We all sat around in my living room, friends in the fight against those nursing school teachers who seemed hell-bent on making our lives miserable. There were about ten of us crammed into my small living room for this Saturday study group, and I was the de facto leader. I didn’t need to be there. I didn’t need much more than to glance through the notes to get good grades, but I wanted to help these on-the-bubble students pass. I taught what I knew. Everyone wanted to study with me because, well, test scores speak for themselves in nursing school.
Yes, I was one of those, and I always have been. Give me a book, and I can ace a test. It isn’t really genius. It’s just that I know how to take a test. Of course, I was immensely proud of my 4.0. I didn’t lord it over people, but I did feel rather smug I guess, rather superior. I felt this meant the nursing world was my oyster. I was cocky that I would breeze through orientation, but I certainly didn’t feel I knew it all. I also didn’t put my fellow students down. In fact, I enjoyed helping them, fighting the good fight to get them to pass.
One day, my teacher said something that made the bottom drop out of my stomach: “The best nurses are usually those in the middle of the pack. Those who score high tend to not do so well.”
Was she talking to me? She said it to the class, but was she talking to me?
Maybe I was paranoid, but it turns out that there was a kernel of truth in what she said.
When I interviewed out of nursing school, no one cared that I graduated at the top of my class, although I told them repeatedly. They were more interested in how I would handle a crisis and what sort of person I was and whether or not I would fit in with this culture. Despite my obvious hubris, I am actually someone who can work well with others, can care for patients, and can be a part of the team. The only thing is that my work in school didn’t matter a damn to them.
What really opened my eyes was orientation. I was lost. Everything I had learned was so much chaff. It came into play from time to time, but it really and truly did not matter.
I remember the first time I had four patients. It was a juggling act. The fact that I knew all the bones of the hand by heart was completely irrelevant. I needed to look at vital signs and know what they meant. I needed to know when to pass meds and when to chart. Most importantly, I needed to know when I didn’t know something, and I needed to ask for help.
Fortunately, questions have never been a problem for me, and I was able to become a safe nurse because of that. This 4.0 student spent more time with her preceptor or charge nurse than she did with her patients in the first year of nursing.
And still, all that book learning I had was merely peripheral. Sometimes, it came into play. I would know obscure things about electrolyte imbalances, for instance. I was also considered one of the go-to nurses with problems in my later years.
But my knowledge is not what makes me a good nurse.
I found that my personal sense of patient safety was the most important. My ability to handle more and more stress became the calling card of my practice. My life was about looking at a situation and making a decision. Do I call a doctor about this, or do I have the means to fix it myself? Do I delegate this responsibility, or do I do it myself? Should I ask for help, or do I know enough?
My mentors—my preceptor, my manager, the various charge nurses, and the more experienced nurses—made me into a nurse. It wasn’t that huge book I lugged around for so many years. It takes a village to raise a nurse. Not a textbook.
These are skills that are not measured by GPA. These are skills that I have but don’t come as easily to me as multiple-choice questions. The point is that if you are a 2.5 student, don’t worry. Your ability to pass tests and get good grades has nothing to do with real world nursing. Trust me. I’ve been there. I am a good nurse. I worked hard to become one, but it didn’t have anything to do with what I did in school. It was about a fabulous preceptor, a supportive group of experienced nurses, and hard work on my part.
Not graduating at the top of your class? You may just be the best nurse yet. If you are someone who can manage your time well, you will make a good nurse. If you are someone who can stare down a stressful situation and make decisions, you will be a good nurse.
Most importantly, if you can and will ask questions when you don’t know the answers—and accept that you know very few of the answers—you will be well on your way to becoming a fantastic nurse. If you just eked by in nursing school, don’t let it bother you. Take it from someone who has been there: It doesn’t matter at all.
During the holidays, one of the biggest things most people lack is time. With so much extra squeezed into these weeks at the end of the year, it’s hard to finish up all the tasks on your list let alone find time to enjoy yourself.
But all that holiday hectic rush can seep into your work day making you feel like you are on a hamster wheel. At work you worry about everything you have left undone on the home front, and at home you worry about all the things you need to finish up at work.
How can you calm this cycle and make your work day more efficient? Here are a few tips to keep you on track.
State Your Intention
As you transition from work to home or home to work, make a conscious choice to refocus your energy. It might sound silly, but stating your intentions for the day out loud can help you shut out all the nagging details of one area of your life to focus on the details at hand.
As you walk into work, you can say, “Today I am going to focus on being the best nurse I can. I especially want to _______ (fill in the blank with your intentions—comfort my patients who are melancholy because of the season, nail my big presentation, mentor the student nurse who will be on the floor).
When you head for home, review your day and then bring your home life to the front. State your intention with a simple, “I am going to give my home life my attention now. I will use my time tonight to ________ (reconnect with myself or my family, enjoy time with friends, focus on my classwork, finish my holiday shopping).
Make a List
Leaving one place behind to focus on the other is a lot easier if you feel like you aren’t forgetting something vital. Keep a list of what you want to accomplish each day, each week, and even each month if that’s possible. At the end of your day, review your list and cross off what you managed to get done. Break it down into an order that works for you. You can accomplish one big task (finishing the unit’s schedule) and five small tasks (booking a conference room for a meeting, checking your vacation balance, remembering to tell a patient a funny story) or you can choose two big tasks. Maybe your day needs to be filled with lots of tiny details that need to get done, but understand that a big task will be impossible to fit in. List even the small tasks like booking a dentist appointment or the long-range ones like thinking about your upcoming annual review. Those are the details that get lost in the shuffle and can cause you to feel less in control.
Use a Timer and a Calendar
Being realistic about what you can accomplish means being able to manage your time efficiently and effectively. It’s unrealistic to devote 30 minutes to shopping for presents and visiting a friend. At work, you can’t expect to write a thorough report in a four-hour block if you have two meetings in the same time frame.
For a while, time how long you spend on a task so you can more accurately plan your time. Have no judgment or expectations about being faster or doing more. Just knowing how you work can make your life easier.
When you have that down, start using your calendar to plan blocks of time when you can realistically get things done. Book specific time to accomplish the smaller things and use your calendar to remind you.
Staying on track and on top of all you have to do at work and away from work can be overwhelming. But there are plenty of ways you can take control and make your life easier. See what works best for you and stick with it.
Here come brand-new nurses with their brand-new scrubs, clipboards, nursing shoes, and stethoscopes, eager to start the adventure as a nurse in the real world of nursing. Securing the very first job as a registered nurse is one of the most exciting—but also terrifying—events that any new graduate nurse experiences. No more simulation labs and clinicals, but real lives (and your license) are at stake. A recent report suggests that nearly 30% of new graduate nurses leave their job within the first year. You had been asking yourself if you would survive the nursing school. Now, you have to ask yourself this question: Am I going to survive the first year as a nurse? Here are some real-life tips from one new graduate nurse who just survived the first year working as a bedside nurse to another.
Cherish Your Orientation Period
New graduate nurse residency programs, such as Transition to Practice programs, are excellent opportunities to receive extended orientation periods, labs, and classes. It is true that often you may feel like you are back in school again with extended orientation time. However, it is critical for new graduate nurses to take this opportunity to learn, practice, and experience as much as they can during this period because once the orientation is over, you will be on your own without preceptors to back you up. After the first couple of shifts on your own, you may miss the orientation days.
When in Doubt, Ask!
The biggest mistake that a new graduate nurse can make is to assume things. “There is no such thing as a stupid question. We are not worried about new nurses asking endless questions regardless of the content, but we will be worried if a new graduate nurse has no questions,” says Jo Burney, who has more than 20 years of bedside nursing experience and frequently mentors and precepts new graduate nurses. Asking questions doesn’t make you look like an incompetent nurse at all. Providing inadequate, or unsafe, care because you weren’t sure what to do but didn’t ask questions about it will make you not only incompetent but also a reckless nurse.
Find Out the Good, the Bad, and the Ugly
Nurses are only human. There are experienced nurses who are excellent teachers and mentors to new nurses professionally and personally. However, there are also experienced nurses who have nothing to offer to you, meaning that they don’t want to teach you and you probably don’t want to learn anything from them either. New graduate nurses should be able spot these different types of nurses. If you haven’t figured it out on your own, ask your preceptor at the end of your orientation for a list of nurses who can be great resources around the unit.
Nursing school may be over, but the education continues. It is highly encouraged to study about the specialty of nursing that you are in, such as the common patient populations, diagnoses, medications, pathophysiologies, protocols, and policies. You may even consider opening the textbook that you said you would never open again after nursing school is over! Do so when you have downtime at work if you can’t make time outside of your work. Having the knowledge behind the nursing tasks you do will increase your ability to critically think and analyze the cases.
Be Personable, but Stay Away From the Drama
You don’t have to be best friends with your coworkers, but it doesn’t hurt to leave a good impression and to get along with them. Introduce yourself to the other nurses and nursing assistants and remember their names. Smile and greet! Simple and small courteous actions will make a difference. If it seems appropriate, you can also share personal things such as family and pets. You want to treat each nurse as an individual rather than just another nurse who happens to be working the same shift as you. However, never gossip or badmouth other nurses even if everyone else is talking and gossiping about a certain person in front of you.
It’s All About Listening
Listen to your patients and their family members. Listen to other nurses, nursing assistants, secretaries, providers, social workers, and other interdisciplinary team members. You can always learn something from anybody, whether it is how to transfer phone calls or how to program an IV pump, as long as you keep your ears and minds wide open for all the million things that you have to remember as a new graduate nurse.
The first year as a new graduate nurse will pass in the blink of an eye, and you will become a novice nurse who is somewhat comfortable but is still a little nervous with unfamiliar cases and emergent situations. You will be so very proud with that one year of bedside nursing experience under your belt, but the journey to become an experienced nurse will always continue.
According to the American Association of Nurse Practitioners, there are more than 234,000 nurse practitioners (NPs) licensed in the U.S. today. As health care delivery has continued to evolve, many Americans are using NPs for much of their health care needs, making nurse practitioners a critical component of the modern system. This growth in demand and responsibility has also increased and evolved the many risks NPs face in their work environments. The new Nurse Practitioner Claim Report: 4th Edition from CNA and Nurses Service Organization (NSO) took a deeper look at those risks by analyzing 287 closed professional liability claims against nurse practitioners (claims that resulted in an indemnity payment of $10,000 or greater) over a 5-year period. Study results found the average total incurred payment per claim was $240,471, and indicated that while the number of nurse practitioner claims have been relatively stable over the past five years (2012-2016), the average indemnity payment has increased at least 2% annually since 2012.
Current Liability Patterns and Trends
Nurse Practitioner Claim Report insights show that the majority of claims against NPs developed from a failure involving core competencies, such as diagnosis, medication prescribing, or treatment and care management. Allegations related to failure to diagnose and improper prescribing/managing of controlled drugs were found most frequently.
These claims demonstrate that nurse practitioners are responsible for reviewing, following up on, and documenting the results of appropriate tests and consultations in a timely manner, as well as properly evaluating each patient prior to prescribing medications.
Other findings from the report revealed:
- The three specialties with the highest average paid indemnities were neonatal, women’s health (obstetrics), and emergency medicine.
- The highest percentage of closed claims occurred in the adult medical/primary care, family practice, behavioral health, and gerontology specialties.
- The health care delivery settings that experienced the greatest number of claims were physician office practices, nurse practitioner office practices, and aging service facility, skilled nursing.
- Both the frequency and severity of nurse practitioner office practice setting closed claims have increased significantly. In 2012, this setting accounted for 7.0% of the closed claims, with an average paid indemnity of $45,750. In 2017, this setting accounts for 16.4% of the closed claims, with an average paid indemnity of $158,611- three times greater than in the 2012 report.
- Five allegation categories accounted for 95.0% of all the closed claims in the analysis: diagnosis, medication prescribing, treatment and care management, assessment, and scope of practice. Diagnosis-related claims had the highest percentage of closed claims, accounting for 32.8% of all closed claims and with an average paid indemnity of $283,263 per claim.
Current License Protection Patterns and Trends
Different from a professional liability claim, an action taken against a nurse practitioner’s license to practice may or may not involve allegations related to patient care and treatment provided by the nurse practitioner. The Nurse Practitioner Claim Report also evaluated this particular risk area, analyzing 404 reported license protection claims affecting CNA/NSO-insured NPs.
Of the closed claims, 240 resulted in a license defense cost in which legal counsel defended nurse practitioners against allegations that could potentially have led to license revocation. The allegation classes with the highest percentage of license protection defense paid claims were medication prescribing/management (27.1%), scope of practice (22.1%), treatment and care management (13.3%), and professional conduct (8.8%). The average payment – comprising legal expenses, associated travel costs, and wage loss reimbursable under the policy – was $5,987. License defense paid claims involved both medical and non-medical regulatory board complaints against nurse practitioners.
Risk Control Recommendations
While rare events may be difficult to prevent, nurse practitioners can glean lessens from the experiences of their colleagues to help enhance their own clinical practices. The following selection of basic risk control recommendations can serve as a starting point for nurse practitioners seeking to evaluate and enhance their patient safety and risk management practices.
- Remain current regarding clinical practice, medications, biologics, and equipment utilized for the diagnosis and treatment of acute and chronic illnesses and conditions related to one’s specialty and obtain regular continuing education.
- Document all phases of medical treatment, including the care plan, laboratory and diagnostic testing, procedures performed, and medication provided in a timely and objective manner. The substance of all electronic communication related to patient care, including diagnostic test-related communications – whether by telephone, text, email, or instant messaging – should be documented in the patient health care record.
- The informed consent discussion represents the first step in managing patient expectations. Discuss (and document) the nature of proposed treatment, alternatives to the treatment, and foreseeable risks and benefits of the treatment options.
- Also engage in an informed consent discussion with patients when prescribing medications. Educate the patient about the need for follow-up, and signs and symptoms that should prompt a call to the doctor or a trip to the emergency department.
A self-assessment checklist also is available in the full report to inspire nurse practitioners nationwide to examine their practices carefully.
This analysis reveals that, while there have certainly been advances in clinical practice and patient safety, many claims continue to develop. It demonstrates that nurse practitioners are expected to diligently screen, test for, monitor, and/or treat diseases known to have high morbidity and mortality rates and are responsible for obtaining appropriate tests, consultations, and referrals to meet the patient’s medical needs. The report findings also reinforce the responsibility that nurse practitioners must prescribe the right drug, for the right patient, in the right dose, by the right route, at the right times, for the right duration and for the right indications.
Armed with this insight, nurse practitioners can apply key risk control recommendations and resources to focus their efforts on areas of statistically demonstrated error and loss.
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.
This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.
In a newly released national survey of registered nurses, data shows that the long-predicted wave of retirements among Baby Boomer nurses is already underway, a trend that will undoubtedly exacerbate existing RN shortages. The survey also showed that an overwhelming majority of RNs expressed a strong desire to see more nurses in health care executive leadership positions. And, approximately half of RNs don’t feel supported by their leaders.
These were just a few of the key insights found in the AMN Healthcare 2017 Survey of Registered Nurses, health care’s innovator in workforce solutions and staffing services.
AMN Healthcare conducts the biennial RN survey to provide the health care industry with immediate and up-to-date information directly from one of the largest and most influential sectors of the health care workforce.
In this ongoing period of transformation nurses surveyed had a lot to say about staff shortages, the delivery of care, and how they feel about their work environment and leadership. The survey was completed in spring 2017 by 3,347 RNs.
The following are some highlights.
Retirement Wave and Nurse Shortage
The aging of America—10,000 Baby Boomers turn 65 every day, according to the Pew Research Center—is affecting the health care landscape in many important ways. Along with pushing patient demand to new heights, a wave of retirements among Baby Boomer nurses—a trend uncovered in the 2015 RN Survey—has taken hold. Among those nurses who say they are planning to retire, 27%—more than one in four—plan to do so in less than a year. That is considerably higher than the 16% in the 2015 survey.
The Baby Boomer retirements are expected to exacerbate nursing shortages, a situation that many RNs feel has worsened over the last five years. In the 2017 RN Survey, 48% said that nurse shortages have gotten worse, compared to 37% in 2015.
Continuing shortages of nurses and intense competition for quality health care professionals are also fueling a national nurse licensure movement, which the 2017 RN Survey showed RNs heavily favor. The Nurse Licensure Compact, launched in 2000 by the National Council of State Boards of Nursing, gives eligible RNs the ability to practice in other compact states without having to secure an additional license. Thus far, 26 states have joined.
More Nurse Leaders Wanted
The 2017 RN Survey showed a strong desire for more high-level nurse leaders (82% favored), coupled with a relative lack of interest among many of those surveyed in assuming such positions. Central to the desire to see more RNs in leadership positions was the feeling among many nurses that they are not adequately supported by their current leaders, according to the survey.
Despite this desire for greater nurse representation among executives, 61% said they would not consider moving into a leadership position, though 17% said they already were in such a role. A relatively small percentage (22%) of RNs indicated their interest in entering leadership positions. Reasons given for lack of interest included not wanting to deal with the politics of leadership structure and a desire to remain at the bedside.
A slightly different picture emerges when the numbers are broken down by age group. Millennial nurses (ages 19-36) were significantly more interested in moving into leadership positions, with more than one-third expressing interest. This compared to one-fourth of Gen Xers (ages 37-53) and only 10% of Baby Boomers (ages 54+). However, Baby Boomer nurses had a much higher percentage of RNs already in leadership positions.
RNs had mixed feelings on trust and other issues regarding their leaders, according to the 2017 RN Survey. When asked whether their leaders were people they trust, good at what they do, care about them, and support their career development, the RN responses were split nearly down the middle. In general, about half of respondents responded positively to questions about their leaders, while the other half responded negatively or weren’t sure. The mixed results suggest that health care providers face challenges in ensuring workers feel cared about and supported by their leadership.
Career Satisfaction vs. Job Satisfaction
A large percentage of nurses (83%) expressed satisfaction with their career choice, and two-thirds said they would recommend nursing to others. Pride in their career was also evident regarding patient care delivery as 73% of nurses said they are satisfied with the quality of care they provide.
Nurses are not quite as happy with their current jobs as they are with their careers—60% said they are satisfied with their jobs. More than half expressed concern that their jobs may be affecting their health—not surprising considering the emotional and physical demands of working as an acute care nurse.
However, when asked whether they would encourage others to enter nursing, 66% of all nurses agreed or strongly agreed that they would. And that percentage was even higher among Millennial nurses. In many sections of the survey, data showed stronger positives among the younger cadre of nurses. While nursing may be facing some challenges in the current era of health care change, the energy of Millennial nurses constitutes a progressive force for the profession and the industry.
To learn more about the 2017 RN Survey, and read our full finding, please visit www.amnhealthcare.com/2017-RNSurvey.
Being a nurse, we are often required to work long shifts. When nurses work extended hours, most of them do not have time to eat properly. This can adversely affect their health and well-being. Some nurses even develop long-term medical conditions, such as heartburn, indigestion, and peptic ulcer disease. Previous studies have shown that jobs with high stress and responsibility and shift work contribute to peptic ulcer disease and metabolic disorders. Eating for good health is one way that nurses can reduce the impact of stressors on the body and promote their health while working the night shift.
Here are four steps to help you maintain healthy eating and improve your nutrition when working a shift schedule.
1. Eat before going to work.
It is important that you have your main meal before going to work. If you are on the afternoon shift, you should have your main meal at mid-day around noon. If you are on the evening shift, eat your main meal at about 6 pm or 7 pm. You should also have a small meal or healthy snacks such as nuts, apple, and crackers during your shift. Try to avoid eating large meals during the night as it can cause heartburn, gas, or constipation.
2. Drink plenty of water to prevent dehydration.
Bring a bottle of water to work. Water can help you to stay alert and not feel so tired during your shift. Avoid drinking sugary soft drinks and alcohol before, during, and after work. Unsweetened herbal tea and low sodium 100% vegetable and fruit juices are other nutritious beverages that you can drink.
3. Avoid fatty, fried, or spicy foods.
Try not to eat greasy foods or foods with high fat, such as cheeseburgers and fried food, before going to work because these foods may lead to discomfort and indigestion.
4. Limit (or moderate) your caffeine consumption.
Try to limit caffeine intake at least four to five hours before the end of your shift. Since caffeine can stay in your system for many hours, this can affect your sleep when you are ready for bed.