Tag Archives: new graduate nursing jobs

If you, as a nursing student, MUST learn EKGs…..

want to learn what’s really important in nursing? it’s not what you think… I don’t often get to the point of revealing my deepest secrets to the world, it takes a lot  to actually put these things in print.  For example, even though I know the name, hand gesture and usage of the  One Universal Surgical Implement, when I was initiated into the cult I was sworn to secrecy that I will only reveal it to those cognoscenti that show themselves capable of handling such knowledge…..

Responsibility always comes with knowledge.

Remember that. Before i would ever reveal anything, you must prove yourself worthy. And of course, the first step is to buy and read my book about Nepal. It’s the kind of book you can give to the nurse in your life for Nurses Day or for graduation from nursing school.

Anyway, there were too many protests to last last blog

They call this “push-back” – readers who said they just needed to be ekg-certified….. O to be young again!

The Six Rhythms

There actually only six you need to know. trust me. This Pearl of Wisdom has been enshrined in the American Heart Association Manual for twenty years, but somehow people gloss over it and say, it can’t possibly be so simple….

Link to a website

In Nepal I met Jason Waechter, an MD from Canada who was working with Patan Hospital.

He was wicked cool.

has all kinds of great stuff about critical care on his website.

I particularly recommend the handout on basic ekg.

also – I have a two-page handout on rhythm strip analysis which I will share.

To get the two-page handout,

subscribe to the blog,

share with all your friends, and

send me an email. joeniemczura@gmail.com

ten-four, over and out in Honolulu today…..

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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 nurse go to graduate school right away if they can’t get a staff nurse job?

Funny you should ask… I will answer in a minute, but before you read on, please take a look at my book about hospital care in a Low Income Country. My book won’t help you get a nursing job, but it will remind you of the value of nursing.  And why not go the right of the screen, and click oon the little box that says “sign me up” ?????

It’s a tight economy for nurses

The job market has changed from just two or three years ago. This past month, three different new graduates told me they were worried about their prospects of getting  a staff nurse job. Each of the three asked me the same question.

“If I can’t get a nursing job right away, should I go to graduate school?”

And

“What track should I take? Is it better to be a nurse practitioner or a nursing administrator?”

The pros:

You will have more credentials.

You will be doing something productive.

In the long run, you can get it over with before you have other responsibilities.

The cons:

Running up more debt in student loans.

Not having enough experience to draw upon.

Still having job search trouble after graduating.

As always, the answer that fits you depends on your circumstance. If you are young and your parents will still foot the bill this is different from being say, thirty and with two kids.

My story

For me personally, I went to grad school after being an RN for a year, worked in ICU while in school, and then took a management job for ten years after grad school. I knew I wanted to teach eventually, and the MS degree was always in the back pocket, just in case. By the time I made the move, I had two kids and a house and a mortgage; I was living in rural Maine far from the nearest graduate program. Having the credential allowed me to make a career change within the nursing profession that would have eluded me if I needed to go back to school right then. So, the timing was auspicious.

I did my grad school in a “Clinical Specialist” track, what would now be lumped in with other ARNPs. There was a window of opportunity in the nineties, when the ARNP standards were revised during which I could have become an NP with nine more post-Master’s credits, but I decided not to at the time. The classes would have been 65 miles away; it would have cost $2500; I would have needed to do a clinical placement in an MD office practice. Finding the MD sponsor would not have been a problem, but I always did ICU and the thought of looking at otitis all day or dealing with management of HPTN, was not appealing. Those things are important but in my heart of hearts I wanted to be doing hospital-based acute care.

Call me a traditionalist.

How many NPs do we need?

For awhile there, the federal government was subsidizing the expansion of NP programs around the USA. There are statistics to say we need these primary care providers, but I wonder. When layoffs and restructurings happen in the health care industry, reductions in clinic staff always seem to involve the NPs before the doctors. I just don’t think the underlying reimbursement structure is well-established enough. And if you are a family NP? There are fewer kids nowadays and family care includes a lot of clients who lack insurance. This has been true for decades. Even in the 1980s, both of the two pediatricians in town had less take home pay than I did as ICU manager of the local hospital (they had office overhead, employees, etc).

What does an ARNP do all day?

A friend of mine in Maine is a women’s health APRN. She spends her whole work day doing contraceptive counseling, pelvic exams, and fitting diaphragms, IUDs and depo-provera inserts. She loves what she does. Simply gushes with enthusiasm. I don’t want to deny the importance of women’s health – it is critical. But would I want to do that? No way.

There is significant Continuing Education required to be an ARNP – to maintain certification takes 80 hours per year (varies from state to state).  this is a sizeable investment of time and money. Yes, we need to stay current in our field. But this is time spent away from patient care activities.

How to fix the nursing job market

In My Humble Opinion, we need to fix the gridlock in Washington DC before the health care situation will be improved. We have a series of paradoxes: lots of patients; lots of need; a huge cohort of older nurses preparing to retire in the next few years; and a larger supply of newer ( younger) nurses waiting in the wings. But jobs in health care are being held hostage by Congress. We need to get some grownups in charge back in the Capitol Building.

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Tips for nursing students attending your first Job Fair

I invite you to subscribe to this blog. click on the button at Right. Also, check out my book.  It won’t help you get a job but it will remind you why nursing is important.

Job Fairs?

Here in Hawaii we don’t often conduct a “job fair.” It’s  not how things are organized here.

but now I have readers from That mythical place known as The Mainland,  and a Job Fair is one of those ways to get face time with people who are involved in hiring.

Here is how it works: somebody gets a large public space, like a hotel ballroom during a conference, and rents out booths to exhibitors or vendors. Often the organizer is one of the Nursing Specialty Organizations or the State Professional Association such as ANA-Maine or The OR Nurses. The revenue from the vendors is part of the conference budget. The sponsoring organization brings the nurses, the vendors are promised that the schedule will include free time for the attendees to wander around. Often, the conference program will list all the vendors or exhibitors in advance.

Here is a story about Speed Dating

Ten years ago was the first time I taught the senior level management and issues class at a small college on the east coast. We had thirty seniors, since it was a residential college they were all about twenty-two years old. Our career center organized a small job fair right on campus, to which about two dozen local employers came. The Job Fair was held on the day of the class, and I decided to cut class short so as to allow all the students to attend.

I wandered down to the job fair myself about fifteen minutes later and watched what happened. Where was everybody? Half the students were gone within a few minutes; they had strolled through and spoken to nobody. The others were standing in small clumps on the other side of the room from the vendors. This is not good, it’s like a junior high school dance, I thought to myself.

Within a half hour all the nursing students had left. We were a bit embarrassed, as the hosts, because we had hoped that each vendor would make some kind of meaningful contact with our group. Fortunately we had not charged the vendors very much, and nobody came from a long distance, or I would have felt like we should return them their money.

The Assessment

At the next class meeting we spent a bit of time talking about getting over your nerves when you make a “cold call” to a job recruiter. The students expressed the idea that they didn’t know how to start the conversation, or how to act. Now, when these same students were in uniform in clinical they were confident and verbal, comfortable with the hospital setting where they meet patients and families every day. But somehow when the setting changed, the confidence took a hit.

The Plan

We needed to role play a job interview, and we needed to have a better strategy. So, the next semester, when we repeated the Job Fair, we did things very differently.

The week beforehand, we role played an interview, and assigned readings from the book using the chapter on the hiring process.  This included a review of basic body language that people fall back on during times of threat or stress.

The Implementation

The day of the job fair, we did two things. first we paired the students, and gave them an actual role to play. for each booth at the job fair, one was assigned to be the Talker, and the other was assigned to be the Observer.

The Talker was expected to ask all the questions and do the interacting. The Talker was expected to bring a list of questions to ask. At any interview there is always a time when the job seeker is asked “what questions do you have?”  – this is a time where the Job Seeker can display their verbal ability and enthusiasm. If you are the kind of person whose has a brain cramp at this moment, it helps to write the questions down and practice them. There are some standard questions used by a lot of interviewers, and you should be prepared to answer.

The Observer was given a small checklist, and told to stand back and – Observe. Complete the checklist during the interaction, as if this whole thing  were an experiment in a sociology class.

The checklist was simple. it included:

eye contact?

handshake and introduction?

“open” body language?

asking three questions?

answers to questions?

looking enthusiastic?

positive statements?

Each pair was to use this at six booths, taking turns so they Talked three times and Observed three times.  In between each booth, the pair was assigned to go to a corner and debrief, so the Observer could give their partner feedback as to how she did in meeting all the elements.

Picking the order of booths to visit is a strategy

I also told the students  to choose the order in which they approached each booth. If there was a vendor that was truly the one they really really wanted, they should go to that one last. If there was a vendor there representing some hospital or agency that was too far away or where they Talker never intended to apply, don’t simply omit this one. Go there anyway, and talk with them. You might find that they are more interesting than you think, and also, the stress will be lessened because there is nothing at stake.

The Evaluation

When we used this approach, the students stayed a lot longer, and after it was over, the vendors expressed their appreciation. Every vendor at a Job Fair works to send people who will be approachable and nonthreatening, and every Human Resources Professional knows that the person being interviewed will be nervous. The vendors could tell that the students were not so nervous as the previous time.

At the end of the exercise, the paired students submitted their raw notes to me. This wasn’t really “graded” but it did support the self-learning about socialization and seeing how you come across. The only way to do this better would be to video the interaction and allow people to have an instant replay.

One of the students said “it’s like Speed Dating for job interviews”  which is exactly what it was. The Observer partner was the “wing man” for the Talker, and the opportunity to discuss the interaction with a nonthreatening friend was very valuable.

You can go a long way with the dating analogy. Just because you talk to somebody does not mean you need to go down the aisle with them…..

It goes without saying that you should dress for a job fair as if you were being interviewed; and that you should consider writing a followup to each recruiter for whom you have a specific interest.

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Is FaceBook hurting your search for a nursing job? 1 Corinthians 13:11

UPDATE: The National Council of State Boards of Nursing now has a video on Social Media for nurses. click here to see it! I strongly recommend that every nurse, new or old, become familiar with this.

Now you have graduated from nursing school and you are out there looking for a job.

Only it is  taking longer than you expected to find that dream job that caused you to study so hard and to dedicate your life to nursing school. Is it me? You ask. Nursing is a profession that demands a high degree of emotional investment, and if you are not getting a job, it’s easy to second-guess yourself down to the core. Think back to when you started nursing school. There were stories about nursing as being recession-proof. The Baby Boomers will all retire and who will replace them? When you started nursing school, you may have met new nurses who were walking proof of what a good career choice nursing is – and it’s true, just three years ago the job market seemed to be wide open compared to how it is now.

It’s the economy.

If you have the sense that the Clock of Doom is ticking, or the Sword of Damocles is hanging over your head, lighten up. Look around. The national economy is not some abstract thing that happens only on TV or to everyone else. In the USA we’ve had nine per cent unemployment, part of a worldwide slowdown and the daily news says Europe is in big trouble. Here in USA,  one party in Congress has done everything it possibly could to prevent expansion of health care funding, even though it is needed by an aging population. As long as the anti-Obama forces control congress, it is my belief that the nursing job market is going to be more difficult than it needs to be.  That’s little consolation while you are searching, but it should help your self-esteem: it’s not you.

Small things make a difference.

When there are five applicants per nursing job, sometimes there will be very little difference between the winning candidate and the second- or third- place candidate. It may very well be that some extraneous factor beyond your control, made the difference, such as which high school the winning candidate attended, something they said about being a baseball fan in the interview, that sort of thing. It can be very superficial. The best advice is to be yourself. When you read things like the paragraph above, there is a tendency to try to over-control things and get nervous about saying the wrong thing, or writing the wrong thing. You still need to wake up every day and be who you are. Make a schedule of exercise and time with friends.

There are things you can and should control.

That’s where social media and the internet come in. Any hiring manager will be under pressure to choose the best employee, and they will attempt to learn as much as they can about their applicant, which is why the “foot-in-the-door strategy” (which I will call “FITD”) is so important. I will discuss the FITD strategy  in a future blog, (subscribe now so you won’t miss it!). Now that you have graduated, though, the FITD strategy may not be available to you. In that case, it’s time to take another look at social media.

What does your FaceBook page say about you?

In the past several years we have all been cautioned about HIPAA, over and over again we are warned never to post anything about our patients, online. At every hospital you sign a HIPAA acknowledgement during orientation. All too often the student overlooks the idea that confidentiality affects them too. Your potential employer can use the internet to check you out. They can check your FaceBook page; they can Google your name; they can run a background check (for a fee) and a credit check (nowadays they pressure you to agree to this by putting a box on the application for you to check and give permission.  Did you give them the okay?).  They can legally learn a lot about you  – it’s all there for them to see. Most often, you are the one who put it there.

There are internet “reputation-monitoring services” available to which any employer can subscribe. The way these work is, they run a search for the name of the company, they scour the internet for any possible mention of a given employer’s name, and automatically send an alert to the Human Resources Department for review by a person, whenever the keywords appear. One the one hand, it’s all an invasion of privacy, but on the other hand, when we posted it to the internet, we enabled it ourselves. So, think about it.

Then do the following: Look at your own social media profile from the perspective of your potential employer. Be advised, the H.R. Department person who will look at your profile is likely to be a person older than you with a different sense of humor.   They will have a different idea as to what is funny or disrespectful. If you have to, find a person about your mother’s age who will look at your profile objectively and tell you what it says about you.

Set everything to private.

Learn about the privacy settings on FaceBook, and use them. You don’t have to make it easy for a stranger to find things they don’t like. From the employer’s perspective, a conservative approach is always preferred – if an employee is ever named in a lawsuit, it is inevitable for the attorneys in the case to dig up dirt to discredit that employee. Do you want to be that person? Take yourself out of the “search.” You can hide your FaceBook profile so it won’t show up on a Google search.

Rethink your friends and what they can tag you with.

There is an old saying among high school guidance counselors that to learn about a student, all you need to do is to look at their friends. (I hung out with the nerds in high school.  I was an Eagle Scout for gosh’s sake.  To this day that just about sums me up).  If your friends are presenting themselves in some out-of-the-mainstream way, a reader might conclude that you too, are out-of-the-mainstream.

Look at it from a risk management viewpoint

In the hospital’s defense, they know that errors occur in the hospital industry and they don’t want to ever get sued. They know that if they are ever sued for malpractice, the attorneys will dig up every thing they can on every person involved in a potential problem. Ask yourself: If I was ever sued for malpractice, would I want to explain in court, why I thought something on my FaceBook page was funny or hip?

Scrub your photos, your ‘likes’ and ‘dislikes.’

When I reminded students of this a year or two ago, one person approached to express his gratitude and admitted that it was long overdue to remove some fashion photos in which he appeared wearing only a speedo and  a Mardi Gras mask, covered with gold body paint holding a champagne glass in hand. Another told me she was prompted to remove photos that revealed that her entire torso is covered in tattoos. TMI! (tattoos are a generational thing, and so is body piercing. twenty years from now, it will be okay. For now, the HR person is the same age as your mom, and so it’s not quite in the mainstream).  Set the album to private or remove it altogether.

Go to Google and run a search on your own name.

You will be surprised what you find. Everything you have ever done on the internet since about 1995, is still there. If you ran track in sixth grade, your time is searchable. Don’t believe me? Try it.

That brings up another issue: what is Okay? well, if your profile shows that you are an active churchgoer, humanitarian, well-balanced, hardworking, dependable, loves small children and has a Golden Retriever for a pet – these are good things.

To be continued.

I present these ideas to raise your consciousness level about nursing as a professional career. You can find a Biblical Quote that backs me up. Please consider subscribing to this blog, and sharing as widely as possible. Go to the little box on the right that says “sign me up”

and while you are at it, check out my book on Amazon.

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Filed under resume and cover letter, resume writing