Nursing Survival Guide

Getting the Nursing Job: Resume Tips

Author: Jennifer L.W. Fink, RN, BSN is a professional freelance writer with almost a decade of experience as a Registered Nurse. She’s worked in both hospitals and nursing homes as a med-surg, geriatric and transplant nurse. Her national publication credits include Parents, RN, Ladies’ Home Journal, Nursing Spectrum, Pregnancy and Journal of Christian Nursing.

The nursing job market is projected to experience more growth in the next decade than the market for almost any other profession, but still nothing is ever guaranteed. Finding the perfect job for you involves mastering the art of the job hunt from networking to writing impressive cover letters and resumes and interviewing with ease.

Find out what it takes to secure a nursing position and how to create a winning resume with advice from an expert nurse recruiter and manager, both of whom have helped countless nurses navigate a tricky job market.

What if I don’t have any “real” nursing experience? What should I put on my resume?

Don’t sell yourself short! Structure your resume to highlight your experience and skills, says Gail Biba, RN, BSN, CNRN, nurse manager of the neuroscience intensive care unit at Johns Hopkins Hospital. If you’ve completed an internship or externship, list it prominently on your resume. You can also include a brief list of your clinical rotations. Biba likes to see a bulleted list of clinical skills – such as experience with certain types of catheters, cardiac monitors and central lines, as well. Include seemingly unrelated work and volunteer experience. Johns Hopkins, Biba says, strongly values volunteerism, and she likes to select new hires that fit well with her unit’s culture of service.

I have an ADN, but my dream job is at a hospital that gives preference to BSN-prepared nurses. Should I still submit a resume?

Absolutely, says Donna Cardillo, Career Guru for nurses, who is a contributor and expert for Nursing Spectrum, NurseWeek Magazine, DoctorOz.com and the former health care careers expert for Monster.com. “Employers may prefer a lot of things,” Cardillo says, “But when all is said and done, they are looking for a candidate with a lot of personality, someone who’s got life and enthusiasm, and not just a certain credential background.”

To get past the “BSN-preferred” hurdle, try addressing the issue directly in your cover letter. “Mention that you understand that having a BSN is important and that you are committed to lifelong learning and have a plan to pursue your BSN degree,” Cardillo says.

I’m interested in critical care nursing, but all of the critical care job ads ask for previous critical care or med-surg experience. Should I give up on critical care for now?

Not necessarily. While some critical care units will only hire experienced nurses, others are open to qualified new grads. Johns Hopkins Hospital, for instance, requires prospective critical care RNs to have completed either a clinical rotation through an ICU or an internship or externship in an ICU. If you have that experience and are interested in critical care, you should definitely apply. As a nurse manager of a critical care unit, Biba wants applicants “who can hit the ground running,” but understands that there’s no way your basic nursing background can fully prepare you for a job in the CCU. So she looks for nurses who are passionately interested in critical care and who view the family unit as their patients. She also looks for a willingness to learn. Highlight those qualities on your resume, and there’s a good chance you’ll get an interview.

Donna Cardillo suggests attending local chapter meetings of the American Association of Critical Care Nurses. “Job ads are only one source of finding a job,” Carillo says. “If there’s something you want to do, you should rub elbows with those already doing it.”

I’ve sent out a ton of resumes, but haven’t gotten any calls for interviews. What should I do?

Number one: Brush up your resume. Have a friend comb through it for grammatical and spelling errors (correct any that are found). Tweak your resume to highlight any and all relevant nursing experience, including part-time jobs and clinical rotations.

Then, try a change of tactics. “Sending out resumes and cover letters is the least effective way to find a job,” Cardillo says. “It’s okay to submit applications, but new nurses should focus on networking. Get out to local chapter meetings. Attend career fairs. It’s more work to physically get out there, but face-to-face networking is the most effective way to find a job.”

Getting the Nursing Job: Interview Tips

Author: Laura Raines is a freelance writer and editor of “Pulse,” a nursing and allied health publication published by the Atlanta Journal Constitution. She is also a regular contributor to the AJC on the subjects of jobs, careers and education.

Finding a nursing job used to be clear sailing-there was a shortage of workers. In today’s economy, the waters are considerably choppier. Expect to apply repeatedly, and wait for a call.

“Today’s job market is a perfect storm,” says Kay Spruill, executive director of recruitment for WellStar Health System in Atlanta, Georgia, which received more than 200,000 applications for open positions last year. Decreased patient volume, increased nursing graduates, hospital budget tightening, older nurses delaying retirement, and experienced clinicians returning to the workforce all make for “an extremely competitive market for nurses, especially new grads,” Spruill says.

To secure employment you’ll need to steer wisely through the interview.

Ask yourself…

Am I dressed and acting professionally?

Wrong: Wearing Jeans, flip flops, or too much perfume or jewelry; showing cleavage; coming in with long painted fingernails (a health hazard to patients); being late; texting; chewing gum; using inappropriate language and not making eye contact.

Right: Being well-groomed and wearing business attire, completing a test drive to ensure you know where the interview is and will arrive early, shutting off or silencing your cell phone, greeting your interviewer with a firm handshake and smile which shows confidence and enthusiasm.

“You’re asking a nurse manager who works 24/7 with life and death responsibility to spend an hour with you. Show respect,” says Spruill.

“A professional appearance translates to a sense of pride in yourself and your work,” says Terri Veneziano, vice president, nursing clinical and business operations, at Robert Wood Johnson University Hospital in New Brunswick, New Jersey. “Not making eye contact raises the question of low self-esteem or dishonesty.”

And I want this job why?

Wrong: Not knowing about the organization or how your qualifications fit the job; not answering questions directly; not showing interest in the position or work environment.

Right: “Research the organization and people you’ll be meeting using the employer’s website, Google and LinkedIn. Ask yourself how your career goals fit the mission of the organization and what extra you can bring to the job,” says Diane Smith, principal for nurse recruitment, DHR International, Cincinnati, Ohio. “An interview should be a comfortable conversation. The more you know, the better it will flow. Strong communication skills always impress,” says Smith.

“Be ready to articulate from a nursing perspective why you want to work here. That’s crucial,” says Veneziano. “The best answer is that you’d be proud to work here because of our reputation, values or what you can learn. Show us your passion for nursing and how you share our commitment to patients,” says Veneziano. Successful nurses take pride in what they do.

And I stand out how?

Wrong: Assuming a degree and fulfillment of minimum requirements will get you hired.

Right: “In this market, many candidates will have the education and clinical skills needed. It’s the soft skills that make you stand out,” says Spruill. “Your resume tells us you can do the job. We’re interested in how you’ll do the job.”

“We can teach you oncology nursing; we can’t teach you a positive attitude,” says Smith.

Draw from all your past experiences for examples of your integrity, responsibility, initiative, flexibility and team work. “One applicant put herself through school by babysitting. She always engaged children and impressed parents. That told me a lot about her reliability, resourcefulness and customer service attitude-which her references confirmed,” says Spruill.

Am I ready for the tough scenario and behavioral questions?

Wrong: Not anticipating behavioral/situational questions, which all interviewers ask. For example, how would you handle a difficult coworker? If a patient in the ICU was dying, would you let the family stay past visiting hours? What prepares you for the frantic pace of the ER?

Right: Knowing examples of how you met challenges in the past and what you learned from them. “People get thrown off by touchy-feely questions, but that’s how we learn about your critical thinking skills, your ethics and your values,” says Veneziano.

“Be honest about why you were laid off or changed jobs, but keep it factual and positive,” says Smith. “Bitterness, negativity and trashing a former boss never play well.”

Additional interview tips from Diane Smith:

Top Five Areas of Nursing for New Graduates

Author: Terri Polick has been a nurse since God was in diapers.

Congratulations. You’ve passed your NCLEX Examinations and you are officially a registered nurse. Now it’s time to look for a job, but as a new graduate, where should you start? We’ve highlighted the five jobs in nursing almost guaranteed to turn new nurses into seasoned professionals.

• 
  

  Medical Surgical Nursing

  Thanks to Hollywood, a lot of new nurses want to start their nursing careers in the emergency room. The ER and other specialty areas may look glamorous, but they really aren’t a place for rookies. New graduates who want to work in a hospital should seriously consider working at least one year in a general medical surgical unit before they take a job in a specialty area. A medical surgical unit will allow you to develop your basic nursing skills while you learn about a wide variety of medical conditions and illness. Look for a hospital that offers nursing internship programs. These programs offer new graduates the support they need as they transition from nursing student to professional nurse. Get your foot in the door early-the best way to land a job in a good unit is to work in a hospital as a CNA before you graduate nursing school.

• 
  

  Gerontological Nursing

  We all get old, and as we age, more of our ranks will need gerontological nurses to care for us in our homes and in community health centers. These nurses have expertise in meeting the physical and psychological needs of the elderly. New graduate nurses who enter this field have the opportunity to learn about an array of medical and psychological issues that will help them build their nursing knowledge while they enter an expanding health care industry. The US Bureau of Labor Statistics projects that nursing in general will be one of the fastest growing careers within the next 10 years, and the fastest growing population of people will be those over 85 years old. Gerontolgical nurses deal with death and dying on an ongoing basis, though, and it can be difficult to watch the decreasing mental and physical health of patients to whom you’ve become attached.

• 
  

  Military Nursing

  The U.S. military is a great place for nursing graduates who want to jump-start their nursing careers. Graduate nurses who join the military are given special mentorship by some of the most highly educated and proficient nurses in the world. The patient to nurse ratio is much lower in military hospitals as compared to their civilian counterparts. This ratio allows new nurses to learn nursing assessment skills without feeling overwhelmed. Military nurses work in multiple specialty areas, in world-class facilities and within a collegial environment. The military offers many benefits as well, including: signing bonuses, continuing education opportunities, and tuition reimbursement.

• 
  

  Public Health Nursing

  The U. S. Public Health Service Commissioned Corps also offers new graduates a place to grow as a professional nurse. Their mission is to promote public health and disease prevention programs while improving public health science. New graduates receive mentorship from public health experts and make a powerful impact within disadvantaged communities. In most cases, Commission Corp nurses also receive the same benefits that members from uniformed services receive which include: continuing education opportunities, tax-free accommodations, meal allowances, a month of paid vacation per year, malpractice insurance coverage, and tuition reimbursement.

• 
  

  Second Career Nursing

  Many nursing graduates entering the health care arena are older individuals who are starting a second career. These individuals have the opportunity to use skills obtained in their first career when they enter the nursing profession. A former public school teacher might be perfect for a clinical nursing instructor position. A one-time IT specialist, on the other hand, would be a great fit for the field of nursing informatics. Employers are looking for people with experience, so cash in on all the things you know. Your nursing education plus life experiences will open up a lot of doors when you’re looking for a job.

Five Creative Career Choices for Today’s Nurse

Author: Lorry Schoenly, PhD, RN is a nurse writer and educator with over 25 years of experience. She has been certified in five different clinical specialties including critical care and emergency nursing. Starting as an associate degree registered nurse, she continued her schooling in traditional and distance-learning settings to obtain a BSN, MSN, and PhD in nursing while working full-time and raising a family. Lorry teaches nursing in a variety of settings including webinars and online nursing courses.

One advantage of a nursing degree is how versatile it can be in a changing job market. Nurses have a variety of traditional settings to choose from when considering a career path like working in a hospital, doctor’s office or other health care facility, but there are also several innovative options available. Consider one of these five creative careers for which your RN license will qualify you.

• 
  

  Case Management

  Case management nurses (CMNs) work to improve the efficiency and effectiveness of health care plans for particular patients. They are employed by hospitals, medical groups and insurance companies to improve patient outcomes while containing treatment costs. They do this by coordinating services across various health care providers thus eliminating delays or omissions.

  Individuals who are successful case managers excel at project management and negotiation. Good communication skills are important, as case managers interact with patients, families and care providers regularly in order to coordinate care and provide resources for the patient.

  Because case management requires an extensive understanding of systems and processes of care for a particular health care specialty, most employers look for nurses with several years of applicable experience. However, new nurses with extensive health care background in another position may find opportunities in case management. For example, a dietician or social worker who is now licensed as a nurse may find a rewarding career as a diabetes or psychiatric case management nurse.

• 
  

  Forensic Nursing

  Forensic nurses apply health care principles to the criminal justice system. The field of forensics is relatively new as is the forensic nursing specialty. Forensic nurses conduct exams and collect samples from those who are suspected to have suffered sexual assault, child abuse or domestic violence. Forensic nurses may also work for the coroner’s office or with forensic pathologists to gather evidence in questionable deaths.
  Duties vary depending on the setting; however, a key function of the job is obtaining and preserving medical evidence for legal use. In addition, forensic nurses work with crime victims and their families to obtain information for use in legal action.

  Forensic nursing combines the detailed work of evidence investigation with the communication skills needed to engage traumatized and suffering individuals in discussion about sensitive topics. A background in emergency care and an understanding of the legal system are helpful.

  The growing need for nurses in this specialty is a boon for new nurses. If you already have a legal or emergency background, such as, as a paralegal or a paramedic, you have a jumpstart on a forensic nursing career. In addition, certification programs can help establish credentials for newer nurses are trying to enter the specialty.

• 
  

  Travel Nursing

  Travel nurses work through an agency to accept time-limited nursing assignments in a variety of settings and locations. Both short-term need and chronic shortages require health care facilities to fill staff vacancies with qualified nurses interested in regularly changing their work setting. Travel nurses accept assignments with specialized agencies to work for a limited time in hospitals, long-term care facilities and even prisons or jails.

  Travel nurses must be able to orient and fulfill necessary job requirements quickly. Successful travel nurses select assignments that align with their prior work history. They are flexible, self-directed and easy to get along with.

  Many nurses like travel assignments because they enjoy the variety of the job. Some use traveling nurse assignments to try out a new area of nursing or a potential new place to live.

  You can find a travel position as a newer nurse, but should be careful to work with an agency that will help you find a good match. Most agencies want at least 18 months experience as a nurse before matching you with travel assignments.

• 
  

  Life Coaching

  Personal coaching is growing in popularity as a means to get organized, overcome obstacles and gain life skills. Life coaches work with individuals or small groups to reach personal and professional goals. A growing number of nurses are using their health care expertise to become life coaches and help those who are struggling with particular health care issues.

  Nurses act as a change agent in their clients’ lives by helping with problem-solving, motivation and accountability. These nurses are insightful, able to listen empathetically, and provide moral and practical support and encouragement. Other helpful skills for life coaching include being able to collaborate with a diverse group of individuals and knowing how to motivate different personality types.

  Nurses successful in the life coach role are self-aware and mature. Many new nurses come to the profession with a background conducive to coaching others. Life coaches often operate as independent practitioners or are loosely aligned with general coaching groups and associations.

• 
  

  Nurse Entrepreneur

  Nurse entrepreneurs start and run their own businesses. Nurses can provide support to patients through home care services, patient education programs and telehealth businesses. They may start consulting businesses providing expertise to insurance companies and law firms, or they may provide services to health care businesses, educating staff. Nurses can also work independently as writers and speakers in their specialty area.
  The duties of a nurse entrepreneur are varied and specific to the business focus; however, most businesses involve management functions such as marketing, financial management, and customer service. Successful nurse entrepreneurs are highly motivated and enthusiastic about their product or service. They are self-directed and hard-working.

  Newer nurses with a creative idea or service should consider a career as a nurse entrepreneur. It may take time for a new business to grow toward profitability, so finances should be carefully considered.

Why Nurses Need Malpractice Insurance

Author Terri Polick has been a nurse since God was in diapers. Read more at Nurse Ratched’s Place.

You think it can never happen to you. You’re a competent nurse. You care for patients to the best of your ability, but one day something goes horribly wrong. What do you do?

Protecting Your Interests with Malpractice Insurance

Nursing Associations suggest that all nurses purchase their own malpractice insurance. There is a common belief that only physicians, surgeons, hospitals and clinics get sued. While they make up the bulk of malpractice defendants, the truth is anyone with a professional healthcare license can wind up in court. Traditionally, the legal system viewed the doctor as the “Captain of the Ship,” and he or she was held responsible for the actions of all other staff members involved in a patient’s case. Today’s legal system views each member of the healthcare team as a licensed individual who is responsible for his or her own actions. If you are a licensed professional nurse, and you are accused of departing from the standards of practice, and that departure causes injury or death, you are at risk for getting sued.

Limitations of Employer Malpractice Insurance

How will you defend yourself if you become involved in a malpractice lawsuit? Don’t count on your employer to come to your rescue. It is a misconception that an employer’s malpractice policy is an employee benefit. The policy may have substantial gaps in coverage, and is in place to protect the employer, not the employee. The usual strategy during a court case is to make the employee look good so that the institution looks good too; however, if there is a conflict of interest, the employer’s legal team may not think twice about sacrificing an employee in order to keep their client out of trouble. It’s times like this that nurses need legal representation that has their best interest at heart, and malpractice insurance will enable a nurse to hire his or her own attorney.

Employer malpractice insurance also has other serious gaps. For instance, it may not cover all damages that are awarded in a lawsuit, and it will not cover an employee who gets sued over something that happens outside of the workplace. Nurses are frequently asked for curbside consults from friends and family, and they can get sued if something goes wrong.

Defending Your Nursing License

An employer’s malpractice insurance also has one other little-known shortcoming that has tremendous consequences for nurses. An employer’s policy does not offer licensor protection. This coverage is critical if you have to go before your state Board of Nursing to protect your nursing license.

Many nurses believe that their state Board of Nursing was created to protect their nursing practice, but the mission of the Board of Nursing is to protect the public’s welfare, not necessarily a nurse’s career. Each state has a Nurse Practice Act, and the Board of Nursing is charged with its enforcement. It’s important to remember that anyone, including an employer, can lodge a complaint against a nursing license, and in the situation where the employer reports a nurse, the employer is not going to spend money to defend that employee. Having your license challenged is a frightening experience, and even “good” nurses can find themselves under investigation by the Board of Nursing. Nurses need legal representation to protect their legal interest when they have any adverse legal interaction with their Board of Nursing. Malpractice insurance, which includes administrative/regulatory board coverage, can help nurses protect themselves.

The Truth About Malpractice Insurance

There are many misconceptions about malpractice insurance that keep people from buying policies. The biggest misconception is that you are more likely to get sued if you carry malpractice insurance. This is not true. There are many reasons why a nurse could become embroiled in a malpractice suit and having malpractice insurance doesn’t alter those reasons. Malpractice insurance is inexpensive and provides coverage to protect you and your nursing license.

You can find more information about malpractice insurance at proliability.com and at nso.com.

We hear all the time about just how much technology is impacting modern life, and if you work in the health care field this is particularly true. For nurses, for example, technology has changed the face of everything from training programs, which now can have advanced virtual life and simulation components, to nursing practice in which a world of information on medications and diagnoses is loaded onto handheld devices. Below we’ve gathered our top 10 nursing apps and technologies, guaranteed to improve your nursing practice whether you’re still in training or already on the job. Click on the play button to view these tools in action.

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  AccuVein

  Description

  Already used by hundreds of hospitals, AccuVein is a lightweight, handheld device that allows nurses to quickly pinpoint hard to find IV sites for needle placement by using infrared technology.

  Why it’s helpful

  When nurses find it difficult to locate veins in patients, the AccuVein quickly displays exactly where to place a needle – plus you can take this device to-go.

• 
  

  Nursing Central

  Description

  Designed to answer your burning nursing questions from disease symptoms to term definitions, Nursing Central contains a database of over 5,000 drugs and 60,000 nursing terms, all in an easy, mobile download.

  Why it’s helpful

  At $159.95 the price tag might seem steep, but many nurses say that just having a copy of Davis’s drug guide at their fingertips, makes this app worth it – the multitude of other features could be considered a bonus.

• 
  

  Informed RN Pocket Guide

  Description

  This pocket guide originally started in print, but now comes in an even more convenient e-format ($5.99). It boasts assessment tools for the novice and seasoned nurse alike, with information covering pediatric, respiratory, GI, mental health topics and more.

  Why it’s helpful

  Both nursing students and professors rate this app highly. You have access to medical calculators and assessment tools, which are divided into categories such as cardiac or neurological tools. Plus, the low cost makes this app an accessible essential.

• 
  

  Netter’s Anatomy

  Description

  Netter’s anatomy has long been a best-selling anatomy primer, but now 300 formerly print cards have been reworked into an easy to navigate app that will give you detailed views and information on all the structures of the human body.

  Why it’s helpful

  The $39.99 asking price might seem a bit steep for an app, but once you download the Netter’s Anatomy flashcards, they are yours – no renewal or subscription needed. For students in particular, the built-in quiz feature will be indispensable.

• 
  

  Simulation mannequins

  Description

  Nursing schools have been using patient simulators for years – with simulation becoming ever more realistic. Nursing students can practice procedures on a range of patients. There’s even a fully equipped birthing simulator that lets users train to assist in births.

  Why it’s helpful

  Simulator software gives students the opportunity to interact with the same tools and scenarios they would encounter in the field. The simulators don’t replace real patients and clinical rotations, but they do give students a chance to make mistakes as they learn without anyone getting hurt.

• 
  

  Second Life

  Description

  Originally intended as simply a social game, Second Life lent itself well to e-learning, letting students and teachers create avatars and virtually attend classes. Everything from lecture halls to hospitals can be recreated and students can navigate any nursing scenario that can be imagined.

  Why it’s helpful

  Vanderbilt University was the first to implement the Second Life system as a learning tool for nurses. Instead of meeting in an actual classroom, students meet in a virtual Second Life classroom, something they can do from the comfort of their own homes.

• 
  

  TUG

  Description

  Over 100 hospitals in the US now make use of the TUG, a robot developed by Aethon that can be programmed for pick-ups and deliveries and lug up to 500 pounds. Once installed with a hospital blueprint the TUG can pick up and deliver medication, food, and lab results, using lasers to avoid obstacles along the way.

  Why it’s helpful

  Nurses at Sinai Hospital in Maryland are working with the TUG robots and seeing great results. In fact, one tug can do the pick up and delivery work of over two nurses. With a looming nursing shortage, that’s a huge benefit and frees up staff for more direct patient care.

• 
  

  Medibabble

  Description

  The US is a constantly evolving melting pot of various languages – Medibabble is an app that helps health care workers navigate all these languages. It’s programmed with a multitude of diagnostic questions and exam instructions designed to help eliminate any possible language barrier.

  Why it’s helpful

  Some reviews suggest that this app might need some updates – even so the tool is free, loaded with multiple languages, and programmed for a variety of medical situations. A translator may not always be available, so Medibabble is worth having on hand.

• 
  

  Evernote

  Description

  Writing things down is almost archaic these days, so consider Evernote your high-tech to do list alternative. Keep track of study materials, web pages, journal articles, documents, memos and yes, even notes. Sync them to any mobile device, and you’ll have handy reminders wherever you are.

  Why it’s helpful

  Nursing students and professors can use Evernote as an organization tool. When study material, projects, and papers start to pile up, use Evernote to keep things together in one place. All the content in Evernote can be stored, labeled, dropped into folders and categorized in whatever way makes the most sense for you. Best of all, Evernote is free.

• 
  

  Smart pill bottles

  Description

  They may look like a regular prescription pill bottles, but the Vitality Glow Caps are anything but. The GlowCap has an embedded wireless chip, which can be programmed for personal reminders. When it’s time to take medications, the bottle will alert you with lights, bells, and even a phone call. Once opened, data is sent to your care provider – invaluable for coordinating care and keeping track of patient adherence.

  Why it’s helpful

  As a tool for nurses and those in the medical field, smart pill bottles like the GlowCap allow for less time spent monitoring patients pill intake. For geriatric patients, in particular, this technology is a lifesaver, not only reminding patients to take pills, but communicating with their web of health care providers and even refilling prescriptions.

Survey Results

BestNursingDegree.com asked experienced nurses to sound off about what the nursing field is really like. Was nursing what they expected? Would they recommend it as a career? What kinds of things do they think that nursing students should be aware of? What do they love or hate about their jobs? If you’re considering nursing, read on for veteran nurse opinions on everything from what nursing specialty to start in, to what to expect from your fellow health care workers.

1. I have a(n):

• A. LPN
• B. ADN
• C. BSN
• D. MSN

2. I work in:

• A. A hospital.
• B. A doctor’s office.
• C. Home health.
• D. A nursing home.

3. I’ve been a nurse:

• A. Less than 1 year.
• B. 1-5 years.
• C. 6-10 years.
• D. More than 10 years.

4. My first job after nursing school:

• A. Was like I had expected it to be.
• B. Was mostly as I had expected.
• C. Was somewhat as I had expected, but there were a lot of things that surprised me.
• D. Was nothing like what I had expected.

5. The best thing about my first nursing job was (open ended question – representative answers below):

My coworkers, the patients, and finally having a job.

6. The most surprising thing about my first nursing job was (open ended question – representative answers below):

The many roles I was expected to fill, how much I learned in the field, and the reality of the nursing shortage.

7. The worst part of my first nursing job was (open ended question – representative answers below):

Having to work the night shift, figuring out how to manage my time, and working to gain the support of the more experienced RNs.

8. I think my nursing school prepared me pretty well for the challenges of working as a nurse:

• A. Agree
• B. Disagree

9. I wish my nursing school had provided me more information on or preparation for (open ended question – representative answers below):

How to fill out paperwork and charts, how to optimize the job search, and how to handle the realities of working with multiple patients at once.

10. In my first few months, working as a nurse was:

• A. A tough adjustment from the school environment.
• B. Tough at first, but got better quickly.
• C. A mixed bag.
• D. A smooth adjustment from the school environment.

11. The members of the nursing staff I worked with in my first position were:

• A. Extremely supportive and acted as mentors to me.
• B. Fairly supportive and worked as a team.
• C. Not that supportive, but working with them was manageable.
• D. Generally intimidating or not very supportive.

12. In my opinion, the best area of nursing to start your career in is:

• A. Med-surg.
• B. ER.
• C. Telemetry.
• D. ICU or critical care.

13. Please explain your answer to question 12 (open ended question – representative answers below):

Med-Surg because it provides new nurses with skills and experiences they can apply to many different areas of the hospital; ICU or Critical Care because it gives nurses a variety of skills and the confidence to move into other areas of the hospital; or whichever area of nursing best suits you.

14. The most challenging element of nursing is:

• A. Doing the physical work.
• B. Managing the emotional elements of nursing.
• C. Caring for or interacting with patients.
• D. Working with other nurses and health care professionals.

15. I spend the majority of my time as a nurse:

• A. Caring for or educating patients.
• B. Completing documentation.
• C. Working on administrative tasks.
• D. Coordinating care.

16. I have __ patients at a time.

• A. 8 or fewer
• B. 9 to 15
• C. 16 to 25
• D. more than 25

17. My patients are (open ended question – representative answer below):

The best part of being a nurse.

18. In terms of daily responsibilities, I feel like I have:

• A. An appropriate workload that matches my skill set.
• B. A workload that does not match my skill set.
• C. A workload that is a bit hectic, but still manageable.
• D. An unmanageable workload.

19. In general, my shifts:

• A. Are the length of time and the days that I request or expect.
• B. Are much longer than I expect or on days that I don’t expect.

20. I find doctors and other health care staff at work generally helpful and respectful.

• A. Agree
• B. Disagree

21. If I could change on thing about the nursing field, it would be (open ended question – representative answers below):

The attitudes toward new nurses in the field from both older RNs and the public, the amount of time spent on paperwork vs. patient care, and hospital budget cuts.

22. Being tech-savvy is:

• A. Very important for my job.
• B. More or less important for my job.
• C. Not that important for my job.

23. In terms of my future in nursing, I see a lot of opportunities for growth.

• A. Agree
• B. Disagree

24. In my work environment, continuing education and advanced degrees are:

• A. Required.
• B. Heavily promoted.
• C. Encouraged.
• D. Supported, but not a top priority.
• E. Not encouraged or discouraged.

25. Overall, nursing is (open ended question – representative answers below):

A rewarding career, a profession that needs more workers, and a challenge that is worth the time and effort.

New Nurse Survival: The Dos and Don’ts

Author: Renee Thompson, MSN, RN, CMSRN has more than 20 years nursing experience and speaks nationally for organizations on clinical and professional development topics. She holds adjunct faculty positions at several universities in the Northeast, teaching courses in nursing research, professional communication, leadership and quality outcomes. She is the Program Chair for the National AMSN Convention, a published author and a member of the editorial board for the Medsurg Nursing Journal.

A successful transition from student to professional nurse involves more than just knowing the nursing process, disease states and five rights of medication administration. It involves an understanding of the health care environment, and how to avoid the landmines that can sneak up on new nurses when they start their first jobs.

To help you with that transition, here are the 10 dos and don’ts for new nurse success:

Do:

• • 1. Know the expectations.
    All nurses receive a job description upon hire. Typically we put it in a folder with the other gazillion papers we’ve received and never look at it again. As a new employee, though, you are bound to comply with the expectations and responsibilities identified in your job description. Read it. Know it. Read it again.

• • 2. Build a relationship with your boss.
    The number one reason people stay or leave their jobs is the relationship they have with their bosses. Your boss can be your biggest ally and can protect you from the challenges of being new. Meet with him or her regularly. Ask how you can be successful.
  • 3. Build a relationship with your preceptor.
    Your relationship with your preceptor determines new grad competence and confidence. Agree on an orientation plan that both meets your individual needs and enables your preceptor to handle the extra work involved in orienting a new nurse. Ask your preceptor for feedback, negotiate learning opportunities and continue the relationship after the orientation ends.

• 4. Be a professional.
  We communicate our competence by what we say, how we say it, what we do and what we wear. Make sure you are inspiring confidence in your patients and colleagues by always acting and looking like a professional – no matter what.
• 5. Get involved.
  Nursing is a career. It’s not a job. Once you’ve successfully completed orientation, find ways to get involved in the profession. Join a local nursing organization and attend its meetings. Ask to participate on a quality improvement committee or council. Take on a unit project that improves processes or work environments.

Don’t:

• • 1. Stay with a bad preceptor.
    If after two weeks, you’re not getting what you need from your preceptor, speak up. Don’t wait until you’re on your own before identifying that you didn’t get a good orientation. You are ultimately responsible for your orientation, so make sure you are getting what you need from your preceptor.
  • 2. Suffer in silence.
    “Nurses eat their young.” Although we know this fact and despise it, it’s still happening. If you find yourself in a hazing situation, don’t suffer in silence – do something about it. You deserve to be in an environment where you are supported – not bullied. Confront the aggressor, tell your preceptor or go right to your unit manager. The key is to speak up.

• 3. Do something that you’re not comfortable doing.
  Many new nurses get caught up in the unpredictability of health care and find themselves being asked to do things that they’ve never done. Be careful. If you don’t follow policy, you could be held liable if the patient has a negative outcome.
• 4. Associate with “energy vampires.”
  “Energy vampires” are the people that suck the life out of you. They thrive on complaints, negative gossip, and the misfortunes of others. There is no room for them in a profession that is supposed to be knowledgeable, competent, caring and compassionate. When faced with an energy vampire, take the high road and walk away.
• 5. Do everything yourself.
  As a new nurse, you may feel uncomfortable delegating to nursing assistants or even other nurses. Many nurses will soften the request by saying, “Can you do me a favor?” This implies that they are doing something for YOU and not for the patient. Understand that the only way you are going to be successful is if you learn to delegate. Start small and start early in your career. Set the precedent that everyone has a role to play in the delivery of care.

Are You Burning Out?

Author: Jennifer L.W. Fink, RN, BSN is a professional freelance writer with almost a decade of experience as a Registered Nurse. She’s worked in both hospitals and nursing homes as a med-surg, geriatric and transplant nurse. Her national publication credits include Parents, RN, Ladies’ Home Journal, Nursing Spectrum, Pregnancy and Journal of Christian Nursing.

Believe it or not, burnout most often affects the best and brightest nurses – and new grads aren’t immune. Nursing is a tough profession, and if you don’t find a way to balance your optimism with the realities of healthcare today (short stays, high patient acuity), you’ll be on the fast track to burnout. Choose the answer choices below that are closest to your experiences to assess your risk of burnout. We’ve even included some pointers to keep you from flaming out before your time.

Tips for a Successful Nursing Shift

Author: Terri Polick has been a nurse since God was in diapers.

Nursing is a tough job, especially when you’re just starting out in your new career. You have so much to do during your shift and one of the biggest challenges is learning how to juggle your responsibilities within the workplace. It can seem overwhelming at first, so we’ve outlined some of the techniques that will help you manage a busy day.

1. Get your rest.

You can’t organize your workload effectively if you start off already sleepwalking. Fatigue and sleep deprivation will set you up for a chaotic day with impaired judgment and concentration that can lead to serious mistakes. In fact, in an article published in American Nurse Today in March 2010, nurses who responded to a 2008 medication safety survey reported that fatigue increased their risk of making a medication error.

Along the same lines, some nurses try to balance too much at once. I worked with a nurse who did just that, taking on two jobs as her husband had just been laid off. She was able to make great money, but her performance faltered. In the end, she was given an ultimatum – quit the moonlight job or get fired. She later confided to me that she was glad that she was forced to leave her second job. Her work improved, and she was a much happier person.

The moral of the story: don’t take on too much. Don’t volunteer for extra shifts if you’re exhausted, and don’t work too many shifts in a row. Get some rest so you can do the best job possible when you do come into work.

2. Get all the necessary info at the start of your shift.

Ask the off-going shift for a detailed report before they leave the unit. Find out about the lab values, vital signs, and treatments due on your shift. Many hospital units have walking rounds, which allow the oncoming shift nurse to do a quick head-to-toe assessment on each patient in the presence of the previous nurse. Take advantage of these rounds and quickly check patients’ color, respiratory status, and pain levels. Also check IV lines, drainage bags, tubing, and the monitoring equipment that is by the patients’ bedsides. It takes a little practice, but soon you’ll be able to listen to report, take notes, and do a bedside on your patient all at once.

Don’t rely on memory. Instead, take detailed notes. Even create your own report sheet and make copies if your unit’s sheet is inadequate. I couldn’t squeeze everything onto the scant little unit report sheet I was given, so I created one that met my needs and took it to Kinkos. Later, it seemed like everyone wanted a copy. After all, no one wants pertinent patient information to fall through the cracks.

3. Get organized and prioritize.

Take a few moments to look over your detailed report notes and prioritize your day. Break down all your tasks, make a list, and just do one item at a time. Don’t try to multitask everything.

It’s imperative that you learn the art of delegation. Assign certified nurse assistants to perform tasks that are within their scope of practice, and ask other nurses to help you out if you start falling behind. Nurses who try to multitask too much are less efficient, make more mistakes, and are more likely to burn out at the end of their shifts.

4. Get your nutrients.

The toughest part of the work day is the last few hours when you’re sprinting toward the finish line. Don’t undercut your ability to deal with those last few hours by skipping meals. A recent study supported by the Federal Agency for Healthcare Research and Quality showed that nurses routinely miss meals to care for patients and that this practice can contribute to nurse burnout.

It may not seem like a big deal, but when you skip a meal, your body goes into fasting mode and uses less efficient energy sources. Glucose, the brain’s main fuel is compromised, and the deficiency forces your body to use fats in the form of ketone bodies. Ketosis causes fatigue, low blood pressure, and potentially, nausea, which can all impact decision-making skills and stamina.

Instead of skipping meals or setting yourself up for a later snack binge at the nurse station, bring a healthy brown bag lunch from home. That way you won’t have to leave the unit for lunch, and you’ll have food available when you need a caloric boost.

5. Get your notes together to wrap up your shift.

Take a small break near the end of your shift, even if you’re swamped so that you can recap your day and prepare for report. Go to the break room to collect your thoughts, or do what I do – go into the ladies room to look over your notes. After all, when was the last time you were pulled out of the bathroom except for an emergency? Taking those 15 minutes will help you catch loose ends and make your report go much more smoothly when the next shift comes in.

6. Get in some “me time.”

It’s really important to take care of yourself after you leave work. Fit some “me time” into your schedule. Keep in contact with friends and enjoy activities outside of the world of nursing. Limit the amount of stress you expose yourself to outside of the workplace and maintain a level of physical activity in your daily life. Nurturing yourself when you are away from work will enable you to keep juggling your nursing responsibilities when you are on the clock.

Giuliana Nava, RN

Bio: My name is Giuliana Nava. I graduated from Salve Regina University in 2010 with a BSN. I currently work on an acute medical surgical floor, specialized in strokes and acute respiratory issues. I’m in the process of applying to graduate school to become a family nurse practitioner.

Episode 1: Giuliana on Talking to Doctors

Episode 2: Giuliana on Working With a Preceptor

Episode 3: Giuliana on Delegating

Episode 4: Giuliana on Finding a Job