Jackie keeps the hospital balanced with her unique bedside manner and own brand of medical justice. Every day is a high-wire act of juggling patients, doctors and fellow nurses along with her indiscretions. Jackie

It is going to be interesting to see what kind of light Nurse Jackie will shine on the nursing profession.

Please go here for Nurse Jackie Discussion.

Nurses Position Yourselves for Future Opportunities

Posted in Independent Contractor, Nursing, Nursing Jobs, Nursing Specialties, Per Diem, Permanent Placement, Travel Nursing, Travel Nursing

The state of the nursing profession currently reflects the state of the economy. With unemployment hitting record levels, many non-active nurses have returned to the profession and others have taken on more shifts in order to meet the needs of their families.

Hospitals have been hit hard in the pocketbook by the fact that many patients are putting off elective procedures and anything that isn’t of an urgent nature. It has been a slow flu season and therefore the number of children, elderly and chronically ill have not required hospitalization for complications of flu.

Jobs are in Middle America
The number of nurses available for travel assignments has grown and therefore with simple economics of supply and demand, those who are more flexible and have more experience are getting the premier travel assignments. The east and west coasts have been more affected by the economic crisis than middle America and consequently the opportunities in these regions have been affected as well. The jobs now are available in the middle of the country, not Florida and California.

The good news is that the economy will turn around. How soon is being debated. Some predict a few months and others at least a couple of years.

The other factor is that in the next few months, we will see more nurses taking time off from taking on extra shifts or returning to work and being overworked and burned out. This will open up more opportunities.

Gain Experience and Improve Skills
For nurses who are employed or have current travel assignments, make the most of what’s available to you. Extend travel assignments as possible and look for opportunities to polish skills or to gain more experience in specialty areas. Continue your education.

Some travel nursing companies are looking for a minimum of 2 years experience in a specialty area, and making changes right now might even be a negative, but think further into the future and get the experience you want and need. The one thing that is happening across the board for nurses looking for permanent or travel opportunities, is that nurses with very little experience beyond basic med surg are having a harder time finding jobs.

As the economy improves, all those patients who have delayed procedures and care are going to need to have it done and the system is going to be overwhelmed. The nursing shortage has not been solved. There is still going to be a shortage of nearly one million nurses by 2020. Nurses who have positioned themselves to meet the challenges of the next couple of decades will be way out in front.

Post Acute Care Will Grow
Post acute care, especially home health care, is expected to be the fastest growing branch of the nursing profession over the next few years according to the Bureau of Labor Statistics. Nurses who have excellent skills in a wide variety of patient care will be able to make this transition more easily.

For older nurses who cannot stand for eight to twelve hours a day, home health care may offer a new career path for many years past what they could serve in an acute setting. The key to survival in home health is being confident in your skills, having strong critical thinking skills and being able to work autonomously. Documentation skills are a very important issue in home health care as well.

© 2009 by All Rights Reserved.
By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book and author/owner of

Home Health Nursing

Posted in Featured, Independent Contractor, Nursing, Nursing Jobs, Per Diem, Permanent Placement, Travel Nursing

Home Health Nursing

Have you ever considered home health nursing? Like any other nursing specialty, it’s not for everyone, but it can be a challenging and rewarding career option for the right candidate.

Not to be confused with private duty assignments in the home, home health nursing involves making several visits each work day to a variety of (at least temporarily) homebound patients.

These visits entail a complete head-to-toe assessment which can be brief or complex depending on the patient, the findings, or the physician’s orders. The visit will also include patent and caregiver teaching. Again the extent and complexity depends on the specifics of the situation. Each visit should build on the previous teachings and may involve some sort of return demonstration or pop quiz, if you will.

There may be a task to perform such as assessment and wound care, incision care, IV administration and/or site change, Foley catheter change, G-tube change, etc. The patient and/or caregivers may need specific instruction in the care of these as well.

Or the patient and caregiver may need in-depth instruction for a new diagnosis such as diabetes which would include such things as blood glucose monitoring, insulin or other medication administration, and how to identify and treat the signs and symptoms of hypo or hyperglycemia.

Patients and caregivers may also need instruction in medications including dose, administration, possible side effects, purpose and desired results. Other areas of common patient/caregiver education include specific dietary and nutritional needs or restrictions, and home safety issues.

Teaching caregivers how to safely assist patients with hygiene care (bathing, showering or a bed bath), transfers and ambulation may require the assistance of a PT or OT, but the home health nurse also needs to know how to perform and instruct in these as well.

Home health care is most often ordered by the physician following discharge from the hospital, or it may be ordered in lieu of hospitalization. In most instances it is not expected to be long term, but rather to help the patient and/or caregivers become independent in the necessary care.

For reimbursement purposes, Medicare and insurance companies have specific guidelines and criteria that patients must meet to be eligible for home health care. The home health nurse is responsible for reviewing this and documenting accurately. One of the worst parts of home health nursing is the paperwork! Much of it can now be done using a laptop or hand held computer, but there is still a lot of documentation to be done.

The nurse is the eyes and ears of the physician in the home. Many times home health referrals are made because the physician suspects that the patient needs more assistance or instruction in order to improve his/her outcomes. Or perhaps a higher level of care is needed.

The home health nurse learns to assess a home situation and to make recommendations for durable medical equipment (DME) and other disciplines to participate in the care such as a PT, OT or ST. A home health aide may be added to assist with hygiene care and to teach the patient and/or caregivers how to safely bathe and groom the patient.

If necessary, a medical social worker (MSW) may be called in to assist the patient and family in making more complex short term or long term plans for care, or help them to cope with life changing circumstances.

The beauty of home health care is being able to spend quality time with patients and caregivers one-on-one. But home health care is a team approach and the nurse is not expected to do it all.

It can be scary at times because there isn’t another nurse just down the hall to call for assistance or consultation. But there is backup a phone call away, and with cameras in cell phones, it can be even easier to get that consultation.

The autonomy and the ability to utilize skills that sometimes seem wasted in the fast pace of a hospital setting often draw nurses into the home health arena. Call a home health agency and ask to make a ride-along visit with a home health nurse to consider if this might be something you’d like to explore further.

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

©2009 by All Rights Reserved

Dealing With a Nightmare Nursing Assignment

Posted in Nursing, Nursing Jobs, Permanent Placement, Travel Nursing, Travel Nursing

Dealing With a Nightmare Nursing Assignment

What happens when you encounter a nightmare nursing assignment? Whether you are a travel nurse or this is a permanent job, you may not be able to run screaming from the building never to return. So what can you do?

First off, take a deep breath and remember that you are a professional, If possible, leave the building, or at least the unit, for a few minutes to help clear your head. Perhaps the best you can do is retreat to the bathroom. Mentally punch a few walls and then try to decipher what just happened.

The most important thing is to make sure that your own patients are well cared for. If your issue is with another staff member, avoid him/her by spending more time with your patients.

If the issue is with a patient or family member, you can first try killing them with kindness while you make sure their needs are met, and then avoid them by spending more time with your other patients.

Let your nurse manager know what’s going on so that s/he can back you up and isn’t blindsided by complaints. Let him/her know that you’re trying to work this out, but need a little break from the situation. Perhaps s/he can offer some assistance.

Approach the situation using your critical thinking and problem solving skills. Try to step back and not let your emotions take precedence. Use the Nursing Process to assess, diagnose and create a plan to deal with the situation. It may take some time and require small but steady steps to make it work.

Some of the the things you need to consider include:

  • Is this something you can fix by yourself?
  • Do you need some advice, help or support from others to implement your plan or to make it work?
  • Is this a personality conflict?
  • Is this an issue of patient safety or quality of care?
  • Has there been some misunderstanding? How can you clear up the issue?
  • What can you do to avoid this problem in the future?

If this is your permanent job, you should speak to your nurse manager and decide together what can be done to improve the situation. Don’t go to him/her pointing fingers, go seeking assistance in solving a problem.

If you are a travel nurse, you may also need to consider whether the problem stems from being the traveler who “makes the big bucks and has all the perks?” If this is the core of the issue, you need to discuss this with your nurse manager and figure out how to turn this around.

Travel nurses are brought in to help reduce a specific nursing shortage situation and it’s up to the nurse managers in that facility to help permanent staff to understand this and to appreciate the help; not resent it, or to abuse a fellow nurse for accepting this role. Management needs to set the tone.
Travel opportunities are open to all nurses and just because someone does not take that option should not give them reason to resent or mistreat those who do. We all know that that isn’t the way it usually works, but travelers need to stand up for themselves and hold nurse managers and administrators responsible to set a positive tone about using travel nurses in their facilities.

The situation should also be brought to the attention of your recruiter. Hopefully it an be resolved without having to involve the recruiter, but s/he should be aware of the situation and it’s resolution for future reference.

If the situation can’t be resolved, or not to your complete satisfaction, you will just have to complete the assignment and/or make plans to move on as soon as you can. Put your focus on the positive aspects of this and learn something from it.

Understand the situation and look for something where you can avoid this situation in the future. Also count down the days left so you can see the light at the end of the tunnel. Remain professional and continue to provide the best possible care for your patients.

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

© 2008 by All Rights Reserved.