please consider buying my book on nursing in a Low Income Country. It won’t help you get a nursing job, but it will help you remember why we all do this job.
Disclaimer: while you are awaiting a nurse’s job, go to the National Council of State Boards of Nursing website. This is the repository of legal advice regarding all licensure issues. You will do a better job threading your way through scope of practice issues, if you are well grounded in the principles behind delegation and license requirements. ( and it will also help you on NCLEX)
Pick me! Pick me!
In today’s job market for new graduate nurses, “getting your foot in the door” is a catch-phrase. The goal is to identify yourself as a person and not simply be among the pile of resumes on the desk in Human Resources. There is an unspoken plea “if only you got to know me as a person, you’d like me so much you’d be compelled to hire me.”
We’ll get back to this last thought. If you are thinking this way, it means that your self-esteem is being eroded by the frustrations of a job search in today’s marketplace.
Read the previous blogs in this series
In a previous blog I gave suggestions as to strategies to get your foot in the door while you are still a student. What if you have graduated and these have not worked for you? In that case, the conventional wisdom goes, you can still get on the payroll by taking a job within the hospital in some other role, such as a ward clerk or nurses aide. Should you do it?
The Great Unknown
There is no “one size fits all answer” to this question. Some other time I will explore how this situation was created, how the health care industry got to this point, how the hospitals seemed to have decided this was a good strategy, and how it has worked. To do that would require a deeper exploration of health manpower issues related to the work of Peter Beuerhaus and the interconnected State Centers for Nursing. Probably deeper than you want to go, right now – your problem is to navigate these waters, you don’t have time to contemplate who created the sea.
The Promise of the future
In some cases, taking an aide job works fine: You take the aide job, get processed, and somewhere over the next six months you get transferred into an RN position as these get opened up. Good for you.
In other cases, you find that you are the tenth new graduate nurse hired into this position, you will need to wait your turn, and the first person in line has been waiting theirs for a year. Not so good for you.
Variations on the theme
One local hospital decided to do a major Informatics upgrade, installing a state-of-the-art nursing computer system, and hired about two dozen new nurses. Each was trained on the computer, then served as resources for the existing staff during the implementation period. This seemed to work out well for all parties: the hospital got the new computer system up and running, the new nurses got hired eventually into nursing jobs, and the new nurses also came on board with advanced training in the computer system.
There are two dangers of taking an aide position. The first is easy to see: what if there are still not enough RN positions opening up, to accommodate all those waiting in line. I know of one hospital unit where there are now seven such aide positions, and each of the persons in that role has passed their NCLEX. they are legally entitled to practice as a Registered Nurse.
Scope of Practice
The second danger is less easy to see, but real nonetheless. Here is where the term “Scope of Practice” comes in. For every position in a hospital, there is a job description. A carefully laid-out list of skills, tasks, knowledge and accountability for every player on the field. In the Policies and Procedures for every hospital, there is always a statement that says every employee will adhere to their Scope of Practice. It’s simple enough when you look at it, and it is a critical policy to protect the hospital from untoward liability – the hospital has an obligation to supervise events that take place inside.
The problem you face is an aide job is, you must only practice as an aide. Even if you passed NCLEX, if you are hired as an aide, you sign the chart “jane Smith, CNA” when you do an activity. You may only accept tasks delegated to you that are within the hospital rules. You may not give meds, not even if it meant you were doing the RN a “favor.”
Telling a War Story to illustrate the point
This happened to a friend of mine. She graduated nursing school and took an aide job on a cardiopulmonary floor. She was very articulate and verbal, eager to use her assessment skills. One day at work, there was a COPD patient on oxygen with an order to titrate to keep the SaO2 greater than 90 %. On morning rounds she took the SaO2 and adjusted the oxygen while she was there. She did not tell the RN until a few minutes later. It didn’t matter that the assessment she made turned out to be correct, or that the action she took was within the parameters set by the Medical Doctor. She got a letter of reprimand. Another time a patient had pulled the IV apart and the nurse-practicing-as-an-aide put a gauze bandage on it and held pressure, instead of getting the RN immediately. This was probably the immediate action the RN would have done, but since my friend did it independently she got another reprimand. She was suspended from that job.
In the hospital’s defense
To the hospital, the need to maintain control over these things, over-rode the idea that the person involved was technically correct. In the long run, nurses everywhere need to maintain the authority to define nursing practice. We have the licensing rules for a reason. But the outcome was devastating to the individual involved, in this instance.
For this person, the foot-in-the-door strategy did not work. She left that job, and had a lot of self-doubt. From there, though, comes a happier ending. She talked to some of the faculty members that taught community health nursing, and learned that if she were to work through an agency she could get a per diem RN position working at a nearby prison, providing health services to the inmates. Soon this got her more hours. She was also using her full knowledge and scope of practice within the policies of the agency that employed her. She is happier now.
The bottom line
If you use this strategy, be sure to explore the ins and outs of delegation so that you don’t get caught in this trap.
Tomorrow’s blog will answer another question: Should you relocate?
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