Real Nursing: Every Second Counts!!: A Comprehensive Guide-book on American Nursing & Healthcare Issues (From Real Nurses’ POV)

By J. Alaric Justice

Real Nursing: Every Second Counts provides a detailed working view of nursing and American healthcare institutions. It shows the obstacles faced by U.S. healthcare workers, and the rigors of their workforce which contribute to constant staffing shortage and burn-out. Further, it offers employees, companies and concerned citizens alternative methods and tactics for correcting poor quality patient care.

• Language: English
• Publisher: Lulu Publishing Services
• Release date: Feb 13, 2018
• ISBN: 9781483468761

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JUSTICE

Copyright © 2018 John Carlos Johnson.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of the author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

ISBN: 978-1-4834-6875-4 (sc)

ISBN: 978-1-4834-6876-1 (e)

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

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Lulu Publishing Services rev. date: 1/10/2018

AUTHOR’S PREFACE

Nursing.

By its very definition, it is a caring profession. Hearing the word conjures forth images of women, either as they tend to the ill, injured and elderly, or as they breast-feed babies. In both basic scenarios, they are caregivers and nurturers, showing compassion and warmth.

William Osler (1849-1919), one of the founding physicians of Johns Hopkins Hospital, said the following about this path of helping others: A trained nurse has become one of the great blessings of humanity, taking a place beside the physician and the priest. That is high praise, especially considering that nursing requires considerably less time in fundamental training than either of the two roles listed with it by Osler here.

Some refer to nursing as a calling, marking it as a deep or primal archetypal urge from the recesses of our innermost consciousness for those drawn to it. That would place this noble service profession as evolving from the same spiritual plane as priests, pastors and other religious clergymen. On the other hand, however, some consider law enforcement and military service to be on the same level of calling as well.

It is often said that it takes a special person to be and stay in nursing. Unfortunately, certain facts show us that – as a nation – we lack needed numbers of such people in our society today. This is easily seen in high turnover rates, as well as constant vacancy numbers at all position levels and settings. This both contributes to and results from a national nursing shortage that seems to grow almost daily.

Nursing, after all, is not all sunshine and roses. It is often a thankless job, especially when dealing with the patients and families needing nurses most. Unfortunately, not all our customers realize how much assistance they require, no matter how much we educate them each day. Quite often, nurses are verbally cursed, struck, bitten, spat upon and have items – objects and bodily fluids – thrown at them just for trying to help others.

Any member of this field, from the newest uncertified nursing assistant (or hospitality aide) to the most seasoned director of nursing, is expected to show concern and a commitment to immediate action for every individual patient. That’s just the public perception of the job, part and parcel to the total package of this career path. No matter your level, you are never above getting your hands dirty to help a patient, whether that person has fallen to the floor or unwittingly smeared feces all over herself.

Nonetheless, nursing is considered one of the most secure career fields in America today, repeatedly hitting top ten lists. Few jobs show more potential than this one, across the board, according to both government and private job data sources. Whether you’re looking for high demand or projected growth, nursing is the industry to be in.

So, if nursing is so secure, why is it so hard to keep qualified and experienced personnel in our healthcare facilities? Why are trained nurses leaving the field constantly?

That is part of what we will explore in this book.

The pages to follow will not be the typical nursing or healthcare book. Generally, such texts are written by healthcare workers for other healthcare workers, often just to impress other healthcare-related figures in higher positions. While we will cover topics here from perspectives to be appreciated by members of the nursing field, we will do so in a manner that will be clear and appreciated by anyone who chooses to read these pages, no matter their vocation or background.

Quite often, nursing books are written by master’s degree nurses or others with doctorates. They have huge lists of peer-review panel advisors, and they write in much the same way that peer-review technical journalists write, for other professionals of the highest levels. In other words, the average practitioner simply cannot understand or appreciate most of what is presented, making it pretty much a waste of time if the goal is to promote change or growth in the field. So, you won’t see that kind of writing here.

In part, information will be presented using quotes and stories from real professionals in the field. Obviously, because positions could be at risk if employers realize what these people are saying, the names of both personnel quoted and the facilities they work will be altered, hinted or only initials will be used. (I’m partial to mysteries, so expect crossword-style clues for the names of companies.) Once these tales and comments are observed, however, please remember that they represent real scenarios that nurses are dealing with every working day.

For my part, I have been in healthcare off and on since 1992, starting as a Navy Hospital Corpsman trainee after Desert Storm (in preparation for the expected Clinton downsizing that would later phase out my prior anti-terrorist enlisted classification). For over a year, I served as the sole medical office assistant to over 300 military personnel before being summarily tossed out by the right-sizing efforts, then became a civilian medical records technician until my company was bought out by another. At that point, I made the switch back into direct patient care as a certified nursing assistant in 1994, and served in that capacity for 2 years before also becoming an emergency medical technician in 1996. Returning to active duty military again in 1998, I served as an Army command-and-control C4I Field Radar & Enhanced Tactical Operations Center Technician, but was sent to a cavalry unit with absolutely no field radar… so my entire platoon and I were informally cross-trained as scouts, replacing our radars with binoculars.

Fortune and fate also pulled me back into healthcare while in the Army, allowing me to become a Combat Lifesaver, a military first responder intended specifically to provide first aid and intravenous fluid replenishment in conditions far removed from hospitals. It was a perfect extension to my EMT training, allowing me to maintain my clinical skills.

So, like most nurses today – and many from our history – nursing was not my first choice. I’d been a correctional officer and police officer, a sales associate and safety trainer. Strangely enough, all of these enabled me to better serve as both nurse and manager later.

Since becoming a nurse, I have seen many things: how poor state decisions can immediately lead to decreased National Council Licensure Examination (NCLEX) pass rates for that state; how tremendously different the nursing workplace of today is from that of the 1990s, and how the profession itself has changed with increased patient loads for all personnel; the overwhelming change of the U.S. American culture, and the impact that has had on the quality of care provided; and so much more, things neglected in the thousands of healthcare and nursing articles I have read over the years. Despite being only a Registered Nurse, I have professionally served as: a travelling specialty clinical instructor (to nurse practitioners and other nursing team-members in a grocery-affiliated chain of small clinics) throughout Kentucky, Tennessee and Ohio; the sole occupational health nurse and safety manager to over 500 warehouse personnel (until becoming the regional safety manager for the same logistics group over 20 different facilities); as well as an assistant director of nursing (ADON) to two nursing facilities, a director of nursing (DON) twice, and Clinical Care Consultant (helping facilities prepare for various kinds of regulated oversight surveys). From the bottom of the nursing ladder to management, I have been astounded, horrified and laughed at much to be found in this field…so, expect lots of those true stories to be my own.

It is with this in mind that I write this book, to share observations – both good and bad – that I have seen and experienced as a nurse. At this time, my highest nursing credential is only PHTLS (Pre-Hospital Trauma Life Support) and aside from a number of 6-week specialty healthcare programs, my only other related education is in healthcare management. Yet, despite seeking constant training, real world experience in patient care settings has taught me much more…and some of those lessons will be covered here.

Again, I must be clear, though. This is not intended as merely a nursing guide for nurses. Instead, the pages to follow are intended to guide nurse managers, administrators, doctors, other healthcare practitioners, state health surveyors, ombudsmen, and all citizens concerned with nursing and our national healthcare system. I am a big picture kind of nurse, so open your minds and prepare to join me in working to improve our current systems, processes and ways of doing business in American healthcare.

There are many in modern healthcare management who are not focused solely on promoting quality healthcare. This is partly why we have so many complaints about poor care, long waits and medical errors in our hospitals and other health facilities. Likewise, there are many others – patients, family members, and even many healthcare personnel – who fail to understand that the common big business mindset (of putting the bottom-line dollar amount above all other concerns) is the major guiding principle in many healthcare companies today. That kind of management, and the fact that facility managers and administrators have lost any real semblance of authority or control over their establishments (long ago replaced by powers-that-be in corporate offices far, far removed from the pressures and concerns of the patients and caregivers), contribute greatly to our inability to both maintain quality care and to retain staff members of every level.

This corporate concept of centralized management, originally intended to promote unified standards among numerous facilities, now inhibits response to patient care needs. Patients, their families and their caregivers are directly on site, yet often have very little influence over the quality of care offered within their facilities. State surveyors and accreditation agencies may temporarily boost such quality and performance with annual reviews, but one month of improvement is too little in the full spectrum of service given in a whole year. The increased staffing offered when surveyors are on site is immediately cut back afterward, often for weeks to months at a time, for no other reason than to balance the books and return that bottom-dollar profit statement to reflect higher yields for corporate shareholders.

This is what nurses, their assistants and other healthcare workers (HCWs) deal with daily, this slowly crawling snail of corporate machinery too large to do anything more than crush those it is supposed to serve and empower. Inching along, painfully sluggish to watch, workers of all levels – including managers – fall to the wayside in frustration.

As the title suggests, however, we will repeatedly come back to one common notion: "Every second counts." So, expect a sense of urgency and a pressure to act on the things shared here.

Thanks for buying this book and being here with me in seeking improvement for U.S. healthcare. So, let’s get to it.

J. Alaric Justice

GLOSSARY

During the publication process, I was literally harassed about libelous content in my book. However, the only specific examples of questionable content cited concerned common abbreviations and acronyms used in nursing. Although the book is written at a level for non-nursing audiences to appreciate, and each acronym/abbreviation is detailed before being used alone, I was left wondering if my professional content reviewers in any way reflected the confusion and resistance I might encounter from other audiences…especially after they continued to argue, refusing to cite more examples, for weeks.

Therefore, for the sake of simplicity and sanity, here is a list of acronyms common in this work. We do want it to be clearly understood, after all.

1

Myths & Reality:

Exploring the Nursing Workplace

"The great enemy of truth is very often not the lie – deliberate, contrived and dishonest – but the myth – persistent, persuasive and unrealistic. Too often we hold fast to the clichés of our forebears. We subject all facts to a prefabricated set of interpretations. We enjoy the comfort of opinion without the discomfort of [real] thought."

― John Fitzgerald Kennedy (1917-1963; 35th U.S. President)

What is nursing like? What can we find in the real-world work of a nurse?

The answer to that would depend, in part, upon the individual employee and the setting involved. On the other hand, there are certain expectations that would be pretty much universal in all settings.

Looking at ten different sites listing the myths associated with licensed nurses, I found a lot of overlapping information. To me, a male nurse experienced in long-term care and occupational health more than hospitals, nearly half the items listed in some of the shorter lists don’t apply at all. Nonetheless, let’s go over some of these mistaken beliefs being put out about this field.

Myths of Nursing

(Adapted from Kaplan University website, retrieved 8/15/16)

• Nursing is for females only.

• They work only in hospitals and clinics.

• Nurses work crazy hours.

• Nurses are only doctors’ assistants, and are at the MD’s beck and call.

• It does not matter where you train for nursing.

• Nurses are only wannabe doctors, people that failed out of medical school.

• A nurse is a nurse is a nurse… all are the same.

• Nursing is only dirty work.

• Advancing in the field is possible only with higher education.

• Due to nursing shortage, it is easy to get your desired job.

(Adapted from ScrubsMag.com blog, retrieved 8/15/16; included 3 already listed above)

• Nurses just pass meds.

• Nurses clean poo all day.

• Contrary to TV, they don’t all sleep around with doctors.

• Contrary to TV, doctors don’t draw lab specimens; nurses do.

• Nursing is all the same.

• Nurses just take orders from doctors.

• Nurses are all failed doctors.

(Adapted from Methodist College website, retrieved 8/15/16; included 2 already given above)

• Nursing education focuses on only technical skills.

• Nurses stay in their own circles only.

• Nurses can work three 12-hour shifts and be done for the week.

• Nurses have to do everything for the patients and doctors.

• Personal work interests will stay the same over time.

• Nursing school is easy.

• Nursing school is just like any other college.

• Your learning stops once you earn the degree.

(Adapted from Monster.com NursingLink website, retrieved 8/15/16)

• The nursing shortage guarantees you’ll get your desired job.

• Once you start in a clinical role, you’ll be stuck there forever.

• An ASN/ADN (associate degree nurse) is not a real nurse.

• Continuing education is only important for pursuing higher degrees/licenses.

• To avoid burnout and work stress, don’t develop personal relationships with patients.

• Nursing/ healthcare lets you help people as you want.

(Adapted from AmeriTech College & Health eCareers websites, retrieved 8/15/16; both included 3 given above)

• The pay is low.

• It is easy work.

(Adapted from Master’s in Healthcare blog, retrieved 8/15/16; included 4 already given from sites above)

• Not as hard as physician’s work.

• Nurses are only gofers for doctors.

• It is a dead-end job.

• Nurses all do nothing but grunt work.

• The pay is bad.

(Adapted from Huffington Post website article, retrieved 8/15/16; included 3 items already provided above)

• Nurses only report to doctors.

• The country has more than enough nurses.

(Adapted from NurseBuff website blog, retrieved 8/15/16; included 3 already listed above)

• Nurses are only frustrated failed doctors.

• Only run errands for doctors.

• Nurses only wipe butts and do dirty work all day.

(Adapted from UK Nottingham healthcare blog, retrieved 8/15/16)

• Nursing is only menial work.

• It’s a dead-end field.

• It requires long work hours, for low pay.

• Nursing is not intellectually challenging.

Now, considering that most of these lists came from colleges and job posting boards, we can imagine that most of the myths and myth-buster information provided was from a specific tactical slant. Their goal, of course, is to present the most desired picture for the profession. Both in the list of so-called myths themselves and in the countering information, the intended effect is to attract applicants to the school, program or profession.

Here’s a perfect opportunity for me to insert a quote from a former coworker at two different facilities, perhaps the youngest male nurse I have worked with so far. His comment aptly summarizes how many nurses feel about the information presented to the public by various references.

Man, these schools and nursing organizations don’t represent us and what we deal with every day. They just out for their money, whatever they got to do to get it. So, they lie, straight to your face and in every single article and ad they put out. I doubt most of the people in those nursing groups like the ANA and NLN even know what it’s like to work the floor, so they can’t speak or represent or lobby about stuff they don’t even know.

— W.J. (RN in long-term care, KY, 2016)

So, let’s summarize the different notions quickly.

Common Myths of Nursing

• Nurses work mainly in hospitals and clinics.

• They work many hours.

• Nurses are little more than doctors’ assistants.

• They are failed/wannabe doctors.

• All nurses (and nursing positions) are the same.

• Nursing is menial/dirty/grunt work, doing everything for patients and doctors.

• Nursing is a dead-end field, with few opportunities for advancement.

• Due to nursing shortage, it is easy to get a nursing job.

• Nursing is easy, not as hard as being a doctor.

• Nursing is a no-brainer, not intellectually challenging.

• Nurses get stuck in the same level/ position their entire careers.

• The pay is not good.

• Continued education is only for those pursuing higher degrees.

Time to break it down. Obviously, some of these false notions counter each other. Within those very contradictions, we see where the logic is faulty.

1. Nurses work mainly in hospitals. 31044.png Due to the increasing number of nursing homes, assisted living facilities and home health agencies – as well as the rapidly changing healthcare laws and funding – this is simply not true, especially in certain parts of the country and major cities. The U.S. News & World Report online shows 81 nursing homes in the metropolitan area of Louisville KY, while the online Yellow Pages lists 96 different nursing homes for the same area; similar sources indicate 19 to 35 different assisted living facilities for that city also. There are only 12 established hospitals and 7 community clinics for this same locale, supplied by 12 schools (now 11, since the ITT Tech chain closed this very week); at an average of about 120 nurse graduates each year from most of those individual schools and colleges, we can safely say that the local hospitals cannot take in more than a fraction. Approximately 80% of this state’s practicing nurses currently work long-term care or assisted living facilities, not in hospitals or clinics. Nationwide, we actually see a progressive decline in the percentage of nurses working hospital settings, from 66% in 1980 to 62% in 2008 (according to the AACN "Nursing Fact Sheet, retrieved from www.aacn.nche.edu on 9/18/2016); that means that 3 in 10 U.S. nurses will work in other settings, that number rising or decreasing based on geographic location.

2. Nurses work many hours. 31046.png This is another of those things that depends mainly on the nurse. It is a common complaint in nursing, however, that schedules change pay period by pay period or month by month. Due to the combined forces of the nursing shortage and constant staff turnover, there is plenty of overtime available in most facilities (and when employees are not jumping to meet the demands, that overtime becomes mandatory). It is NOT a 9 to 5 type of job (since a nurse is dependent on being relieved by another person before they can prepare to get off the floor), and nurses are often still charting or finishing other work tasks hours after they’ve been replaced for floor duties. Whether working 5 eight-hour shifts or 3 twelve-hour, most nurses will see considerably more hours on their pay-stubs than they were originally scheduled (even without possible mandatory overtime for those occasions when other nurses call-in, show up late, or otherwise fail to come to work).

3. Nurses are little more than doctors’ assistants. 31048.png Again, this is partly determined by the practice setting and partly by the individual nurse. Most settings, the doctors are hardly seen compared to the nurses, so nurses bear the brunt of the labor and complaints and management for all issues. Although I have scarcely worked hospitals, there has not been a hospital I worked where I did not have to gently correct a doctor concerning an order (generally regarding patient medication allergies or noted side effects). So, a strong nurse with good communication skills and a persistence in advocating for patients will be both an asset and a thorn to the doctors they deal with.

* * *Special Note: An important point to make here, directly related to this misperception of doctors being the superior position in a master/servant relationship with nurses, is that doctors often mistreat nurses. It is largely and mainly through poor communication, malfeasance in action, or more visible verbal abuse that this kind of maltreatment occurs; there are documented cases of physical abuse, as well, but few and far between. On top of this fact – and possibly perpetuating it – is that hospitals, as well as most other healthcare facilities and companies, allow this misconduct (either by ignoring it or failing to appropriately respond in any coordinated fashion). That is an important consideration for anyone thinking to enter this field (and it may be partly why nursing groups are constantly pushing for more education, mistakenly thinking that more education alone will deter such errant behavior).

4. Nurses are only failed medical students. 31050.png With perhaps one exception, I have not known any nurses that started out as medical students. Medical school to this day tends to attract Americans from upper-class families, those that can afford the potential debt of expensive medical schools; nursing, on the other hand, attracts more middle-class persons, as well as lower-income people striving to break economic barriers. In addition, as evidenced by the number of associate degree nurses (and those who choose not to pursue further college nursing education beyond that), most nurses lack the desire to have a college career before starting a real profession.

5. All nursing is the same. 31052.png Again, I have to agree with the college sites and articles in saying that this is wrong. There are many paths one may take in nursing, and each offers its own benefits and challenges. As a hospital Med-Surg nurse, I learned much about surgical procedures and post-op care, as well as tending to people with numerous different disease processes or injuries. On the other hand, as a long-term care nurse, I learned much more about wound care and had to deal with the pressures of tending to as many as 60 patients – no joke or exaggeration there – on my own. As a salaried occupational health nurse, I never passed a single pill, but still maintained 12-hour days a full 5-day work week and was on-call 24/7 for all manner of employee injuries and allegations, with no help or relief at all. So, by no means will I ever say that all nursing is the same.

6. Nursing is menial grunt work. 31054.png Here again, it depends on the setting and the nurse. In the doctor’s offices I’ve worked, the grunt work was taking vitals and collecting information on the patient’s current complaints/ condition, as well as calling patients at home to follow-up on them after their most recent visit. In occupational health, not only did I personally go on site for every company work injury or allegation between Louisville and Lexington, I also did surveillance and home visits on those claiming injuries or requiring special care. For skilled nursing facilities, that menial labor includes frequent vital signs and neuro-checks on residents that have fallen, as well as cleaning soiled butts and performing various wound care/prevention treatments (most often around more butts). For my part, I will tell you that I do not believe that a nurse is ever above wiping butts, since that is part of the foundation of nursing; even as a DON, my aides would constantly find me answering call lights, putting patients on bed-pans, and cleaning those residents who needed such.

7. Nursing is a dead-end field. 31056.png Nursing gives us whatever we put into it. As an occupational health nurse, I pushed to be autonomous and self-sufficient, earning my PHTLS to be of better service to injured workers. This, coupled with my constant lunch-and learns (for floor supervisors) and weekly Ever-Run PowerPoint presentations (for employee health and safety education), led to my promotion to Safety Manager (for which I immediately jumped into a First Aid & CPR Instructor course); when the regional safety manager slot came open, within months that was mine also. As a Safety Manager, I went through a short online training course for Legal Nurse Consulting to better document the cases I dealt with (since legal and workers’ compensation documentation requires much more detail than nurses are accustomed to); when promoted again, I pushed to gain certification as an OSHA-30 trainer, again to better serve my company. So, from my perspective, the only limits in nursing are those we impose upon ourselves by refusing to learn and apply some of the ever-growing disciplines this field has branched into.

8. Due to the nursing shortage, it is easy to get a nursing job. 31058.png The key phrase there is nursing job, and you are not guaranteed to get your desired position or setting. In fact, in this major metropolitan city where only 15 percent of nurses work in hospitals and clinics, only 1 percent of our total local nursing workforce are employed in any of the recognized nursing specialties commonly sought by travel agencies (such as emergency nursing, labor-and-delivery, intensive care units and such). Therefore, if your hopes are set on such positions, you’ll likely have to settle for another setting until you can get your foot in the door with a peripheral nursing position (like getting into a hospital Med-Surg unit and serving there for several years before progressively making your way toward the hospital ER). During your wait, seeking specialized training related to your chosen focus – on your own time and dime – will definitely improve both your resume and your chances.

Other states have much dimmer views, statistics that directly counter the assertion that a nurse can easily find a job. For instance, in California, 43% of the nursing program graduates were unable to obtain work in that field within 18 months of graduating; of these, 92 percent reported being turned down for lack of experience, 54% were told no jobs were available, and 42% were turned away for lacking a bachelor’s degree (43 percent of CA nursing grads can’t find work, San Jose Mercury News, 5/16/2012). In another report on the same data, nurse-author B.J. Bartleson (RN, MS, NEA-BC) went on to say that 31% of those surveyed took 6 months or longer to obtain nursing work (resulting in another 6% of respondents being advised that they’d been out of school too long), another 25% were forced to work in volunteer or non-nursing healthcare positions just to stay close to the field (New Survey Shows No Jobs for 43 Percent of State’s Newly Licensed Nurses, 5/1/2012). California, obviously, is not the only state to report such issues; a 2011 survey by the National Student Nurses Association revealed that more than one-third of newly licensed RNs that year could not find nursing employment within 4 months after graduation (Nurses without jobs: A sign of the times, Alyssa Sellers, 5/11/2013)…and I personally don’t know of many people that can afford to go four months without decent employment, especially after incurring a massive college debt.

9. Nursing is easy. 31060.png Whew, there are nurses who get pissed off when they hear or read that one. Personally, I’d like to see even one doctor try to pass meds and do treatments for 40-plus patients. Let’s see how the doctor handles being yelled at or accused by family members almost daily, or how he deals with the unruly dementia patient who refuses both to sleep at night and to be bathed/ showered for weeks at a time. How will he deal with the resident who kicks at him, masturbates constantly, and throws urine or feces at anyone who comes to check on him? There is nothing easy about nursing, and that is one of the main myths that we seriously should dispel both for the public at large and in the healthcare company boardrooms.

10. Nursing is a no-brainer. 31062.png Nurses still must deal with all manner of constantly changing medical technology, to include computerized electronic medical records and diverse configurations of intravenous (IV) medication pumps. When technology fails, which it often does in healthcare, nurses must figure out different ways of meeting patient needs. That means, when the pharmacy-delivered IV pump won’t work, you still need to do manual drip calculations to determine how many drips per minute to provide the patient with the prescribed fluids or medication. In addition, nurses often have to make on-the-spot judgment calls concerning patient condition (especially when doctors don’t return calls or texts in a timely manner). Further, when short-staffing occurs due to call-ins, it’s the floor nurse who often needs to quickly determine how to best divide the patient load between the staff on hand; nothing like four CNAs calling in for the same shift will set your head spinning to figure out how to juggle hall assignments. So, again, there is much gray matter utilization required in nursing.

11. Clinical nurses get stuck in the same level/ position. 31065.png We’ve already covered this, really. If a nurse wants to be more than a floor nurse, he/ she must push for it, both at home and at work. That means taking the time to study up on changes in the field and within their own company. A staff nurse who takes the time to learn about an electronic health record system as soon as the company starts piloting that program, and continues to research online to create her own reference material for that system before it goes live in her own region, can make herself an invaluable resource to the facility/ company and thereby create new opportunities for herself. I’ve personally known one little chubby LPN who did exactly this, becoming first an EHR trainer and then a medical records coordinator with no formal training at all. So, as stated before, our limits are only those we impose upon ourselves through our own inaction and lack of personal initiative.

12. The pay is no good. 31067.png Obviously, this is not true. After all, pay is one of the main reasons people come into this field (sad as that is to admit for our society). However, it is important to understand certain things about nursing pay: first, that certain nursing settings (like home health nursing) offer much less than the norm, paying RNs in that area less than an LPN might make in long-term care; second, nursing pay often freezes, if not steps back, from time to time (resulting in a national nursing pay increase of only 6% in the same time period [from 2003 to 2011] that the rest of America’s work force averaged a total increase of closer to 20%); and third, that no amount of money is worth a risk to your license or the lives of your patients (as is experienced when a single nurse has 20-plus patients to tend to). So, that said, don’t be surprised to discover that a nurse who made $25/hour in 2010 is only making $26/ hour – if not still $25/ hr. in the same setting