The Everything New Nurse Book: Gain Confidence, Manage your Schedule, and Deal with the Unexpected
By Kathy Quan
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The Everything New Nurse Book - Kathy Quan
THE
EVERYTHING®
NEW
NURSE
BOOK
Gain confidence, manage your schedule,
and deal with the unexpected
Kathy Quan, R.N., B.S.N., P.H.N.
Copyright ©2006, F+W Media, Inc. All rights reserved.
This book, or parts thereof, may not be reproduced
in any form without permission from the publisher; exceptions
are made for brief excerpts used in published reviews.
An Everything® Series Book.
Everything® and everything.com® are registered trademarks of F+W Media, Inc.
Published by Adams Media, an imprint of Simon & Schuster, Inc.
57 Littlefield Street, Avon, MA 02322 U.S.A.
www.adamsmedia.com
ISBN 13: 978-1-59337-532-4
eISBN 13: 978-1-4405-2369-4
ISBN 10: 1-59337-532-8
Printed in the United States of America.
10 9 8 7 6 5
Library of Congress Cataloging-in-Publication Data
Quan, Kathy.
The everything new nurse book: gain confidence, manage your schedule,
and deal with the unexpected / Kathy Quan.
p. cm. — (An everything series book)
Includes index.
ISBN 1-59337-532-8
1. Nursing — Vocational guidance. 2. Nursing.
[DNLM: 1. Nursing. 2. Nurse's Role. 3. Nursing Process. WY 16 Q15e 2006] I. Title. II. Series: Everything series.
RT82.Q83 2006
610.730629 — dc22
2005033328
This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting, or other professional advice. If legal advice or other expert assistance is required, the services of a competent professional person should be sought.
— From a Declaration of Principles jointly adopted by a Committee of the
American Bar Association and a Committee of Publishers and Associations
This book is available at quantity discounts for bulk purchases.
For information, please call 1-800-289-0963.
THE EVERYTHING® NEW NURSE BOOK
Dear Reader,
You have chosen a fine and noble profession. It will bring you great joy and satisfaction, and you'll experience your fair share of frustration as well. Nursing is a demanding and rewarding profession that is facing, many challenges. There is a tremendous shortage of nurses and it is only going to get worse before it gets better. This will make your job harder and pose many difficulties for you, but it's nothing that you cannot weather.
This book is about all the things you didn't learn in school. There is only a little bit of theory to show you how to put it to use and make it work for you. I have drawn on my own experiences and those of many wonderful colleagues whom I have had the pleasure to know to provide you with some tips and helpful hints to survive your first year as a nurse.
I wish you all the best in your new career, and I hope that you find great success and happiness along the way.
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PUBLISHER Karen Cooper
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To the loves of my life: my husband Tim and my children Amy, Rob, and Becky!
Contents
Top Ten Things for New Nurses to Know
Introduction
1 What Is a Nurse?
Definitions of Nursing
Roles for Nurses
Opportunities for Nurses
Responsibilities of Nurses
Nursing as a Profession
A Brief History of Nursing
2 Why Become a Nurse?
Pros and Cons
Why Not Become a Doctor?
Why Do You Want to Be a Nurse?
Gender Issues in Nursing
Nursing as a Second Career
The Nursing Shortage
3 How to Become a Nurse
Prepare in High School
Be an Aide First
Choosing the Program for You
Finding the Right School
Financial Aid
Surviving School
Your First Clinicals
Graduation and Preparing for the NCLEX
4 Deciding Where to Work
Why Choose a Large Teaching Hospital?
Working as a Graduate Nurse
Passing the NCLEX
Being a Hospital Nurse
The Interview
A Word of Caution about Sign-On Bonuses
5 Surviving Your First Day
Come to Work Prepared
Get the Equipment You Need
Invest in a PDA
Buy Comfortable Shoes
What to Expect as the New Nurse
6 The New Kid on the Block
Orientation
Expect to Annoy Someone
Ask for Help
When Patients Question Your Age
Gossip and Office Politics
Be a Team Player
7 Your Scope of Practice
Do No Harm
Your State's Nurse Practice Act
The Realm of Responsibility
Clarifying the Nurse's Role
Handling Nurse Wannabes
Nurses Never Diagnose Disease
8 Time Management
Planning Out Your Day
Use a Timer
Stay Organized and Focused
Document as You Go Along
Avoid Leaving Projects for the Next Shift
Expect the Unexpected
The Importance of Writing It Down
9 Utilizing Teamwork
What Is Teamwork?
How to Delegate
The R.N. Is Responsible for the Team
No One Is above Emptying Bedpans
Can We Make This More Fun?
Tension Between Shifts
10 Learn from Your Mistakes
Slow Down and Take a Break
Learn to Say No
Using Your Policy and Procedure Manual
The Five Rights of Medications
Patient Safety Rules
When an Error Happens
Surviving Your First Mistake
11 What You Learned in School
The Nursing Process
NANDA
Using Care Plans
Cultural Differences That Affect Health Care
Clinical Pathways
The Idealistic Graduate
12 The Patients
Sick People Are Not at Their Best
Coping with Difficult Family Members
When It's Okay to Cry with Your Patient
Losing Your First Patient
When Families Argue about Patient Care
Patient Teaching
Empowering Patients
The Learning Process
Looking at the Whole Patient
A Little Knowledge Can Be Dangerous
13 The Doctors
Communicating with Doctors
Coping with the Old-Boy Attitude
Standing Up for Yourself
Finding Mentors
Patient and Family Education
Learning by Observation
To Date or Not to Date?
14 The Nursing Shortage in Action
Pulling Together to Survive a Shift
When Someone Calls in Sick
When You Get Left in Charge
When Someone Quits or Gets Fired
Why Nurses Leave Hospitals
What Nurses Need to Be Happy
Float Staff, Registry, or Travel Nurses
15 Expect to Get Sick
You're Bound to Catch Something
Infection Control
Stress Management
Proper Body Mechanics
Avoiding Needle Sticks
When You Get Sick
16 Working with Technology
Using Computers and PDAs
Technology Is Your Friend
The Totally Paperless Hospital
Increasing Your Knowledge Base
Using Your Facility's Equipment
How Technology Will Help Reduce Errors
17 Discharge Planning
Beginning with Admission
Mandated Reporting
Understanding Insurance and the UR Process
Involving Family Members in Your Teaching
Understanding Home Health Care
Accessing Community Resources
18 Documentation and Communication
Writing Skills
Accuracy and Timeliness
Reporting Off
If You Didn't Chart It, You Didn't Do It
Omissions Are Errors
Legal Implications of Documentation
19 Confidentiality
HIPAA
Understanding Your Facility's Policies
Protecting Patients' Privacy
Dealing with Celebrity Patients
20 Continuing Your Education
Soak Up Knowledge Like a Sponge
In-services, Seminars, and Journals
Look for Opportunities to Improve Your Skills
Keeping Up to Date with Pharmacology
New Treatments and New Products
Health Care Is Constantly Evolving
21 Setting Future Career Goals
Advanced Degrees
Specialty Training and Opportunities
Other Roles for Nurses
Professional Organizations
Networking
Moving to Another Department
22 Taking Care of Yourself
Don't Take It Home with You
Keys to Avoiding Burnout
Find Ways to Reward Yourself
Managing Your Stress
Your Personal Health Care
Appendix A: Glossary of Terms and Acronyms
Appendix B: Additional Reading
Appendix C: Web Sites
Acknowledgments
I have many people to thank. First, I want to thank my family — my husband Tim and my children Amy, Rob, and Becky, and our extended family of children Heather, Dana, and Chase — for their love, devotion, and help throughout the writing of this book. Many thanks to my mother, who has always been my biggest fan and most honest critic. And to the girls
who have encouraged me to reach beyond my comfort zone and follow my dreams.
Thanks to all the many wonderful nurses I have known and worked with over the years. You are all part of this book and part of who I am as a nurse. Thanks so much to the rest of my family and friends who have encouraged me and supported me in this effort in so many ways. And to Barb Doyen, my agent, who sought me out and helped me all along the way even through emergencies and craziness. Thanks so very much to all of you!!
Top Ten Things for New Nurses to Know
1. Nursing is one of the noblest professions.
2. Nursing involves a process of lifelong learning.
3. Once a Nurse; Always a Nurse.
4. Nursing is a profession and not a gender.
5. Nursing combines the art of caring with the skills and technology of math and science.
6. Nursing is one of the most physically and emotionally demanding jobs.
7. Always set the bar high; expect professionalism.
8. If you've burned out,
you just need to find another niche as a nurse.
9. The present nursing shortage isn't going to be solved entirely by recruiting more nurses.
10. Nurses make a difference in someone's life everyday and are masters at the fine art of caring!
Introduction
illustration Welcome to the world of nursing. As you embark on your new career, know that you have made a wise and wonderful choice to give of yourself to help make a difference in someone's life every day. Nursing is one of the most rewarding and yet challenging careers. It can be a thankless job and at the same time, nursing can bring you countless hours of joy and some of the most heart-felt love.
Nursing is one of the most physically and emotionally demanding careers. You will require a great deal of physical stamina and a strong sense of humor to perform your daily duties. Nurses combine the art of caring with a broad scientific knowledge base to provide care, promote wellness, and improve the lives of their patients. It takes strong communication skills, both written and oral, combined with a scientific mind and a warm heart and soul to form the foundation for a good nurse.
You will learn to laugh and to cry with your patients, to share their joys and disappointments and sorrows. They will all touch your life in very different ways and some will become a part of you forever. Nursing is a lifelong learning experience. You will learn something new every day. You will teach your patients how to improve their lives, to become responsible for their own outcomes, and to be independent in their own health care.
You will learn many new techniques and skills and nurture many talents and abilities, some of which you never knew you had. You will become competent and lose your fear and feelings of inadequacy as you grow into your new profession. You will also experience many negative aspects and encounter nurses who are burning out. Your enthusiasm could help them to rediscover why they chose nursing and how to make nursing important again in their own lives.
This book is based on the experiences of many nurses and is meant to help you to understand that you are not alone in your feelings at any stage of your career. Every nurse was once a new grad. Every nurse has had just as many firsts as you will: first shot, first birth, first death, first error, first patient, first special moment when it all makes sense. Share in their triumphs and failures as you grow into one of the finest professions.
Always smile and be honest. Consider how you would like to be treated if you were in this predicament and never take care of someone in a manner less than what you would demand for your loved ones. Set the bar high and demand excellence; mediocrity is common and boring and unacceptable. Be professional.
Always remember to recharge your own batteries. Take care of yourself so that you have the strength and stamina and desire to care for others who need you. Learn from your mistakes and move on. Enjoy your career and always keep track of your accomplishments and successes. Find something positive about every day. If you ever lose track of why you became a nurse, think back to these moments and your doubts will fade. Good luck and thank you for becoming a nurse.
chapter 1
What Is a Nurse?
A nurse is someone who cares for the sick and infirm. But a nurse is so much more. The nurse comforts the sick and dying and participates in the joy of birth. A nurse is your best friend when you lie awake in a hospital bed at night scared and lonely. A nurse may also seem like your worst enemy when he comes at you with needles and tubes to probe your body.
Definitions of Nursing
A nurse is a professional caregiver. Someone who advocates for patient's rights, promotes health, educates patients and families, and strives to eliminate pain and suffering. A nurse carries a large responsibility in the care and treatment of her patients. Nursing is one of the most rewarding professions and yet at times can be one of the most frustrating and thankless. A nurse is a highly skilled individual who learns to combine the scientific aspect of health care with the fine art of caring.
The following definitions will provide you with an understanding of the basic levels of the nursing profession. They will serve as building blocks for determining what education is required, what roles are open to each level and how to explore opportunities for advancement.
Nurse: someone who cares for the sick and infirm. A nurse is a member of the health care team and provides different kinds of health care to patients based on the nurse's level of education.
Registered Nurse (R.N.): a nurse who has graduated with a diploma or a degree from a state-approved nursing program, passed the state board examination for professional nurses and has been granted a license by the state to practice professional nursing in that state. R.N.s with advanced degrees and certificates will have increased options for their scope of practice.
Licensed Practical (or Vocational) Nurse (LPN/LVN): a technical nurse who has graduated from a state-approved nursing program, passed the state board examination for practical nursing and has been granted a license to practice in that state as a practical nurse. The LPN/LVN works under the supervision of an R.N. or a physician to provide patient care. With IV Certification, the LPN/LVN can perform certain aspects of IV care. The title of Practical or Vocational nurse varies by state law, but the role is essentially the same.
Nurse's Aide (CNA): also known as a nursing assistant, a CNA is unlicensed. A CNA delivers limited care to patients under the supervision of licensed nurses. The CNA may take vital signs and assist in activities of daily living such as giving baths, making beds, dressing, feeding, and positioning patients. The CNA completes a training course that includes classroom and clinical instruction. They are regulated by state agencies.
Scope of Practice: each member of the health care team is allowed to perform certain duties based on the content and level of education received, the license granted, and the specifics of the laws and regulations of the state in which they are practicing.
Nurse Practice Act: the group of laws in a state that protect the public health. It defines the scope of practice for nurses in that state. The Nurse Practice Act (NPA) also includes the requirements for education and licensing, as well as disciplinary and punitive measures for unsafe practice. It is the responsibility of every nurse to know the responsibilities and limitations outlined in the NPA of the state(s) in which the nurse practices.
State Board of Nursing: the governing board in each state that oversees the statutory laws that comprise the NPA for that state. This board is responsible for protecting the public by determining who is competent to practice nursing in that state and suspending or revoking the license of anyone who is deemed incompetent.
For additional information and definitions, please refer to Appendix A:Glossary of Terms and Acronyms. There are many other members of the health care team. In some settings, medical assistants, CNAs, and other non-licensed personnel may be referred to as the nurse.
While they play an important role in health care delivery, confusing their role with that of the nurse is a practice that is misleading and at the very least should be discouraged.
Roles for Nurses
One role is the practical nurse, sometimes referred to as the technical nurse. This is the LPN/LVN. The other is the professional nurse. This is the R.N. Both play an essential part as members of the health care team. Their roles and responsibilities vary. An R.N. can perform any of the duties of an LPN, but the reverse is not true.
In some instances, an LVN's skills at specific tasks may be more refined than those of her supervising R.N. This can often be the case because the LVN has the primary responsibility for performing bedside nursing and tasks, while the R.N. is given a supervisory responsibility for the patient's care and often forgoes the hands-on practice of direct patient care.
illustrationRN training involves more science, math, patient assessment, critical thinking, and theoretical aspects. This includes the nursing process, which encompasses the whole patient and his response to his illness as well as patient treatment.
Both the LVN and R.N. combine the knowledge they acquired in school with their own art of compassion and caring to provide excellent care. Beyond the basics of science and the treatment of disease that both LVNs and R.N.s receive, LPN training is primarily focused on bedside nursing and performing tasks such as changing dressings and Foley catheter care.
LPN/LVN Training
The technical nurse attends a vocational school. Some community colleges and adult education schools provide LPN training. This is usually a one-year to fifteen-month program that includes classroom as well as clinical hands-on instruction. After graduation, the nurse must sit for a board exam to become licensed to practice.
In recent years, many nurses and professional nursing organizations have advocated for a mandate to require all R.N.s (professional nurses) to have a B.S.N. Those without this degree would be given a grace period to acquire the degree or an option to work at a newly designated level. There was also a movement to eliminate the LPN role altogether. However, the increasing nursing shortage has thwarted these efforts for the present.
R.N. Training
The R.N. has several options for education. Each level of education prepares the student for the role of a professional nurse. All nurses will sit for the same R.N. board exam in order to become licensed as a Registered Nurse. However, there are distinct differences in the programs and the level of preparation they provide. Consequently, salaries and opportunities for advancement are often tied to the level of education.
Diploma Nurse Program
The Diploma Nurse program was once a primary option for R.N.s, but it is rapidly disappearing. This is because nurses no longer work primarily in a hospital setting. There are only about fifty such programs left in the United States today. These provide nurses with a three-year nursing education. Diploma programs are associated with a teaching hospital and nurses reside in a dormitory setting. They attend classes in the hospital and work regular shifts on the floors of the hospital to obtain their hands-on clinical training.
Associate's Degree
Community colleges provide an Associate Degree in Nursing (A.D.N.)program option for R.N.s. This is typically a two-year associate's degree program. It includes the same general education courses required for any associate's degree. For nurses, this will include math (minimum: algebra) and science (chemistry, physics, anatomy, and physiology and microbiology). The nursing courses include classroom instruction and hands-on clinical courses that may be provided at several institutions as available within the community.
Bachelor's Degree
The third option is a four-year program, a Bachelor of Science in Nursing (B.S.N.) in which the nurse completes all the general requirements for a bachelor's degree with all the above math and science, as well as a comprehensive program in nursing. The nursing courses cover the same materials as the other programs, but add a more intense study of the nursing process, nursing theory and models, and leadership skills. It is also a springboard for advanced degrees. As such, a B.S.N. is often required for leadership roles and management positions in the nursing profession. In some cases, the R.N. must make a commitment to obtain a master's degree in nursing within a timeframe. This is becoming more common again because of the shortage of nurses and the need to allow those with less education to advance more rapidly.
Advanced Degrees
Advanced degrees for nurses include fields such as a master's or Ph.D. in nursing, health care, and health care administration. A Master in Business Administration (M.B.A.) in health care or health care administration is also a popular choice for nurses with an inclination for business.
Opportunities for Nurses
Health care as a whole is one of the fastest growing career opportunities worldwide. Combined with the growing shortage of personnel, nurses are in high demand and will remain so for at least the next ten years. Part of the reason for the shortage is the ever-expanding opportunity and accompanying need for nurses. Nurses no longer work primarily in hospitals, nursing homes, doctor's offices, and clinics. These will continue to be major employers for nurses, but as many new opportunities arise as a result of constant changes in the workplace, nurses are leaving these sites. New nurses are also exploring the opportunities that have grown out of advances in technology and medicine.
LVNs
Most of these new opportunities require an R.N.; and often a B.S.N., but some areas do offer opportunities for LVNs as well. Sometimes these are limited roles such as in home health care, hospice, and private duty where the LPN can perform certain tasks such as Foley care, venipuncture for lab specimens, wound care, ventilator care, and basic bedside nursing.
The only truly expanded role for LVNs is IV care. IV certification at present is an additional optional course of study in most states. Each state's Nurse Practice Act for LPNs spells out the level of care of IVs that this certification covers. In most instances, dressing changes and hanging new bags and possibly adjusting the rate of flow, is about all that is allowed. New laws are being legislated to allow LVNs to flush central lines and perform central-line care.
illustrationExpanding nursing roles for R.N.s are in areas such as information technology, forensics, telemedicine, prisons, geriatric day care, assisted living facilities, schools, research, home health, private duty, hospice, holistic care, and the military. Many corporations are now hiring an onsite nurse to assist with employee health issues.
Be sure that you have a clear understanding of the policies of your employer as well as the law in the state in which you practice. Never rely on the culture of what is acceptable in your facility as the final rule. You are responsible for knowing the law and abiding by it. If some administrator has bent the law for the convenience of the facility, you can be held liable.
Advance Practice Nurses
Advance Practice Nurses (APNs) are nurses who hold advanced degrees and/or certifications in specialties that include certified registered nurse anesthetists (CRNA), certified nurse-midwives (CNM), certified diabetic educators (CDE), clinical nurse specialists (CNS), and nurse practitioners (NP) in such areas as palliative care, pediatrics, geriatrics, family practice, women's health, and mental health. There are many more areas of specialization and more to come in the future. Nurse practitioners work under the supervision of a physician. In some