Tag Archives: first nursing job

Hawaii Nurse Jobs Update Oct 30 2013

Nursing Jobs in Honolulu

As of Oct 30, there are signs that the nursing market in Hawaii is looking better. In April I re-posted a link to an article in the Honolulu Star-Advertiser that said we had a “saturated” job market.

The need for nurses isn’t going away

It’s just that we have a mismatch in the number being produced and the number we can absorb. this mismatch is due to accelerate. click here for a nifty graphic update about the need for nurses.

Geography Lesson

For those of you not living here, some geography is on order.

Most of the big hospitals are located in downtown urban Honolulu (yes, there is a city here. about 900,000 people. if we were on the mainland we’d have an NFL team. we are the 11th-largest city in the USA. we are not a foreign country.). But the population growth on the island of Oahu is planned to take place in the western side of the island, in the part called Kapolei. For years, there was a hospital in Kapolei, run by the Sisters of St Francis. It went bankrupt after running deficits for years, and hundreds of nurses became unemployed. The job market could not absorb so many nurses at the same time. The building sat vacant for awhile. It was/is a nice building. ample parking. central to their neighborhood. convenient for a whole bunch of people.

During that time, if you lived there and you wanted to go to the hospital you would need to drive on H-1, the most congested interstate highway in the USA ( how we got an interstate here, while we are separated from California by two thousand miles of open ocean, is a whole nother matter).

The building was finally bought by Queen’s Medical Center, the biggest hospital here. QMC has a “Magnet Nursing Service” and is very forward-thinking. they have planned to reopen the Kapolei building.

Job Fair(s)

which brings me to the next step. they will hold two job fairs for nurses in Honolulu, one this coming Saturday Nov 2nd in Kapolei, and another Nov 9th, the following week, in Manoa. they are hiring for all kinds of jobs, not just nurses.

Also, anecdotally, I have run into any more of my former students who are now finally getting out of the holding pattern and into new grad residency programs, particularly at Queen’s. The general consensus is that things are easing. I know I am biased, but I think UH is a terrific school of nursing, and I want to make sure our graduates get properly launched into becoming the fine nurses we educated them to be.

the link

If you want to get to a specific link for the job fair, CLICK HERE.

good luck on the job hunt!

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Nurse Burnout, Reality Shock, Marlene Kramer

note: all words or phrases that are underlined lead to hyperlinks – be sure to click on them and see what happens ;-)

The B word?

In my recent blog about adrenaline junkies, I got a private message reply asking for advice: What if you were an adrenaline junkie now verging on burnout?

Well, naturally my first reaction is to tell that person to go to Amazon and buy my book about nursing in Nepal. One basic premise of the book is to explore what happens when you are a lifetime adrenaline junkie and you finally get to a problem so big, so overwhelming, that God can’t even deal with it. Yes, such problems exist, and yes, God has a special way to address them over the course of time. There is an answer – but you will have to read all the way to the end.

this book is about medical missionaries in Nepal. sure to become the number one beach read for summer 2014! go to Amazon and pre-order your copy at  http://www.amazon.com/Sacrament-Goddess-Joe-Niemczura/dp/1632100029/

this book is about medical missionaries in Nepal. sure to become the number one beach read for summer 2014! go to Amazon and pre-order your copy at
http://www.amazon.com/Sacrament-Goddess-Joe-Niemczura/dp/1632100029/

you could also buy my second book. see picture of the cover at left.

Marlene Kramer,RN, PhD

I read a lot of papers written by nursing students on the topic of burnout when I teach the senior-level leadership, management and issues classes. I always check to see whether the person was diligent enough to find the book “Reality Shock: Why Nurses Leave nursing” by Marlene Kramer. This one is old by now – written waaay back in the 1970s – but it was such a classic that it still deserves to be studied and cited. (note: On Amazon there are only three used copies, and the minimum price is $199.50… go figure…). In fact, one Google source indicated that it has been cited 743 times in subsequent scholarly work. Dr. Kramer is now retired but had a long distinguished academic career. Her work on reality shock and burnout created a national dialog at the time which led to the work of Patricia Benner and others.

Kramer and Magnets

There were many who thought that Kramer portrayed nursing in a highly negative way, and this reaction produced a result that is still evolving today. The argument was “Okay, you have showed us what is wrong but why can’t we focus on the good things that are happening?”  Which is of course, what a reasonable person would ask.  Nursing advocacy, the heart and soul of what nurses do, is based on righteous indignation and the desire to make things better, and so Dr Kramer was firmly in the tradition started by Florence Nightingale herself.

Magnet Hospitals

The reaction to Dr Kramer caused the American Nurses Association to promote the studies about magnet hospitals – places where the new nurses were being nurtured and developed. and from there to the whole Magnet Nursing Service movementThere is now an independent non-governmental agency which evaluates hospitals that voluntarily apply for Magnet Designation.  Can we agree that this is a good thing? We still have a long way to go, and the budget climate is not helping us, but an argument could be made for saying that Kramer gave the entire profession the wake up call that led to this work. She got the ball rolling. Every hospital should have a Magnet Nursing Service.

Return to wallowing in negativism

back to burnout. There are four phases.

the honeymoon. This is where the new nurse is still being oriented and everything is wonderful. The preceptor is so smart! The staff is amazing! The paycheck is HUGE! we all love to be around such a person and delight in the innocence of youth.

crash and burn. the onset of this is hard to predict, but usually about the six-month mark. Takes place when the nurse starts getting feedback from every direction, not all of it is easy to take because people are telling him or her that they are not perfect. The nurse is now saying “These people are jerks. This hospital has its priorities wrong. nobody is listening. Why did I ever want to be a nurse?”  This person can be angry and depressed.  Nothing is wonderful anymore. The road has a fork in it. One choice is to leave; the other choice is to stay.  When the nurse  leaves (regardless of where they go), it  causes the cycle to repeat with new nurses.  Turnover of this nature is expensive for all concerned. The National Council of State Boards of Nursing has recently recognized that up to 25% of staff nurses who do get a job, leave their first position within a year, which has caused the NCSBN to work on what they call “Transition to Practice” issues. In this way, we wonder if anything has changed since the 1970s……

recovery.  This is a phase of letting go of anger and depression, characterized by the return of a sense of humor. The preferred outcome of crash and burn.  The nurse wakes up and realizes that some things are good, some are bad and not everything is perfect. Or Burnout the nurse quits the job and goes to another job (to enjoy another honeymoon!) or maybe leaves bedside nursing altogether.

and resolution. where the nurse develops a sense of perspective and is able to contribute effectively.

The Care Plan for the Nurse?

The key is to assess yourself and those around you, and adopt some specific interventions.

the honeymoon? keep the new nurse grounded in reality. No, it’s not as perfect as you think

crash and burn? similar to above. No, it’s not as bad as you think. Hang in there and keep working at it!

recovery? find new ways to be productive now that the new nurse has been around the block.

and resolution? find joy and happiness in leading your life, with nursing being just a part of it…

Water over the dam

There’s been a lot of work on related topics since 1975. For example, the whole “codependence” thing came and went – the more codependent the nurse is, the more likely they are to experience burnout.  Closely related to this is the idea of OCD, and I gave my two cents on this in a prior blog. We have had periods of cost-cutting when a new wave of managers rejected efforts to nurture and  mentor new nurses through their role transition issues. Sometimes it feels like all the negative and positive trends are now stewing in the same pot…..

The Bottom Line

Probably the most important lesson is that you may go through these phases by yourself, but you are never alone. Use your peer-group resources. Each nurse has to start by assessing themselves as to where they lie on the four-phase continuum. Keep your sense of humor, and keep your self open to sharing with others.

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How to avoid the Nursing Work Culture From Hell

please subscribe to this blog. click the button at right. If you agree with this post, please share as widely as possible. together, we can work to improve the daily worklife of every nurse and every nursing student.

Culture at the workplace?

A workplace becomes a surrogate family for the people who spend time there. When people spend so much time together, the personalities come out. A group will adopt a set of informal rules that guide each day. This becomes “workplace culture.”

If you have been a nurse for any length of time, you develop a sixth sense for this. The minute you walk on to the patient care area, you get a vibe of what it’s like there.  It may be calm and peaceful, it may be chaos, it can be happy or tense. It can be this way independently of how much nursing care the patients require. When you interview for a nursing job, be advised: the best managers know about workplace culture, and they are looking to add staff who will value it and honor it. A theme of this blog has been to encourage new nurses to live up to their caring potential, and it includes caring for those around them as well as for the patients.

Urban Community Hospital – a “war story”

My first nursing job was not a place for teamwork. It was an “urban community hospital”  and chronically understaffed. Each shift was a contest to see whether you could get through all the work yourself, and the assignment was heavy. It was a trauma ward, lots of gunshot wounds and stabbings and victims of beatings, along with a population of heroin addicts and homeless persons. Lots of crime victims. The staff consisted of a head nurse who had worked there since the dawn of time, and each spring there was a fresh crop of new graduate RNs. The hospital would hire a batch of new grads all at once, they would stay a year, then leave once they got “the golden year” of hospital experience. Or at least they were planning to leave then; most left my particular unit before hand, chewed up by the system of unsupportive coworkers. The crew of nurses aides were all older than the young RNs.

Walking Rounds

We did “walking rounds” there, change-of-shift report consisted of a procession of sorts, all the nurses in a group  following the kardex from bed to bed like it was the Bible at the beginning of Mass. The circus was led by the head nurse, same age as my mother. She generally arrived each morning with an attitude, and would heavily criticise the night nurse, pouncing on any inconsistency she found between the way the patient looked and what was written in the kardex; or how the story was presented.  Very theatrical. As report was read, she would examine each patient (“you said the IV was NS w 40 of K, why is it I see a bag of LR hanging?”) This included getting on her hands and knees to look under the bed, on occasion, as well as barbed sarcasm. Every day.  One day she chased a rat out of the ward, to the cheers of the rest of us…. but that is a whole nother story ( it was a very large and well fed rat). Yes, she was teaching us how to have standards and to follow them; but nowadays we would call her approach “horizontal violence’ or “verbal abuse” or “eating the young.”  That was the way it was in that time and place.

These days there is a national movement toward something called “Magnet Culture” – hopefully to eradicate that sort of approach. UPDATE: a former student emailed me after reading this, to alert me to some excellent work published by Sigma Theta Tau about Bullying in the Nursing Workplace.

New RN working nights

I was on eight-hour shifts, a day night rotation and soon found myself working nights about eighty percent of the time – the only time I was on days was on the head nurse’s weekend off.  The day I passed my Boards I was Charge RN whenever I showed up from then on. That was how I spent my first year as an RN. Since I was on nights so much, it meant that I got to be the person going through the gauntlet every morning. And yes, I did well at it – better than the others. In those days I could be just as sarcastic and unforgiving as others. I would spit it right back at the head nurse, to the astonishment of other first-year RNs on the crew.

I no longer treat others that way.

The usual night staffing was two RNs for up to thirty patients, and even then, I went out of my way to help the other RN be ready, which was appreciated. I promised myself I would never be the kind of nurse manager  that I was now working for, and that if I ever had anything to do with it, I would be kind and respectful.

In other words, it was the Work Culture from Hell. Got the picture? I can go on and on – you got me started, but like a bad dream, I need to wake up and remember that this degree of dysfunction is not the way to go through life. Let’s focus on positive ways to interact, here.

Teaching workgroup culture. learn it and live it.

What I do now is to incorporate healthy work behaviors into nursing school. Nursing school is not simply to learn about patient care; it’s to learn the way a professional person acts and thinks. Sometimes in the Fundamentals lab, a student acts as though the only thing they are there to accomplish  is to learn how to perform a specific skill according to the checklist. They don’t care whether others also learn, and don’t help their classmates or spend time coaching somebody slower to grasp the concept. Somehow there is a subset of students who think it’s okay to be a jerk to those around them while they focus on their own learning needs. This may work for Jack Sparrow, but will not lead to success in a hospital workplace.

This tells me that such a student has a learning opportunity.  Focusing on yourself is not the way to go through life. You are missing a major part of the ride.

(Note: a few years back I developed a one-page handout for how to act in the nursing school lab which I will send to anybody who emails me and asks for it)

How to Succeed as a team

Want to develop the habits of a helpful work group culture? here are some ideas. They are not a “Code” – more like Guidelines.

In both lab and clinical: Your work is not finished until the work of everybody is finished. Nobody sits down until everybody is able to sit down. If one person is getting swamped, we pitch in and help them. In the lab, it’s the students and faculty together, who tidy up and make the lab ready for the next group of students. Don’t rely on somebody else to clean up after you.

In the clinical setting: learn about  each other’s patients. Depending on how morning report is handled, this can be a challenge. If it’s a group report that’s easy; but if it is nurse-to-nurse report, you have to go out of your way to do this.  Find a way to check in with the other staff nurses (or the other students) after an hour or so.

Nobody lifts or transfers any patient by themselves.  There is a strong evidence-base out there regarding nurses and prevention of back injuries, so we have an important reason for this. Some wards have many “heavy” patients, and this attitude makes a big difference. But it’s also a chance to create and strengthen relationships among the staff.

say thank you. this goes a long way. there’s an old saying that “People may forget what you did or said but they won’t forget how you made them feel.” think about it.

use names. there is a parade of people through every hospital area every day. Learn who they are, and use their name in conversation.  You don’t have to go to Happy Hour with them or learn their kids’ names, but why not humanize the workplace? this includes housekeeping, the docs – everyone.

name tags. Ever been in a college class where the professor never learned your name, even by the end of the semester?  At my nursing school, we teach the same course to a different cohort each semester, there are fiftysix or sixty new names to learn. On the first day I always set up a system of using name tags, keeping them at the lab. The students collect at the end of each session. We call each of the students by name. They are not allowed to melt into the woodwork, which is often a surprise for the students.

just like a basketball team
Huddle. this picture was taken in Nepal, but any of my students will recognize this gesture. When I wave my hand at waist  level, they know that I want them to approach. I never have to raise my voice when calling them over. (and yes, they know i will not bite…) At lab and clinical practice,  I call a huddle every now and again. soon the students learn to call their own huddles without me.  Communication is a big part of teamwork. We use the time to share and to plan out our work and get ideas.

The Bottom Line about workgroups

The fact is, we all have a choice to create a healthy work culture, or not. which will you choose?

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Should a New Graduate nurse relocate to find a Nursing Job?

Should I relocate to find a nursing job? (updated Aug 24 2012)

Before we answer the question: why not subscribe to this blog? Go to the box on the right and click where it says “sign me up.”  And while you are at it, buy my book about the time I relocated  (just for the summer), to teach nursing and work in Nepal, the Himalayan country in the mountains between China and India.  It won’t help you find a job but it will remind you of the value of your chosen career. Nurses make a difference in people’s lives, everyday.

And now – Catch-22

Two years ago one of the best students in the graduating class faced a problem: she was determined to be an ICU nurse, but getting discouraged. She’d sent out the resumes, worked her contacts, done everything. The local hospitals were interested but they pointed to “catch-22” – they would only hire if the person already had experience. And how to get that experience? get hired…….

She was offered a job as a nurse’s aide, but resisted the idea. So she took a courageous step. She moved to a large city in California,  where she didn’t know anybody.  It wasn’t San Francisco or L.A., or on the coast;  There was no surfing and no beach. Frankly, her new home was not a city with a lot of tourist appeal unless you like hot weather and dusty desert winds. There, she got the training and experience she’d set her heart on. And this year, with two years of ICU experience under her belt, she moved back to Hawaii. Now she works in ICU at the hospital that was always her dream job.

For her, the gamble paid off. She improved her career trajectory. Things fell into place for her; she was single, no kids, flexible, and resilient. She’d been a top student and always made friends along the way.

Destiny? Kismet?

It’s easy to say in retrospect that it was her destiny, but along the way she had to deal with loneliness and homesickness. During her time in Inland California she didn’t have much of a social life while she pursued professional goals. She worked mainly night shift.  Any of these things may have overwhelmed somebody else.

I think of her when any other new grad asks me whether their career would be better if they looked for Greener Pastures. Sometimes it works and sometimes it doesn’t. The National Council of State Boards of nursing would tell you a cautionary statistic: about 27% of new graduate nurses who do get hired, leave their job within the first year. That is a sobering number. There is never any easy answer.

Before you pack your bags and head to a new location, consult your personal Board of Directors, go back to the school you attended and tell your favorite faculty members about your plans. Ask their advice. Of course, figure out how much it will cost and what your budget is. List the pros and cons. Do all those things.

(added Aug 24th 2012): Travel as a means of escape

re-reading this, it occurs to me that nursing is still a field in which you are portable. It is amazing that you can find a job thousands of miles away, and largely be able to apply what you learned where you are now. The consistency between hospitals throughout this great land did not evolve by accident. In 1978 I moved from Boston to San Francisco with my girlfriend. We spent eight weeks driving cross-country, seeing all the National Parks and we both got nursing jobs well before our savings ran out. It was glamorous! We were leading the lives we dreamed about! We were grownups!  How could I advise the next generation of nurses to be anything less than that?

So… most of all, take your courage with you. 

Let’s get philosophical for a moment.

You’re young, you’re out of college. You chose a major that leaves open the possibility that you *could* take your skills anywhere in the USA, walk in the door, and have a paycheck.

Back in the Day, in the times when there was a nursing shortage, nurses used to do that all the time. There where nurses in my generation who had travelled the USA this way, taking a hitch in New York City, San Francisco, Chicago, Honolulu (of course) and Portland, Maine.

Wherever you go, it will be an adventure. For the rest of your life, you will have a story to tell. It will be a part of you, even if you return home, never to leave again.

You will always have people listing the reasons not to do it.

But you will never know, for sure.

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Part One “Getting Your Foot in the Door” for a nursing job

Jan 19th 2012 Update: link to a good blog on The Hidden Job Market, which is another angle on foot in the door…

Foot in the door

This is one in a series of blog entries written for young nurses. Take a look at the previous blogs about resumes, what to put in a cover letter, how social networking can hurt or help you, and ways to look at your portfolio. If you are a nursing student, you can start now to think about these things. Please share with others.

While you are at it, go to Amazon and buy the book I wrote about Global Health Nursing. It won’t help you in your job search but it will give you a window into a very different kind of nursing and it will help you remember the best reasons you chose nursing in the first place ( I hope).

The basis of the foot in the door strategy is simple:

A) In school: If the organization where you want to work hires ward clerks, nurses aides, billing clerks, etc, get a job there while you are still a student.

B) as part of school: If you want to work on a specific unit of a hospital, try to do clinical there through your school.

And

C) after graduating from school: If your target is a hospital which is not hiring for RN positions, apply for a job as a nurse’s aide or computer tech or anything, so you can become an internal applicant as opposed to an external applicant. Many large organizations will offer positions from within, first.

Let’s take these one at a time.

A) working part time while in school.

Nowadays it’s less usual to be a nursing student who does not work in some part-time job, somewhere, I’ve had students who worked as servers, telemetry techs, billing clerks and even as hula dancers at the big hotels on Waikiki.

You might as well be working in a hospital. Don’t underestimate the job of being a ward clerk. A ward Clerk will become familiar with the systems by which the hospital actually runs;  A clerk  gets into the chart everyday; and a clerk has a daily opportunity to become literate on computer systems such as EPIC or MediPro.

Here is a Pearl of Wisdom: Many of the older RNs nowadays don’t have the computer skills for EPIC are reticent about learning on the computer. The more you become proficient at EPIC or some other system, the more you can use this as a sales point for your resume. You are in the tech generation!

If it’s a nurses aide position, most hospitals will only hire you if you already have the Fundamentals course and some clinical under your belt, and often the state will require documentation that you have enough training to be equivalent. This varies state-by-state.

B) through school, as part of clinical, especially during the last semester

Future employment advice if you are doing clinical at a place you want to work later.

General advice: don’t only focus on the patient.

Oh, you need to do excellent patient care. You need to prepare well, be organized using a “nurse’s brain” and you need to be “on it” every day that you are there, using critical thinking and applying what you learned in class. But you also can benefit by adding some extras. You’d be surprised how students miss the little things: learning the names of the ward staff, (then following through by using people’s names when you talk with them), being polite to the housekeeping staff, (you can’t do your work without them!) and relating to the ward staff like future colleagues. On many hospital floors, the staff is already looking at you to evaluate your potential. Hate to put pressure on you, but it’s true. They are taking notes.

Specific advice for seniors:

Most schools nowadays incorporate a senior practicum, in which you are no longer in a clinical group, but are assigned to work one-on-one with a preceptor.

You don’t always get assigned to the floor you want, but that’s not the end of the world. There is strategy to apply here. For example, at one of our medical centers the Medical-ICU is considered to be the among the best placements; but they have never hired a new graduate and there is a waiting list of experienced RNs who wan to work there. So – you can get ICU clinical but it won’t lead to a job there.

If you don’t get placed in ER or ICU, it’s NOT the end of the world. My usual advice is actually to work on a Medical-Surgical ward, because the skills of organizing your day, setting priorities and making decisions about psychosocial issues are ones which apply to any setting. A few years back we had a student whose goal was to be a CRNA and he did his senior semester practicum in the O.R.  He enjoyed it, but it didn’t really help him learn the assessment skills he needed – he focused mainly on the surgery and on sterile technique. Right after graduation he got an ICU job, but did not do well there; I think he would have done better if he’d done medical surgical and gotten solid organizational skills. The O.R. seemed good superficially but turned out not to be a good “fit.”  Having a placement that meets your needs now is actually more beneficial than getting the dream placement if you can’t make the most of it. Have a heart to heart with the clinical placement coordinator as to what you really need, not just what you want.

The preceptor is critical. You need to know that when it comes time to apply for work there after graduation, about fifty per cent of the input as to whether you should be hired, comes from the preceptor. Recommendations, the interview, the cover letter? Nowhere near as important. When you apply to that hospital for a nursing job, highlight the name of your preceptor in the cover letter.

Read up on how to have a good relationship with your preceptor.  There are some great articles about your relationship with your preceptor on the Web.

The next thing is to consider work behaviors, and for that I have a story. Two years ago one of our senior  students took an ER job right out of school at the hospital where he’d done his senior practicum. This was a “success.” I asked him about it and he said:

“I took your advice”

Oh? ( couldn’t remember which advice he meant, I give lots of advice. What I am writing here is something I have preached for years, but don’t ask me to recall every single thing.)

“Yeah, I knew I needed to impress them with not just my nursing knowledge, but my work ethic. So, I never sat down when I was there. If there was something going on, I offered to help, but in the quiet times I did stuff like defrost the refrigerator, clean the nurse’s station counter with rubbing alcohol, and tidy things up. I didn’t brag about it, but everyone sure noticed.”

So what he was saying was, he was neat and cleaned up after himself, in addition to using checklists and following protocols. He was the kind of guy who showed up to lecture class or lab with a to do list, and I bet if I spoke to his mom he also made his bed at home and helped with the dishes and chores. ( I never did speak with his mom, this is a guess.).

Even if you don’t have your foot in the door, ask yourself whether you have this kind of attitude at which ever job you now have?

Tomorrow:

Situation C – getting an aide job *after* nursing school.

This blog is 1,316 words – long enough to digest in one day; I will break it in 2 pieces. The last part of foot-in-the-door is when a hospital has enough RNs but will consider hiring you as a nurse’s aide even though you have a BS and pass NCLEX.

Til then, share this with every nursing student you know, and Stay tuned!

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