In part two of the series on advice for new nursing graduates, I continue with the interview responses of recent nursing school graduates from the last few years. (read part one here)
The question asked of them was:
“What were the biggest surprises or challenges when you started working as a new nurse?”
Dealing with Senior Nurses — It’s often hard to come to a new work place as a recent graduate in any field. Nursing students are not immune to this. Students arrive with new ideas and practices and this can cause a prickly reaction from the nurses on the floor. Some have become settled in their ways but in most cases old ideas don’t equal out of date ideas, any more than new ideas make them “better.” Show some respect for those who have gone before and try to learn from them instead of telling them about your new and improved methods. If you have learned a different method or technique, communicate with your preceptor, mentor, or supervisor and follow their lead.
Afraid of Saying “I Don’t Know” — It is hard to tell someone you don’t know how to do something when you think it is something you should know how to do. New nurses come in to the work environment with a variety of experiences behind them — even those from the same schools. One student gets a chance to use a variety of catheter techniques while another had no clinical opportunities, one student is the NG tube queen while another hasn’t done it since first year, and so on. Be confident in the skills you know and don’t be afraid to ask for help.
Using Critical Thinking — The instructors in nursing school talked about critical thinking all of the time but it isn’t until a new nurse has a patient on her own that she understands how much she needs to use it. Those of you who mastered (or at least became comfortable with) critical thinking in nursing practice will find that you will use it frequently in caring for your patients. If you don’t think you have good critical thinking skills — check out the next point
You Know More Than You Think You Do! — You survived nursing school, finals and the NCLEX test. Now you are dealing with patients on your own with no instructor staring over your shoulder. It is frightening, right? Sure it is, but have some faith in your self. You DID survive nursing school, finals, clinicals, hard and easy instructors, critical and well patients, and you did pass the NCLEX test. You know more than you give yourself credit for. Trust your well honed instincts and remember the basics: assessment, diagnosis, planning, implementation, and evaluation.
The American Society of Registered Nurses (ASRN.org) released the results of a survey this week looking at the reaction of RNs to the nurse staffing ratio law in California. In the article linked here, the authors say they asked 761 registered nurses questions on how the nurse to patient ratios in that state have affected their workplace.
The responses showed 56% believed they had more time to take a break during their workday and 69% thought the improved patient ratios have given them more opportunity to provide personal care for their patients. This seems to match up with the statements made by California Nurses Association President, Zenei Cortez in the recent interview here on the Nursing Show.
Nurse staffing ratios have become a big issue since the California law went into effect with nurses in many states attempting to pass similar laws. To date those bills have failed to pass and the article points out that in the other 49 states, it is legal for nurses to be assigned 10 or even 15 patients by hospital administrators and nursing supervisors.
This issue is not so cut and dried, though. With nursing staff shortages nationwide, where would the additional nurses come from in the short term as facilities competed with each other to maintain minimum legal staffing levels. California’s law caused a workforce shift of nurses into that state from other parts of the country as hospitals scrambled to attract enough nurses to meet legal requirements. What happens when these laws are more widespread and there are fewer nurses than ever to go around?
Don’t get me wrong. I think that competition is good for the nursing workforce as it will continue to push demand and wages higher for all of us, but in the short term — if these laws gain widespread acceptance, how can we expect facilities to comply with an impossible legal requirement?
Take a gallon bucket and a half gallon of water. You can require me to fill the bucket under the law, but if you don’t give me more water, there will be no way for me to fill that bucket no matter what the law says.
Beta Blockers are a common medication choice on cardiac care units and intensive care units in hospital settings. Controlling hypertension and arrhythmias are important parts of the management of the critical care patient. A recent large scale study published in the Lancet is challenging some of the preconceived notions about the safety of the widespread use of this medication category in pre-surgical patients.
The Canadian researchers who authored the study found that patients who received beta blockers before surgery were much more likely to experience life threatening side effects following surgery. These patients were twice as likely to have a CVA and had a one third greater mortality rate at one month after surgery.
While the docs figure this out, the nursing staff needs to pay particular attention to these at risk patients. Monitoring for post surgical side effects, strokes, and watching for adverse signs in trending of labs and vital signs so that we can alert the physicians more rapidly.
Other standard nursing interventions still apply including encouraging ambulation, use of the incentive spirometer, and turning frequently for those patients who cannot ambulate. By reducing the risk for complications post surgically through good nursing care, we can give all post surgical patient the best chance of a full recovery.
Are you a nurse on a med-surg or post surgical floor? Let me know what your impressions are of this article. Send me your comments at Comments@nursingshow.com
One of the hardest things in any nursing career is to develop good nursing job interview skills. I recently sat down with a group of recent nursing school graduates from the last few years to ask them about their experiences transitioning from nursing school to nursing job.
I’ll be featuring segments of this interview in articles posted here over the next few weeks under the category “career guide.” This segment looks at questions these recent grads had wished they had asked in their first job interviews. A wise person once said, “Those who refuse to learn from the past are doomed to repeat it.” Learn from the experience of those who have gone before and remember these 10 tips for new nursing grads when you interview.
Didn’t remember to ask any questions — The key word here is to remember! I can be the most scatterbrained person in the world sometimes. Especially when I’m in a new place and meeting new people. That is why I have become the list guy. Write your questions down and bring the list with you. That will show your prospective employer that you are organized and have a mechanism in place to get things done and not forget important tasks.
Ask about the salary — Some people think that talking about money and salary is in bad taste and they are right, when you’re at a dinner party. The place where it is in good form and even expected is in a job interview. A good interviewer should volunteer that information but may not if they think you already asked someone else. Ask the question! What do new nurses make? How are pay increases determined? What bonuses are offered for increased education or certifications? Is there a shift differential? How is overtime handled? These are things that you want to know before you go to work on your first day.
Nurse to patient ratio — What is the ratio of patients to nurses on the unit for which you are applying? This is important because the average nurse to patient ratio for the facility may be different than the ratio for your floor or unit. Also, ask about how that changes at night and what mechanism is in place when they are short handed.
Ask about health benefits — What is the health insurance plan like and how are the other health related benefits like dental, mental health, and life insurance? You may make $2 more an hour at one facility but your primary care co-pays are doubled. If you have a family or small kids, that $2 an hour can disappear fast!
Ask about perks for employees — Some facilities have become very creative in the ways they offer “value added benefits.” These are extras you get as an employee that don’t cost the facility that much per employee, but may be a great benefit to you. This goes beyond something like tuition reimbursement (although that’s a good one, too). It includes things like a workout room in the facility, or a gym membership, and even on-premises services like oil changes, dry cleaning pick-up and return, and personal shopper services. These are just some of the extra perks that one hospital might offer to attract and retain employees. When time is money, time saved is money saved and these types of perks might be valuable to you.
Ask questions about the nurse retention rate at 1 year and 3 years — This may seem like a loaded question but you can put it in terms of how they might be addressing employee concerns. Believe me, they know these figures. That is why they are out there hiring. Ask about employee input for change, opportunities for career advancement, learning opportunities, and open door policies with management. What is this facility doing that addresses employee concerns?
What is the UAP ratio? Find out about how many UAP (unlicensed assistive personnel) are on the floor during a shift. This is as important as the nurse to patient ratio mentioned earlier. It doesn’t do any good if there is a 1 to 4 or 5 nurse to patient ratio when there are no techs or CNAs around to help with AM care and linen changes. Find out this number, too!
If there is a sign-on bonus — ASK WHY! The nurse recruiting rage for a while was for facilities to offer sign on bonuses to nurses as an incentive to come work there. Now this tactic has become a last ditch effort of some facilities to fill vacancies. But why do they have such a hard time filling jobs, even in a tight market? If they are willing to pay you just to walk in the door, you need to ask, “What’s the catch?” Now, I’m not saying that you won’t end up working there. If the money’s right and you go in with your eyes open, then you’ve made an informed decision. Just know the details going in.
What is the relationship between the doctors and nurses in the facility? Is there an institutional philosophy of mutual respect? This is a hot button for many nurses. Some nurses just accept that doctors don’t treat nurses very well and look down on the nurses with whom they work. I’m not one of them. I never let someone treat me disrespectfully and I refuse to work for a company that would allow that kind of abuse in their workplace. That said, I have had very few negative experiences like this and I believe that the tone of mutual respect and teamwork is the norm in most facilities, but it is important to know your rights and how a facility handles these things.
Ask to shadow a nurse for a shift — This falls under the category of LAST BUT NOT LEAST in this list. Once you’ve decided that you would like to work in a particular facility, do one more sanity check. Ask to follow a nurse on your unit around and shadow them for a day. Take the opportunity to see how the working relationships on the unit fit in with your style and find out how the policies outlined by your interviewer’s answers to your other questions work in real life. Other than talking about salaries, you can ask your shadow nurse just about any of the prior questions, too. This will give you the final piece you might need to decide whether this is the slot for you.
So that’s it! The top 10 questions new nurses forgot to ask but wish that they did as they started out their nursing careers. Just remember, it’s an open nursing job market out there. Your dream job may turn out to be something totally unexpected. Ask these questions to help you get there sooner and congratulations on graduating!
Welcome to Episode 26 The Nursing Show is a proud member of the Blubrry Podcast Network. Right Click to download (Macs Option Click) Subscribe with iTunes here (must have iTunes installed — it’s free)RSS Feed to subscribe (copy url to Juice, Zune Marketplace, or your favorite podcatcher)Click the arrow to play the Nursing ShowA podcast for Nurses, Nursing Students, and others interested in what it takes to be a Nurse—————————-Sponsors Get 10% off Pepid’s portable nursing solutionsNursing Show Listener Deals at GoDaddy.com –
Code BLU27 gets you 10% off your order at checkoutCode POD27 gets you 10% off any web hosting order at checkoutTry them out and get your piece of the internet at GoDaddy.com!
Welcome to Episode 25 The Nursing Show is a proud member of the Blubrry Podcast Network. Right Click to download (Macs Option Click) Subscribe with iTunes here (must have iTunes installed — it’s free)RSS Feed to subscribe (copy url to Juice, Zune Marketplace, or your favorite podcatcher)Click the arrow to play the Nursing ShowA podcast for Nurses, Nursing Students, and others interested in what it takes to be a Nurse—————————-Sponsors Get 10% off Pepid’s portable nursing solutionsNursing Show Listener Deals at GoDaddy.com –
Code BLU27 gets you 10% off your order at checkoutCode POD27 gets you 10% off any web hosting order at checkoutTry them out and get your piece of the internet at GoDaddy.com!
———————————–Tip of the Week — A Look at Nurse Staffing Laws Zenei Cortez, President of the California Nurses AssociationCalifornia’s Nurse Staffing Ratios Explained———————————–Don’t miss an episode! Get the Nursing Show Newsletter by email. Fill out the email form in the right hand column of the site. Get it now!Comment or share ideas here on the comment link below or by email:Comment@NursingShow.comOther Podcasts from Jamie Davis:
The MedicCast (for EMTs, Paramedics, EMS field work)
In the realm of world wisdom and wrapping up nurse’s week: Do you ever have one of those days when everything seems to click?
You know the days I’m talking about.
Every light is green
The best parking spot in the hospital lot is open when you arrive
You shift report goes like clockwork
Every IV is perfect
You slide NG tubes in “Like Butta”
Your relief arrives on time, your charting is done, and you can leave on time for a change
And then you have the other days when every thing is harder than it needs to be.
You drive in behind a school bus and it makes you late because it stops to pick up students every 5 feet!
You leave the house and have to go back after 10 minutes because you left your badge on the kitchen table!
You have a free day to get all of the extra stuff done at home and one of your kids decides to get sick and you get nothing done!
You get to the parking lot and they are resurfacing the lot and you have to park a mile away!
It’s pouring rain and your kids took the umbrellas out of the car to sword fight, again!
When you finally get in to work, you can do anything right at work: IV pumps break when you walk by, you miss IVs, can’t get NG tubes placed, one of your patients calls you all the time, one of your patients never calls you and then falls trying to get out of bed to use the bathroom
Your relief is late and you have to stay and cover!
Need some perspective? You are not alone. Seems like it’s been one of those weeks in the nurse and medical blogosphere:
Check out this blog post over at PixelRn’s blog. She has one of the harder days recently and writes about it on her blog.
EMTs in the field have it, too! Here’s a great comment by the author of the Random Acts of Reality blog about a member of the London Ambulance Service.
Here’s a great video look at the Podcast and New Media Expo that was held last year in Ontario, California. I was there and can’t wait until this years expo in Las Vegas. I have been invited to speak at this year’s expo and I’m really excited to talk about how podcasting can be used to help educators and students learn and study for classes in this crazy on the go world of ours.
Find out more about how you can attend this conference and learn more about podcasting and new media ventures — Click here.
The Nursing Show is a proud member of the Blubrry Podcast Network.
Right Click to download (Macs Option Click)
Subscribe with iTunes here (must have iTunes installed — it’s free)
