Best In Nurse Blogs:

The Nurse Blogosphere has exploded with articles, posts, diatribes, rants, about the pending case of Amanda Trujillo, MSN.

All for one?

The Incident as I understand it:

Ms Trujillo was fired and has been threatened with the loss of her nursing license.  She reports she was acting as a patient advocate/educator.  The patient in question was scheduled for a liver transplant.

Nurse Trujillo advised the patient that other options besides surgery were available. The patient apparently requested information about hospice care options before having the surgery-and the nurse ordered a hospice consult.  This resulted in her firing and subsequent license review/hearing.

The details of her plight have been well documented elsewhere and I dedicate this version of The Best In Nurse Blogs to those writers.

The Nerdy Nurse

Emergiblog

Nurse Ratched

Those Emergency Blues inital post, with an additional video montage from several nurse advocates.

Nurse Keith, the Nurse Coach at Digital Doorway

The Innovative Nurse

i Coach Nurses

Nurse Friendly

Medical Ethics and Me

The Healthcare Team is broken

What I want to discuss today is not the details of this case as the eloquent nurse advocates listed above and many others are better able to do so.

What I want to discuss is the big picture. The big picture which has allowed this event to trigger the spark that has become a wildfire of indignation and resentment.

As sad as this case is, it is just a microcosm of a problem that exists in our current healthcare system.

Our current healthcare system is broken.  And the fix (and I’m skeptical of the current misguided attempts) will be complicated and painful.

What can be done?

It will not be fixed until physicians, nurses, techs and hospital administrators get on the same team.  Being teammates  is not possible when we allow fellow physicians to bully, verbally abuse, berate, belittle,  or ignore other members of the healthcare team.

How many times have we seen sports teams with great athletes lose in their chase for a championship?  One or two  “Stars” behave selfishly and refuse to be a true “teammate”-poisoning the efforts of all the other team members.

In healthcare, losing doesn’t mean losing a game or a championship, it may mean losing a life, needlessly.

Until we start taking the “team” approach seriously and not just give it lip service, we are doomed.  The healthcare dollar is shrinking and as administrators struggle with keeping their facilities’ doors open, it is just too easy to appease the Docs who order the tests and admit the patients and drive the income.

Even when those same docs are abusive, egotistical boors.

• There has to be a consequence to those physicians who can’t be civil.
• There has to be a support system and non-judgmental investigative system in place to separate the whining, he said, she said, trivial issues from the truly malignant incidents that shouldn’t be allowed in a modern healthcare facility.
• There has to be a system that enforces accountability when a physician can’t control his temper, yells or screams, throws instruments and loses control.  We can’t just (wink, wink) say, “He’s a pain in the ass, but he’s a good surgeon and accounts for 30% of the hospital revenue (wink wink…).

Every nurse, when reading the details surrounding the Trujillo case, concludes the nurse is being abused by the system.  That her rights to assist her patient with information, because it was  in conflict with the physician, were abrogated.

Nurses believe this happened in this case because they see it happen in their institution, day in and day out.

I’ve seen it at every level of my experience. As a high school student shadowing a physician, as a medical student, as a resident, and it continues even today after 26 years in practice.  Doctors continue to abuse nurses and staff members. Sometimes it’s subtle, sometimes it crosses the line to behavior that would be illegal if it occurred elsewhere.

This has to stop.

Reader Questions:

What are your thoughts, not about this incident, but about the big picture? What can be done to improve and develop a collegial healthcare atmosphere? Please, let’s have a constructive dialogue.

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Imagine this conversation:  ” Hey Joan this is Tammy.”

“Tammy where are you, your shift started at 7 this morning and it’s almost 9.  You’re never late, is something wrong?”

“Joan, I just can’t do it anymore, I’m sorry to leave you shorthanded, but I had a panic attack when I got up to go to work.  My husband insists I stay home from work ’till I go to the doctor, he thinks I’m killing myself with the stress!”

I’m sure this conversation has occurred in many households throughout our country.

Not just in healthcare, the teachers I see in my practice say the same thing. The work environment has deteriorated with belligerent out-of-control students, to state and federal goals and guidelines, and pay-cuts and unpaid furloughs, and, and, ……

Burnout is the commonly used term for those whose “giver” got up and left.  You’ve given, given, given until your battery is not rechargeable by the routine weekend, or vacation.

I’m not a social scientist or neuro-behaviorist, but I’m someone who’s worked in healthcare for almost 35 years.

Remember Your Inner Child At Work!

One of the most common problems I see in my patients is the “I can’t do it all anymore” syndrome.

This Wall Street Journal article highlights tips on not letting work place stress get the best of you.  From the trenches where I work, here’s my take on these tips:

• When you’re off your game at work, focus on helping others rather than focusing on your problems or job negatives.  Help a student or intern, mentor a younger worker.  Show someone the ropes.  By giving to others you will be the biggest beneficiary.
• Ask yourself daily: ” Why do I do this?” ” What were the things I loved about this career?”  Take time to remember your goal or bottom line.  Are you in your job to help people?  Focusing on this rather than the day to day trials may help alter the negative thoughts rolling around your brain.
• Limit Expectations: Don’t use your job as your soul/sole source of self-esteem. You are more than a ________(fill in blank).  Remember to develop friendships, hobbies, and other outside activities.  Do something fun every week, not just during a vacation week once a year.
• Look for challenges, not problems.  Easy to say, hard to do-but worth the effort.  Recognize that every job has challenges and look at those as a way to grow/learn rather than as a personal attack or as a burden.

These tips can help you turn around work place stress before it becomes cynicism, ulcers, ruined marriage, or a job failure.

Reader Questions:

What do you say? What works for you to make you stay positive at work?

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Best In Nurse Blogs:

Walking the halls of my local hospital on Friday, it seemed so quiet…The nurses said the census was low, low, low even in ICU.  I’m sure the ER was busy, but I don’t go there unless called.  It’s bad karma.  No flu has hit our part of the state.  The economy has just about eliminated any elective procedures.

My contacts in other parts of the country say the same thing.

Hostess Bankruptcy: Will it improve diabetics' glucose control?

This will be an interesting year in health care.

For now let’s just focus on…..

The Best Nursing Blogs:

I don’t usually pick a top post for my Best In Nurse Blogs, ’cause it’s not a competition.   But you need to go read JParadisiRN’s list post cause it’s too damn funny.  She says she doesn’t know who wrote the list, wish it was me!

Impacted Nurse has 50 tips to have a more productive 2012.

Free webinar with continuing education credits at Infusion Nurse.

Dying Alone is the topic at Those Emergency Blues.  Glad to have you back JD. We’ve missed you.

Keith at Digital Doorway has a book review.

Running Wildly had a virus and had a smashed Kindle.…that’s piling on.  But now she has a Kobo-need to check that out-(I downloaded the app on my iPhone)…  Sick nurses are the worst.  Yes, they’ll admit it too!

AJN has a review of an article about central venous pressure and clinical decisions.  Interesting stuff.

The Nerdy Nurse is giving financial tips, this one about saving money on eyeglasses.  (I better watch her, she’ll be taking over the personal finance advice area….)

Correctional Nurse discusses food allergies.

Check out Sean’s post at Scrubs, detailing his long career in 6 words.  Great insight, and so true!

Remodeled Nursing Curriculum is the focus at The Nursing Show.

The Makings of A Nurse reminds all that the NELRP student loan payback program application deadline approaches.  If you want to know more about the NELRP, check out this post.

Nursetopia discusses painless needles.

Thanks for reading!

Please take a moment to visit these great nursing blogs.  They are a talented bunch of writers who love what they do.  And this is just a small portion of what’s out there in the Nursing Blogosphere.  Please let me know if you are a nurse blogger and think you belong on my blogroll!

Reader questions:

What’s going on with the numbers at your facility? Is the census low or are you busting it?  (With personnel numbers being controlled, you may be busting it even with a low census.  Getting by with less is the new mantra.)

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Newsletter, for special people, with my special mini-e-course on personal finance and my special  free e-book, at no extra charge-cause that’s the kinda guy I am! Don’t you want to be special?

Have you ever had to get something done at work, a project or even a simple task but needed help?  Something you couldn’t do on your own?

If so, you’re in management.  You may not know it, no fancy title is involved,  you certainly aren’t getting paid for it, but nonetheless you’re a “manager”.

In health care delivery, very few organizations except the largest for-profit companies, have  formal management training programs.

The department heads are usually filled by the “OK, Jane quit ’cause she was tired of all the bitchin’ from the nurses about the holiday schedule so who wants to be Department head?”….method.

If you don’t say “Hell no I don’t want that hassle!” you get the job.  If yo’ mama didn’t teach you how to manage people, then you’re on your own.

Management equals more pay!

I’m all about helping you with your finances.  Making more money and spending less are the only two ways to improve the bottom line.

Anyone can be a leader!

Managers are usually paid more.   If you’ve never supervised others,though,  it’s kinda’ scary.

The best way to learn is by doing, the second best way is learning from someone who has been there and done that.

Management Project Example

We just had a large project in our office.  Let’s see what we did right and what we did wrong and see what you can learn about management and leadership.

First off, let’s get my management bonafides on the table.

I’ve had no formal management training.  I have read many books on leadership and personal development.

From Seth Godin, to John Maxwell.  From Guy Kawasaki, Jim Collins, to General Patton.  I’ve been 4 hr’d on my work week, been to the mountain top and seen the purple cow, been butterflied and long tailed to death.  I’ve got the equivalent of an MBA in self-read leadership. I have also run a business for 25+years.

The project:

The project I want to discuss is the implementation of an Electronic Medical Record (EMR) system in my office.  For those of you not in health care, this means the replacement of paper medical charts and all the billing/financial parts involved, with a digital version.  This is not putting in new software on Saturday and using it on Monday. This was a 6 month project with high five figure investment.

My staff are all hard workers of varying backgrounds but none of them are what you would call tech savvy.    Most of them use the internet for email, and occasional shopping but that’s about it.  Some of them don’t have computers at home.

Huge problem #1:  Change.  Every one has heard how technology is costing people their jobs and that was my staff’s first question:  “When we finish this project, will I still have a job?”

Dealing with that was easy. Our staffing is so lean, I knew we wouldn’t be laying anyone off,so I said so without hesitation.

Huge problem #2:  Trust.  To lead people, they need to feel you aren’t leading them into a certain death.  If you are taking them to a place where they’ll feel pain,  they have to believe in their hearts that there is a benefit.

If you are a good leader, and have a great cause, that benefit can be  for others, not just for the individual employee.  My staff had to believe this EMR would allow them to take better care of our patients and be more efficient at their job.  With the benefits explained,  they were willing to suffer, to a point.

It is amazin’ what your employees and co-workers  will sacrifice for the greater good.

Trust like that takes time to build. There is no short cut.  You have to be a consistent leader whose staff knows you can make the tough calls when the time comes.

Huge problem #3:  Stress.  When people are working overtime and are having to think about every keystroke every day, it doesn’t take long before tempers flare.

The best way to deal with a temporary but high level of stress is to be up front.  By letting everyone know that times are tough right now, everyone is on edge, let’s respect each others feelings, it’s OK to vent, let’s not take everything personally, and all the other cliches I could think of-we got by without anyone killing a co-worker.

But it did take constant reminding.  When you are angry at an inanimate object, it tends to spread to the livin’ breathin’ around you.

The important thing here is validating  strong emotions.  Not necessarily agreeing with ‘em, but recognizing their pain.

Sure, there were things said in the heat of battle that shouldn’t have been said. There were hurt feelings for a few days, maybe even a few weeks. But I don’t think any permanent damage was done.

Luckily, our EMR company got the brunt of the blame.  Not that they did anything wrong.  It’s better for the staff to say, “That damn computer, I’m ready to throw it out.”  Or “I wake up in the middle of the night wondering which button I should have pushed!”

Rather than, “That damn receptionist, if she adds one more work-in today, I’m going to get my gun.”  (we live in the south you know, everyone has a gun….)

Each week of the implementation process had goals to be reached and skills to be learned.

Everyone worked overtime.  I worked on Saturdays and Sundays with my staff, catching up with paperwork-excuse me-computer work.

Party Time

At the end of the project we had a party.  No, we didn’t bring a keg to the office.  We did have cake, decorated like a computer work station with a little foul language in appropriate places, and ice cream.   We had a Pinata that the team leader had painted with the name of the software company.  Everyone had a couple of shots at the beast with a big stick, releasing pent-up pain.

A sense of humor is another frequently overlooked leadership/management tool.

We all survived.

What did we do right?

• The project was well defined and  had a timeline.
• The project had reachable goals divided into accomplish-able steps each week.
• Each person had an understanding of their responsibilities.
• A weekly review of the project status ( free pizza helps).
• Those who had better tech skills were expected to help those that might be falling behind.
• We had a team leader who was both a cheerleader, but also a benevolent (mostly)taskmaster.
• We had rewards for all who participated when the project was over.

What could we have done better?

• The team leader should have more leadership training before the project started-we learned on the fly which isn’t always best.
• The practice owners/Docs have to walk a fine line between sharing the pain versus joining in on bitch sessions that are unproductive at best, and undermining at worst.  We managed to do this but did have the occasional slip.

The next project, I’m convinced, will go more smoothly as we’ve been tested in the heat of battle. All involved have seen the best and the worst of their work-mates and know they can be trusted to keep on keepin’ on when times are tough.

Summary

In summary, some management skills can’t come from reading a book, or taking a class.  However, like most things, the more you’ve read and learned, the easier it is to recognize those times that require finesse rather than a bulldog attitude.  You will find answers to tough questions come a little easier and you won’t have as many of those deer in the headlights, WTF,  moments.

If you are afraid to take that step up in your career, remember, everyone in leadership was an ignorant newbie in their past. (even if some have forgotten.)  When things get tough, remember  your career and personal finance goals help,  but focus primarily on helping others, not yourself.

That’s what makes a great leader.

Reader Questions: What helped you make the step to a leadership position.  On the job training, a mentor, and MBA?  What advice would you give new managers with no experience?

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Developing Negotiating Skills

The teen sitting across from me had huge tears running down her face.  I knew from my previous interaction with her she had an attitude.

This was going one of two ways-she was going to break-down, or want to break down everything around her.  She chose the latter….

Let’s see: stupid clinic, stupid nurse, incompetent lab….the praise just kept coming!

Her boyfriend had promised she was his first and only….she knew he was her first.  Everything was great, except for this little herpes culture turning positive.

It  was my job to tell her and burst her fairy-tale bubble.  She wasn’t ready for the real world.

Hostage Negotiation:

We all work and play in the real world.  There are skills we need to effectively negotiate a salary increase, talk to an irate patient, or communicate with a typical teen tyrant.

The salary increase thing will have to wait for a better economy, so I’ll just hone my negotiating skills dealing with my patients until that need arises.  It seems likely that as the economy worsens and the jobless rolls continue to climb, the numbers of stressed and angry patients we see will increase.

Negotiating with hostages is, admittedly, an extreme behavior.

I can’t imagine ever negotiating with a hostage taker (who does?), as I read about how the FEEBs deal with these folks, I recognized skills that I should develop to make my care and counseling more effective.

In fact, even in the most ‘ordinary’ job in the medical field, the nature of our work often puts us face to face with someone who is in crisis.

These are some of the basic strategies FBI hostage negotiators use to help them deal with extreme behavior:

• gather information
• offer support
• build trust
• stay calm

Information.  Medical charts can hold great amounts of personal data on patients.

The tough part is entering a room or the patient’s space and recalibrating the raw data with what actually is front of you. We should be ready to pick up on the vibes of anger, confusion, sadness or any one of a million mixtures of emotions.

Your Emergency Department patient or  family may have found themselves in a crisis situation, new to them, for which they have no coping skills. The lack of coping skills triggers extreme behavior, whether  anger or confusion.

Support.  People in crisis look for a basic human need-support.  All areas of the medical field have contact with people in crisis:

• Pregnant and 14
• Parent of a pregnant teen.
• HIV diagnosis
• No job, no hope, sick and without a doctor.
• Death of a loved one.

This list is infinite.  You need to show with body language and words that you feel whatever emotion is foremost in the mind of your client and that you validate their need for support, help, assistance, or information.

Trust. To offer support that is accepted, some basic trust must be established.  To do this, FBI agents:

• Actively listen by paraphrasing, offering minimal encouragement such as “yes” “I think I understand”.  You also need to quickly identify  and label the emotion you are seeing in the individual.  Is it fear, anger, disappointment?
• Empathize-make sure you humanize the individual.  Let them see you put yourself in their shoes in a non-patronizing way.
• Offer understanding-they need to think you “get them” as the saying goes….

Stay calm.  This can be very difficult.  People in crisis, whether it is over a positive pregnancy test or the news that a lover has been unfaithful, often become emotional.  Emotions often need venting, which may translate into anger at whoever is available.

Never allow yourself to be pulled into an argument or trading personal attacks with anyone.  Against anger, personalize yourself by using “I”, ‘I understand’, ‘I hear what you’re saying’.

Key to Negotiation:

This is the key to the whole process: negotiators peacefully resolve situations where they establish that they are nonjudgmental, nonthreatening, and understand the subject’s feelings.

Daily, I counsel teens and adults in various stages of crisis and confusion.   It’s not uncommon to see anger raise its ugly head.  The social and economic ills of our time are weighing on people, my patients.  I have to get them to accept the problems they have, learn how about them,  and learn what to do about it.

My job satisfaction, important in the face of no raises, few resources and even fewer job options, is affected by my ability to meet the needs of these folks.  Understanding them, in their hour of need, rather than getting angry  and winning the war of words, truly makes me feel successful.

Hopefully I can be a better nurse and a better person as I hone my ‘skills’.  When it’s time to negotiate that raise, I’ll be ready!

Your thoughts:

If you have a job interacting with the public, maybe you can put a few of these negotiating skills to work.  What works for you?  What doesn’t?  Please share with others.

About the author:

FDL BSN is a frequent guest poster. She works in public health.

{photo credit: carolaust.com}

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Guest Post: The Nerdy Nurse!

Hourly Pay Or Salary?

Depending on your role as a nurse, there are usually several ways you can be reimbursed for the care you perform.

For most of us, there are two basic forms of compensation: hourly and salaried. The benefits and detriments of both are varied.

However, it is interesting to take a look at differences because you may just find the grass may be greener on the other side.  For reasons of simplicity, we will use nurses in a hospital setting to compare pay types.

Hourly Wages

Hourly compensation is fairly straight forward. A nurse is compensated based upon the amount of time spent performing their job. You come in, clock in, work and get paid. You clock out and you stop getting paid. It’s fairly simple in the fact that if you work you get paid and if you do not, you don’t. Of course there are almost always ways to replace income lost from reasons of sickness or planned vacation, as long as the nurse does not abuse these privileges.

If a nurse works more than 40 hours in a week then you are usually compensated at time-and-a-half, and sometimes even more. Some hospitals will figure in your average salary based upon your shift differentials, and pay the additional half based upon that rate. Most of the times, nurses have no trouble picking up extra shifts and can easily earn a few extra dollars if the need arises. However, if they miss a day of work, they have to use their sick/vacation time or they will not get the paycheck they have grown accustomed to.

Shift Differentials and Premiums

Nurses often have shift differentials that can help increase their pay and compensate them for working at times that many would feel to be undesirable times to work. For instance, a nurse may get a few extra dollars per hour for working at night, she might even get a few more for working the weekend at night. So potentially a nurse can earn quite a bit more money and have a greater compensation for her time. So potentially, if a nurse wants or needs to, he or she can have the ability to add large sums of money to their paychecks by working extra days or less-desirable shifts.

Some hospitals also have premiums and incentives for those willing to pick up extra shifts or are willing to come in and work if the need arises. The compensation for this can vary from an extra $5-$20 per hour (sometimes more, depending on your location) to flat bonus bucks or shift premiums. These bonus bucks are varied based upon need and healthcare facility. They often range anywhere between $50 and $200 and often come in conjunction with the hourly shift premium.

Bonus Income is Not Guaranteed

It should be noted that these premiums and differentials vary widely from facility to facility. These can, and often do change without notice or warning and often sway with hospital budgets and patient census. These cannot and should not be viewed as reliable and steady sources of income for nurse.  I have seen first hard  nurses  lose $500 a month with a policy change in relationship to shift differentials and premiums.

These are bonuses, or perks, and should be viewed as such.

Shift differentials and premiums for nurses are the first thing to go when the hospital wants to cut back on expenses. When the finances of the hospital improves, sometimes they bring them back but often times they do not. 

Low-Census and Being Called Off

People will always be sick. There will always be a need for competent nurses, but sometimes the need for nurses at a particular time or on a particular unit decreases. This is increasingly common in the summer, due the “July Effect” that many patients are aware of.

 This causes a decrease in elective surgeries which trickles-down across the entire healthcare organization. Thusly, it impacts the wallets of nurses as well.

Hospitals often experience “low census” and many nurses are “called-off” and are forced to either use their saved time (vacation or PTO) or will have significantly less to show on their paycheck. Another thing to consider: your paid-time-off is usually only paid at your base pay as a nurse. So even though you typically earn $30/hour as a nurse on the floor, $8 of that is from your shift differentials. Your base pay is only $22 and 12 hours at $22 is a lot less than 12 hours at $30.

Salaried Employees

For a salaried employee your paycheck remains the same. You annual salary is divided and you are paid based upon that. If you work more or less you are not compensated any more or less. There are usually terms in place that outline vacation and sick time, but typically speaking, your income is constant and there is no real way to earn extra income. However, you also do not have to deal with the uncertainty of hourly wages. Your income is controlled and consistent.

If you can budget well, and have savings on hand for emergencies, being a salaried employee is a beautifully thing. This can bring a great decrease in stress in terms of finances. Your income is predictable, steady, and consequently, your budget can be as well.

Hourly Verses Salaried

Is there a clear cut winner between the two?

Honestly?

No.

It all depends on what you want in your life. Do you want the ability to earn extra income, work at night, or perhaps weekends for increased wages? Well then for you hourly is the way to do. However, if the opportunity arises for a salaried position, and you’re looking for stability, consistency, and uniformity in your finances and budget, then don’t snub your nose at it. Variety is definitely the spice of life, but for this nerdy nurse, I’ll take my paycheck as bland as possible.

Your Thoughts on Income Forms

What are your feelings on paycheck spice? Do you like flexibility and the ability to earn a bigger paycheck or does the idea of consistency in salary strike your fancy?

Would love to get your opinions on consistency in budgeting or lack thereof in relationship to how you are compensated for the work that you do.

Bio:

Brittney Wilson, RN, BSN works as a Clinical Informatics Specialist in Georgia. She describes herself as a Patient, Nurse and Technology advocate and has a passion for using technology in innovate and simplify lives, especially in healthcare. She blogs about nursing issues, healthcare , technology and parenting on The Nerdy Nurse. You can frequently find her on twitter @TheNerdyNurse and writing many technology pieces for My Reality Tech.

As Nurses Week Runs from May  6th to the 12th, I had a decision.  Do I publish my Best of Nurse Blogs post at the beginning or at the end of Nurses Week.

Publishing today allows me to highlight the many posts this past week by nurses about Nurses Week, plus I took my wonderful wife out of town for Mother’s Day last weekend.

That’s my story and I’m sticking to it.

We began our trip in a very sad place however.  We had business in  the Tuscaloosa/Birmingham area.  The storm devastation was heartbreaking.  I’ll be writing about it later this week.  We finished up the week at the beach and had a wonderful, relaxing time.

I read about 5 novels in three days-no personal finance or medical articles allowed. I stayed off the computer except for the minimal to keep things going here!

Please check out the article by Megan Krischke at Nurse Connect,  Experts Offer Advice for Increasing Nurses’ Earning Potential.

I was honored to be on a great expert panel.

Hope you had a great Nurses Week, and now enjoy…..

The best in Nurse Blogs:

Running Wildly has a unique makeup application going. Pics too!

Those Emergency Blues writes about the  unfortunate suicide related to a  medication error.

Correctional Nurse has a video on her field of Correctional Nursing in honor of Nurses Week!

Impacted Nurse gives you Mindset Tips-great suggestions.

The Nursing Show features a post on safety tools. It’s not the tool, but the one holding it, is what I heard growing up. over, and over, and over…

Nurse Teeny at the Makings of a Nurse writes about covering your ass… Interesting perspective.  Documenting good care is not the same as CYA to me.

At Your Cervix had a special party!

JParadisi RN writes about no recognition being great recognition sometimes.  Go read it, it’s hard to explain-she does a wonderful job!

Crass-pollination has a giveaway. Deadline is today, so don’t put it off.

Sean at My Strong Medicine has words about a few challenging patients...

Nursetopia has a resource of free NIH tools for most any clinical situation.  No need to reinvent the wheel if you need a protocol or list.

Head Nurse got shaken up….Literally.

Infusion Nurse is also celebrating Nurses Week, with a few facts and figures.  Check em out.

Nurse Story celebrates nursing week-wish I’d thought of that!

The Nerdy Nurse has a contest and giveaway in celebration of Nurses Week! Go, win already.  Tell her I sent you!

Best In Nurse Blogs

Hope you enjoyed Nurses Week, and these great Nurse Blogs and their writing.

Please take a moment and leave a comment when you visit these blogs.  Most of us bloggers love conversation!

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Guest post: Heather Thomas RN, CFO  of a Destin Boat Rental Company

A deserved second day off, but also the second day my caller ID showed the hospital was trying to call me in. They were, of course, short-staffed.  Duh!

I tried to ignore the phone as it went to voice mail; my nurse manager, someone I respected, groveling for extra help. Our unit was full and someone had called in. Again.

I laid in bed, trying to ignore the guilt laden voice whispering in my ear…”you don’t care about your so called friends and co-workers do you?  You don’t give a damn about those patients…”, who I knew needed the extra help.

Extra Hours

There was a time when I would have eagerly picked up the phone and gone in. The money was good, especially for overtime, and there were a couple of years where I raked it in by working 4 and 5 twelve-hour shifts a week. But I couldn’t do it anymore.

The money-who cares!

I spent my working days watching the clock.  I lived for my days off.   I spent my days off dreading my next day at work. I was tired all the time, but ironically couldn’t sleep.

When I did sleep, I would have nightmares about being assigned a patient and then forgetting them and realizing my mistake at the end of the shift. I was cynical. And sick of being a nurse.

Burnout

It’s something every nurse experiences at some point. Dealing with  under-staffing, struggling to meet the constant demands on your emotions and the physical wear and tear on your body from 12-hour shifts spent on your feet, you can only imagine….  And many of you are thinking “Yeah, so what?”

Time Off

Have you wondered why the saying “recharging our batteries” became so widespread.  Cause it’s true-we all need to recharge our emotional batteries.

Did you know that half of Americans don’t take vacations? Are you one of them? I’d say we nurses are amongst the worst offenders.

Why are nurses worse?

• We are caregivers-it’s in our blood.
• We can’t say no.
• Our friends are at work, and they need me.
• Breadwinner role-I’ve got to work, my family depends on it.

To  treat or avoid burnout,  day or two off isn’t enough. You just need, no,  you  have to get away. But with financial obligations, it can be hard to justify an expensive vacation.

Fortunately, a vacation doesn’t have to break the bank. Here are 5 tips to make a vacation affordable.

1. Set a budget. Decide how much you can spend for your vacation and begin to put it aside. I’m a big fan of using an envelope system. Label one envelope vacation, and begin putting money aside.  You can do the same with an electronic transfer to an online bank savings account.   Name a sub-account “vacation”-have money automatically deposited there. So, sit down and take a good look at your finances. Determine what you can afford to spend and then set your priorities.
2. Pick a destination. It can be tempting- fly to Disney World with the family for a week. But it can be pricey. If you don’t have the budget for a trip like that, look closer to home. Chances are there is a destination you would like to visit within a few hours’ drive. A beach? A mountain retreat? Road trips can be fun.  Travel by air these days is expensive and a hassle.
3. Setting priorities. Now that you have a budget in place, what is MOST important to you? Will you stay in an oceanfront hotel room with a view, or in a vacation rental nearby? Do you have to eat out, or are you willing cook so you’ll have more to spend on  excursions? Develop your priorities. (maybe get a little input from the family….your choice….)
4. Research. You have your spending planned. You know where you are going, and you have a good idea of what you would like to do. Now it’s time to check  online and do some advance planning. I’m not talking about trying to recreate the Griswold’s European Vacation. Check sites for prices and customer reviews. Make reservations early, if possible. Having a plan in place can help you avoid extra expenses.
5. Relax. OK, so this isn’t so much of a financial tip. But remember the reason you are taking a vacation in the first place: to get away. Spend some quality time with your loved ones and enjoy your time off. When you get back, you will be rested, happier, and able to focus on the reasons you became a nurse in the first place.

Dr Dean’s Thoughts:

Heather has this dead on.  I see this in the nurses at work, and in many of the women in my medical  practice.  One of the most common complaints is “I’m tired and I have no sex drive.”  Not taking time for rest and relaxation can be so devastating to your physical and mental health.  Having your finances so screwed up you don’t think you can take time off is part of the problem.  Take charge of your life.  ONLY YOU can make it better.

About the guest author: Heather Thomas RN is a nurse-turned-entrepreneur in Destin, Florida. She is part of a husband-and-wife team of boat rental operators at Destin Vacation Boat Rentals, a Destin boat rental company that specializes in helping people enjoy their vacations.

A series of interviews with nurses about career opportunities and nursing jobs-outside of acute care nursing.

Sales.  A sale’s job  one of the more high paying jobs in any industry.  And yes, there are successful Nurses in sales.  Many companies in health care use sales reps to market and instruct end users how to get the most out of their product.

Nurse as a Pharmaceutical Rep:

Nurse T is a 10 year veteran sales rep for a national pharmaceutical company.

She agreed to talk on condition of anonymity.  Very cloak and daggery.  Her voice has been changed by advanced electronic gizmo’s…(if it sounds like you, it may be ’cause you’re reading aloud…)

Dr Dean: What is your Nursing background?

Nurse T: I got my BSN in 1991. My first job as a new grad was on the Neurology floor of an acute care facility.  After about four years one of the admitting Docs hired me to work in his office.  I took a pay cut but was ready for regular hours and no more nights!

I worked in the office for about 4 -5 years.  It was there that I was first exposed to drug reps, or more formally- pharmaceutical reps or salespeople.  I was the gatekeeper for the practice.  The sales reps had to go through me to get to the Docs..

I was curious about their jobs, so I asked a lot of questions.  They all seemed to be happy and  laid back.  Having a good time!

I asked about qualification requirements and was happy to find a  bachelors degree was all that was required-which I had.

Dr Dean: Is that was what attracted you, the more casual and laid back persona of the reps?

Nurse T: Yes they seemed to be in a good mood.  By then I was a little bored in my job.  I had been in the office long enough not to be challenged.  I wasn’t quite ready to make the big step out of nursing though.

A marketing job in the hospital came open. I applied and was accepted.  This was a job selling our facility to the community, putting together programs to get the word out to schools and the general public.  Drug reps were also involved in this arena with sponsorships and I made a lot of contacts by networking.

Dr Dean: When did you take the plunge?

Nurse T: After a year or more in the marketing arena several sales reps encouraged me to apply.  I put my resume in over about three months with a lot of companies-and nothing.  I had basically given up when I started getting interviews and call backs.  Overall it took about 8 months between first applying and finally getting a sales job.

My first offer was with my current company.

Dr Dean: What was the training like?

Nurse T: I had a lot of materials in the diabetes area-my first product being a diabetic medication- I had to learn first.  That was basically home study for the first couple of weeks.  I then went to the home office for several weeks of training.  Two thirds of the training was science and background information on the product I was to be promoting.  One third was on sales techniques.  A lot of role playing and learning how to make my presentation in a small amount of time was the focus.

Dr Dean: Did you have a mentor or sales trainer once you finished your training?

Nurse T: No, they just told me to go forth and sell.  I was scared to death at my first sales call.   I was a wreck, an absolute wreck!   I remember it like it was yesterday-I can tell you which office it was even though it was 10 years ago.

Dr Dean: What does being a pharmaceutical rep involve?

Nurse T: I make office calls giving information to physicians and their staffs about my products.  It is informational in nature.  It is not a “hard sell” environment any more.  Offices won’t let you in if they feel you are only pushing a product.  You have to provide them with valuable information.

Dr Dean: How did your nursing background help or hurt?

Nurse T: I was familiar with the medical lingo, although the depth of knowledge required was much more deep than what we learned in nursing school.  And of course I had no sales background-that put me a little behind the reps that came from  sales.

Dr Dean: What are the pro’s for jobs as  pharmaceutical reps?

Nurse T: The salary is great-starting salary is probably $60,000 for most in the industry.  You also get a vehicle, gas allowance, and the usual benefits like retirement and health insurance.  Most reps after a few years are making in the $90,000 + range.

Your pay is part salary and part commission-so the more you sell the better your salary.

You also have a lot of flexibility regarding your schedule.  I have found it to work well with being able to spend time with my kids.

Dr Dean: Would you recommend this job for other nurses who are looking for a career change?

Just a couple of years ago, I would have said emphatically yes.  However the current environment with the changes with the health care bill, our job is much more difficult.  Doctors are seeing more patients  because of dropping reimbursements and have less time to spend with you.

We are also much more limited in the ways we can promote a product and have many more people looking over our shoulder.

Almost all pharmaceutical companies are laying off staff making the environment much more competitive.  There may be other sales jobs outside of the health care industry that would be more appealing these days.  If you want to sell though-it can be very financially rewarding.

I kept my nursing license active, just in case.  One thing about nursing is an experienced nurse can usually find a job.

Dr Dean: What tips would you give someone who wanted to give it a shot?

Nurse T: I would remind them that you are “selling” every day.  You are selling good health tips, you are selling yourself when you learn to communicate with your patients and how best to motivate them.  And remember your clinical background gives you an edge over non-health care trained sales people.

Thanks to Nurse T for her time-and she didn’t even charge me!

My Take on Nurses in Pharmaceutical Sales:

It seems as if the health care environment and the new health care bill is affecting all areas of medicine.  The pharmaceutical or drug rep may be a dying beast.  I now get many of my samples and information online.

The current model  for many companies seem to be  more consumer driven advertisements than live reps.  My patients come in asking for a certain med because of an ad on TV or in a magazine.  I’m not sure this is a better  but it’s the way it is….

So times they are a changin…

If you get an opportunity to get into pharmaceutical sales  go in with your eyes open for the overall direction of the industry-go for it.  You may feel the future uncertainty may be worth it for the benefits of getting away from shift work,  acute care,  and better pay.

My job is to help you to see other career opportunities as they truly are, not with rose colored glasses.

I want to thank Nurse T for agreeing to talk with me.  Her honesty about her profession and potential job prospects in Pharmaceutical Sales is refreshing- or maybe she just wants it all for herself…(just kidding!)

{photo credit dno 1967b c.c.}

Make sure you follow me on Twitter @DrDeanBurke- quick links on the side of the blog!  And let’s not miss a post-sign up for email special delivery!

Friends, I love friends-check out my Facebook page, and I’m definitely Linked-In-use the shortcuts on the side-that’s why I paid my Web Master of the Universe Ben the big bucks to put em there-saves you time!

John and Joan were soooo excited bringing home their baby.  After two years of infertility workups, needles and probes, they finally conceived.

All their relatives wanted to help out as they got the nursery ready.  John  loved the idea when his Mom suggested using the crib that he slept in as a baby.

“Honey, I kept it in the attic all this time.  Your Dad brought it down and sanded and varnished the wood.  He got the rust off those metal thingey’s so the side goes up and down easily.”

Yes, you know “the rest of the story!”

I am all about frugality, saving money is important to me.

Don’t try to save money on cribs and car seats.  It’s not worth it!

A recent article in the WSJ about cribs, gave me chills.  I’m sure many of us hand down cribs from generation to generation.  We think nothing about, and are actually proud, to use Grandma’s cribs, blankets, and bumpers.

The March Journal of Pediatrics advises that 26 children are brought to the ER-Every Day- with crib related injuries in the US.

Some of those are not preventable-we all know a baby that can barely stand while grabbing on the crib rails one day, is trying to climb out the next.  At least do all you can to prevent the preventable.

Make sure you buy a crib that passes the new crib standards formulated recently by the US Gov. Consumer Safety Council.  Get rid of puffy bumpers, mobiles, cords close to the crib or any other object that might cause smothering or strangulation.  Stories abound of babies getting tangled up in the cords of those monitors and the bumper ties that were within reach.

Grandmas are special so honor her with  her picture  in the nursery, but letting your most precious commodity sleep in that old crib is like a ticking time bomb!  Put it in the corner with a doll and use it as decoration-if you need to make Grandma happy.

Great Reads from the World of Nursing:

Sarah Beth RN: What Happens When The Lights Go Out?

Karin, RN writes a short post about tax day-did I say it was short?

Bonnie RN writes about breast cancer.

Crass-pollination asks you not to be “Nurse Layzee” reasonable request…

ER Nurse Joy, must be back from Jamaica-asks you to remember the tornado victims.

Not Nurse Ratched has a rant going about patients, families and Nurse Appreciation….

Lost on The Floor discusses scrubs and appropriate scrub wearing behavior.  Probably vomiting on yourself after 10 shots of tequila while wearing your scrubs is a no no!  Of course taking them off while knocking back the last two, wouldn’t be too cool either…I hear tequila does that to some…

Nerdy Nurse has fallen hard for social media-mainly twitter-she also wants you to lift up a fellow tweet.  Check it out.

Infusion Nurse has had to use her skills on an airplane...Been there, done that. Though I was able to use the emergency box.

Sean at My Strong Medicine can’t leave home without it….”Will we be born with one eventually?” I ‘ll ask Darwin when I see him.

Nurse Story has set up a journal club. Maybe you should get tips from her and start one of your own.  I liked the part about the beverages…

At Those Emergency Blues a lovely (as usual) and moving post about Empathy-check it out!

Barbara at Nurse Practitioners Business site gives a few real facts about costs in providing healthcare.  Ain’t nothin free!

Please drop by these great blogs and let the writers know.  Blogging can be a lonely craft at times.

And don’t forget to advocate safety to all those new moms you run into. Nurses get asked for health advice all the time.  Use your platform to advocate for child safety.

One preventable death of a child one too many!

(photo credit: tammra mccauley c.c.)

Make sure you follow me on Twitter @DrDeanBurke- quick links on the side of the blog!

Friends, I love friends-check out my Facebook page, and I’m definitely Linked-In-use the shortcuts on the side-that’s why I paid my Web Master of the Universe Ben the big bucks to put em there-save you time!