Every nurse will experience that first day on the job and all the emotions that go with it. “This has happened to me a dozen times since I graduated from my nursing school. The first day on a job is the most memorable experience in my life,” says Mary Wiske, a retired community health nurse who has experienced several first days at jobs throughout her 25-year nursing career.
No matter whether you’re a new graduate or an experienced nurse, the first day at a new job or new location can be exciting, stressful, or overwhelming. There is so much to learn in addition to the duties or responsibility related to the job. If you are a new graduate, congratulations on your first job! This is your chance to begin your career in health care.
Here are four steps that will help you prepare for your first day.
1. Learn all you can about your new employer.
Read through any contracts, induction packs, or emails you have received. These will have important information about your employment, responsibilities, and what you may need to bring with you when you start. When you are familiar with your job description, you will be able to work more safely and efficiently.
2. Plan the route you will take to work as well as some alternate routes.
Find a map, get directions. Incorporate contingency time for bad traffic, public transport delays, or getting lost. If you are driving, remember to find out where you can park.
3. Get yourself ready – pens, a notebook, and a high-quality stethoscope.
Look for comfortable and durable scrubs that make you look professional. You should also plan to wear comfortable shoes that offer strong arch support and a roomy toe box, in addition to heels that do not pinch or slip and a no-slip sole.
4. Take care of yourself.
Be calm and relax. Remember to go to bed early the night before and have breakfast before you go to work. Give yourself plenty of time to get to work so you do not show up late.
Finally, you are here–the first day on the job. It is normal to feel nervous or excited. It is wise to remain calm and carry yourself with confidence; that is the key to this. Keep a positive attitude and an open mind. Remember to take an active role in your orientation and do not be afraid to ask questions. Make an effort to learn new things and learn how to do something a new way. All you can do is try your best and do your job the best way you know how.
Emergency Nurses Week kicks off today and offers a reflection of the lifesaving efforts and skill of emergency nurses who are called on to deal with catastrophic conditions, both natural and human-created, with little or no notice.
Karen Wiley MSN, RN, CEN, and president of the Emergency Nurses Association, says recent events highlight the unpredictability of the job and the exceptional need for emergency nurses.
“I am most proud of the way our nurses have come together in the past several weeks,” she says. “With the devastation from multiple hurricanes and the unconscionable event in Las Vegas, we have seen countless acts of sacrifice, selflessness, and dedication in emergency care from our nurses. I am proud of my colleagues every day, but the effort I have seen through these tragedies is truly remarkable.”
Wiley says emergency nursing is a complex role that involves treating the physical reasons for the visit, but also careful and expert communication with the team and the patient, families, and loved ones. “Most people do not realize the diversity of work emergency nurses must perform besides treating physical injuries,” she says. “Patients enter emergency departments struggling with addiction, mental health issues, as victims of sex trafficking, and, all too often, are violent themselves.”
If nurses are considering moving into emergency nursing or are wondering if the path would be right for them, Wiley says it helps to consider the range of what nurses encounter on a given day. “Thinking quickly on your feet is an essential skill for emergency nurses,” she says. “Situations change in a moment in the emergency department and nurses must react effectively.”
In the midst of an environment where many things are happening simultaneously, emergency nurses are still in charge of the patient’s comprehensive needs. “Emergency nurses must keep patient advocacy foremost at all times,” says Wiley. “The care, safety, support, and education of patients is our primary focus and dominant concern during a shift in an emergency department.”
Because they will take care of patients with many different conditions and situations, emergency nurses have to stay current on the latest medical information, so they have to be willing and able to constantly reeducate themselves about new developments, treatments, and methodologies. Emergency nurses continuously hone their craft, says Wiley, and that means being able to multitask effectively, efficiently, and accurately in a high-stress situation.
Emergency nursing is physically taxing, but it can also be an emotional challenge as well. Because of the very nature of an emergency room, patients don’t always survive despite the heroic efforts to save them. “Emergency nurses need to be prepared for the death of patients while not letting emotions affect their care,” says Wiley. Many hospitals have supports for their emergency room teams, especially after a trauma event, but the day-to-day exposure to death is something emergency nurses must cope with for their own job performance and their own mental health.
In addition to the challenges of treating so many physical and mental health issues, emergency nurses have to be able to quickly decipher and assess patients’ needs and conditions. “Choosing which patients need the most immediate care is challenging because the number of factors that need to be taken into consideration,” says Wiley.
For some nurses, the emergency room is where they perform best. And the ability to make such deep connections during that time is powerful. “Caring for patients who are in the most vulnerable state of their lives is an absolute privilege and an honor,” says Wiley. “The ability to comfort the patients and their loved ones when they need it most is humbling.”
One of the many specialties in the nursing filed is nephrology—working with kidney patients.
Shamekia Gullatte, RN, BSN, CPN, the Lead Post Kidney/Pancreas Transplant Coordinator at the University of Alabama at Birmingham, has served as a nurse with many different kidney patient populations, including working as a dialysis nurse, a pediatric nephrology nurse, and currently as a transplant coordinator.
What follows is an edited version of our communication.
As a nephrology nurse, what does your job entail? What do you do on a daily basis?
My current job entails educating and managing care of kidney transplant recipients. After working nine years in an outpatient pediatric nephrology setting, I decided two years ago that I want to care for patients who overcame chronic kidney disease and received a transplant. As a kidney transplant coordinator, I meet with newly transplanted patients while they are still in the hospital and provide education about their care. After the patient leaves the hospital, I continue to be a resource for the patient in the outpatient setting.
Why did you choose to work in nephrology? How long have your worked in the field? What prepared you to work in this kind of environment?
As a dialysis nurse, my first professional nephrology position, I became passionate about the disease processes in this patient population. Over the last 13 years, I have worked in various areas of nephrology. I was prepared to work in this environment because I worked 12 combined years as a dialysis nurse and pediatric nephrology nurse caring for children with chronic and acute kidney disease.
My parents laid the foundation for me to be a compassionate person and appreciate every aspect of life, which really are essential attributes of a nephrology nurse. Then I was awarded an excellent education at the prestigious Tuskegee University, where I obtained by Bachelors of Science in Nursing.
What are the biggest challenges of your job?
One of the biggest challenges of my job involves the lack of resources for patients. Some of our patients have limited financial resources and may have difficulties paying medications and sometimes have transportation issues. Although this is a challenge, UAB Transplant has a multidisciplinary team that includes amazing social workers who assist patients with these obstacles.
What are the greatest rewards?
The greatest reward in being a nephrology nurse in transplant is walking into a patient’s room to educate them on their new organ and saying, “Congratulations!” I certainly understand that some patients may have had a tough journey. For example, I can remember when one of my patients told me her story of when she was diagnosed with a rare disease, and she was getting prepared for transplant. This patient had been struggling from dialysis complications. Just to listen to her story leading up to kidney transplant was definitely a tear jerker, but now I was sharing a moment with her that she thought would never come.
I know that I was meant to be a nephrology nurse at UAB Hospital in post-transplant because I get this flutter of joy in my heart and soul every time I receive a new patient.
What would you say to someone considering this type of nursing work? What kind of training or background should s/he get?
To become a nephrology nurse, one would have to earn a degree in nursing and gain clinical experience in nephrology. To become a transplant coordinator at UAB, you have to get all of the above, but also have that little flutter of joy in your heart and soul when a patient receives a kidney transplant. UAB has performed more kidney transplants than any other transplant program in the nation since 1987, and we all take great pride in the care we provide our patients.
Being a nephrology nurse really takes more than just credentials. You have to be a person who is truly compassionate about your patient population, and someone who has a real love and desire for them. I love my patients, and appreciate the opportunity I have to care for them every day.
The American College of Nurse-Midwives (ACNM) is once again sponsoring National Midwifery Week, which kicks off today, October 1, and lasts through Saturday, October 7.
For centuries, nurse midwives have been partners and guides in women’s healthcare around the world. They carry out their compassionate care wherever it is needed as a woman progresses through her life. Nurse midwives are best known for their care during pregnancy, childbirth, and the post-partum period, but they can assist women throughout each stage of their lives—from the teen years to women past menopause.
Nurse midwives deliver services in homes, hospitals, birth centers, and other healthcare settings. They are there to carry out routine physicals through to newborn care.
Although there are several types of midwives, certified nurse midwives (CNM) have a degree in nursing and a graduate degree in midwifery nursing plus additional training and specific certification (through the American Midwifery Certification Board) in midwifery. CNMs are able to prescribe medication. Certified midwives have degrees in an area other than nursing, but then progress through the same certification process. In the United States, the overwhelming majority of midwives are CNMs.
Midwives have always played an important role in patient-focused healthcare as their care approach is directed on the patient and what she needs at that given point in time. Every woman’s body is as different as her healthcare needs, so midwives are trained in assessing each woman’s individual situation to bring her the best healthcare possible.
Most midwives work as part of a woman’s healthcare team, and spend direct one-on-one time to establish a trusting relationship and to learn what the woman wants from her healthcare. Nurse midwives provide their patients with plenty of education so they can make the best, most informed, and most comfortable decision for themselves.
And a nurse-midwife provides the essential hands-on care during labor and delivery, offering both physical comfort and emotional support. Especially during a low-risk pregnancy and birth, the guidance and presence of a nurse midwife gives a woman a greater sense of control as labor progresses and reduces the occurrence of interventions like a c-section while raising the percentage of new moms who initiate breastfeeding.
According to the ACNM, “In 2014, CNMs/CMs attended 332,107 births—a slight increase compared to 2013.” Those numbers amount to about 8.3 percent of all US births. The expertise provided by nurse midwives coupled with the patient-centered and customized plan of care is becoming an increasingly popular option for women who are seeking more personal care from a highly trained professional.
This week, celebrate the nurse midwives in your life with a acknowledgment of how their steady care helps moms and babies throughout the world. If you are a midwife, this is a good time to share your story and call attention to your profession. Post on social media using #MidwivesMakingStrides and share your patients’ feelings about nurse-midwife care.
The Nurse Professional Liability Exposures: 2015 Claim Report Update reveals that malpractice claims against nurses are on the rise. According to the report, more than $90 million was paid in nurses’ malpractice claims over a five-year period.
Nursing malpractice occurs when a nurse fails to perform his or her medical duties competently and that failure harms the patient. It is true that negligence on part of a nurse can cause serious harm to a patient, but the nurse may not always be at fault.
A number of factors contribute to the quality of care that is provided to patients. For instance, the type of facilities available at the hospital or nursing home, the diagnosis made by the treating doctor, the medical information provided by patients or their families, and so on determine the kind of care to be provided to patients.
However, there may be instances when the nurse might be blamed for someone else’s error. If you’re a nurse and something similar has happened to you, you must proactively try to defend yourself with the help of an experienced attorney.
How Negligence and Malpractice Claims Affect a Nurse’s Career
A nurse is required to adhere to the ‘standards of care’ in nursing. By adhering to the standards of care, the nurse ensures best-quality care for patients and stays away from facing the legal hassles of negligence and malpractice. However, a nurse can be sued even if he/she has complied with the standards of care. If this happens, then the nurse’s career will be in jeopardy. The nurse’s license can also be revoked. A lawsuit brought against a nurse can also wreak emotional havoc and strike a fatal blow to his/her self-confidence and self-esteem.
Moreover, other patients under the care of the same nurse may also be affected severely. Therefore, if you believe that you are wrongfully sued or you were only partly responsible for the harm, then you must work with an experienced lawyer and defend yourself.
Remember, medical malpractice laws are enacted and regulated by individual states, so you must appoint an attorney who is well-versed with the laws in your state. For instance, if you are a nurse in Savannah, then you must work with a Savannah personal injury attorney, who can defend you in court.
Defending Nursing Malpractice Claims
After a lawsuit has been filed against a nurse, various defenses can be raised that can absolve the defendant completely or limit the plaintiff’s claims. Some of the most common defenses used to protect nurses in nursing malpractice cases are:
1. Failure to Prove the Elements of Negligence
Just as in any personal injury case, the plaintiff in a nursing malpractice case is required to prove the four elements of a successful claim. These include:
- Duty to the plaintiff
- Breach of duty
- Damage or injury caused due to the breach of duty and
- Proximate causation
If the defendant is able to prove that any one or more of the above elements is not established by the plaintiff, the case may be absolved.
2. Contributory Negligence
If you can prove that the patient was also partly or fully responsible for his injuries/harm, then you can get the case absolved or at least lower your penalty. Contributory negligence involves not communicating the medical history adequately, not following instructions, and not following up. The attorney will study the case and analyze the various factors involved to determine the factor that led to the injury/harm. It is for this reason that you are required to provide in-depth information about whatever happened. However, some states have adopted the comparative negligence approach. So, it is important that you work with an experienced attorney, who can help you understand the laws in your state.
3. Violation of Statute of Limitations
Most states have enacted statutes of limitations, which determine the time frame within which a plaintiff is required to file a personal injury case. If the plaintiff fails to file the case within this predetermined time limit, then it can be used as a defense by the defending party. However, several exceptions have been made to the statute of limitations and these vary from state to state. Therefore, only a seasoned attorney can help you understand whether or not you can use this defense.
There can be several other defenses depending upon your specific case. A skilled attorney will look into the case and decide which recourse will be most suitable for you. Remember, you need to provide enough evidence to prove your innocence. Thus, professional assistance is important.
With nursing malpractice claims rising each year, nurses need to become more cautious about their work and the quality of care they provide to the patient. However, in case you are sued by a patient, you have the choice to get legal help and prove your innocence. If you believe you aren’t at fault, then work with an experienced lawyer and get your name cleared.
Despite a nurse’s best efforts, some patients aren’t willing to follow instructions, but the impacts of patient noncompliance are too serious to ignore.
Prescription drugs provide an excellent example of the importance of adherence. It’s estimated that up to 30% of prescriptions go unfilled and as much as 50% of medications for chronic disease are not taken as directed according to a study published in Annals of Internal Medicine. The study’s authors go on to say that failure to follow prescriptions causes about 125,000 deaths per year and up to 10% of hospitalizations.
Nurses can enhance patient understanding of and adherence to their overall treatment plans by strengthening communication, rapport, and education.
It Starts with Communication
Asking the right questions and opening the lines of communication between patient and nurse can uncover critical barriers to treatment compliance.
- Pose questions in a constructive, problem-solving manner. For example, “I see that you have not been completing your daily exercises. I wonder if they are causing you too much pain, or if there is some other reason?”
- Try to relate personally to the patient to build a stronger therapeutic partnership. Get the patient to express what the nurse and care team can be doing to help them better meet their personal health goals.
- Set and adhere to a discussion agenda for every encounter. Begin with a discussion of the patient’s personal goals and issues before moving on, such as “First, tell me what concerns you most, and then we’ll discuss test results.”
Encouraging Cooperation and Participation
Explain to patients that they must take some responsibility for the outcome of their care and treatment. Let them know that everyone caring for them wants them to be successful in regaining their health. If barriers to compliance persist, try asking the patient what he or she believes would be more effective. The goal should be to achieve a mutually acceptable care plan.
- Clearly and explicitly convey the severity of the problem and the risks of not properly carrying out instructions. Give the patient an opportunity to ask questions and clarify the instructions.
- Find out if there are any underlying factors affecting compliance. For example, “It sounds as though you may be concerned about the medication’s possible side effects. Is that why you have not taken it as prescribed?”
- Identify any practical or logistical difficulties that may hinder compliance.
- End each encounter by having the patient verbalize at least one self-management goal.
Enhancing Patient Education and Understanding
Key barriers to communication – such as low health literacy, cognitive impairment, or limited English – need to be assessed early on to help uncover the best solution for successful communication.
- Have access to qualified and credentialed interpreters for use when necessary.
- Ask patients if they have any questions about their medications and ask that they describe in their own words how to take them.
- Consider involving a health coach, health navigator, and/or case manager for the patient.
- Ask patients to repeat critical instructions and paraphrase in everyday words the medical information they have been given.
Helping Patients Manage Logistics
Sometimes a patient’s noncompliance issue is out of their hands due to a lack of personal support at home or financial restraints. Uncover where those patients are struggling:
- Do health care information records note who can help your patient when they’re outside of the health care setting? Do they have the consistent help of a spouse, relative, friend, or paid caregiver to aid with their care?
- Are patients asked whether they can get to appointments via car or public transportation, and are responses documented in the patient care record?
- If a patient lacks the physical or mental capacity to perform such essential tasks as changing dressings or picking up prescriptions, has a relative or friend been asked to assist, with the permission of the patient or legal guardian?
- Does the patient lack the financial resources to comply with their current care plan? Are they concerned about the out of pocket costs for treatment, or having to take time off of work?
- Document these concerns in the patient care record, and work with the patient and their primary care provider (with the patient’s permission) to find solutions.
Supporting the Effort with Documentation
To help staff deal with hostile, manipulative, or uncooperative patients, written protocols should be in place to help all staff respond to and deal with difficult patients. This should include ways to document and procedures for such common concerns as:
- Repeated prescription refill requests of questionable nature
- Narcotic use and general pain management in drug-seeking patients
- Appointment or procedure cancellations
- Unacceptable behavior, such as belligerent voicemail messages or yelling or cursing at staff
- After-hours patient calls
- Refusal to consent to recommended treatment
- Neglecting to take medications, do exercises, or make necessary lifestyle changes
- Terminating the patient-provider relationship
Driving patient compliance often means health care teams need to repeat themselves again, and again, and again. Different tools and strategies can help nurses drive compliance.
- Remind patients of upcoming appointments, including referrals and laboratory visits, via telephone and/or email.
- Try electronic alerts to remind patients with a history of noncompliance about screening and monitoring requirements.
- Inform blind or visually impaired patients of subscription services that use wireless devices to deliver reminders to take medications or perform vital self-care activities.
- Schedule follow up and referral appointments before patients leave the facility.
- Document no-shows and conduct telephone follow-up within 24 hours.
Know if there is a written policy for terminating the patient-provider relationship if the patient is chronically noncompliant and fails to respond to reminders and other messages.
Keep at It
Patient noncompliance is a deep issue with no easy answers or simple solutions. Nurses in almost any setting will encounter noncompliant patients, but with consistent communication and a persistent, but cooperative, spirit nurses can work to overcome the risk of noncompliance one patient at a time. Nurses also can explore Nurses Service Organization’s patient self-assessment checklist to help facilitate open communications.
Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.