Chapter 14 Beginning Your Nursing Career

1. Chapter 14Beginning Your Nursing Career

2. Career Opportunities in Nursing • You have an opportunity to look for the type of nursing that best meets your personal interests, needs, and capabilities. Hospital Nursing • Patients require level of care provided by highly trained registered nurses. • LP/VN opportunities are in: • Hospital-based clinics, outpatient same-day surgery unit, operating rooms, radiology unit, hospital-based long-term care unit, home health department

3. Career Opportunities in Nursing (cont.) Community and Public Health Nursing • Provided to patient under the administration of established health care programs. • Nurses may work inside community health centers, or outside the center traveling to patients’ homes to give care. • The LP/VN in public health works under the direction of an RN or other qualified supervisor.

4. Career Opportunities in Nursing (cont.) Office Nursing • Physician, dentist, or other health care provider. • Nurses may be responsible for a variety of duties in addition to nursing duties. • Important assets for office nurses: • Flexibility • Adaptability • Self-direction • Excellent communication skills

5. Career Opportunities in Nursing (cont.) Private Duty Nursing • Works directly for a patient in a setting requested by the patient. • Private duty nurses provide comprehensive care to one patient. • Self-employment responsibilities: • Taxes • Licenses

6. Career Opportunities in Nursing (cont.) • Private duty nurse in an institution • Follows policies and directions • Responsible to the physician or other authority in charge of a patient’s care • Private duty nursing in a patient’s home • Works under direction of the patient’s physician • Must have skills and knowledge needed to function without direct assistance

7. Career Opportunities in Nursing (cont.) Home Health Nursing • Provide nursing services in the patient’s home. • Agencies known as visiting nurse societies and associations. • Require the nurse to teach family members to care for their relative. • Care in the home is less costly. • Patients prefer to be at home in familiar surroundings.

8. Career Opportunities in Nursing (cont.) Home Health Nursing (cont.) • Home health nursing opportunities are increasing. • Home health nurse must: • Have excellent clinical skills • Have good communication and teaching skills • Be self-directed • Be able to prioritize work to benefit the patient

9. Career Opportunities in Nursing (cont.) Industrial/Occupational Nursing • Nursing opportunities in the industrial sector are increasing. • Industrial and occupational nurses must be skilled in first aid and emergency care. • Industry programs offer their employees: • Physical exams • Screening tests

10. Career Opportunities in Nursing (cont.) • Industry programs offer their employees (cont.): • Diagnostic surveys • Wellness programs • Nutrition counseling • Fitness areas • Nurses must have the ability to assess learning needs and to plan and conduct programs to meet those needs.

11. Career Opportunities in Nursing (cont.) Hospice Nursing • Hospice provides compassionate care and understanding in a comfortable and familiar setting for terminally ill patients. • Nurses working with dying patients • Require specialized training • Must have a good understanding of themselves • Must be able to interact with family

12. Career Opportunities in Nursing (cont.) • Nurses working with dying patients (cont.) • Must not interfere with patient’s and family’s personal relationships and business • Services can be provided in the home, hospitals, long-term care facilities, and other care settings.

13. Career Opportunities in Nursing (cont.) School Nursing • School nurses deliver simple first aid, immunizations, and health screening. • Schools offer comprehensive program of prevention, treatment, and education. • RN functions independently and often under authority of a physician appointment by School District’s Board of Education. • LP/VNs assist the RN. • School nurses must enjoy children.

14. Career Opportunities in Nursing (cont.) Nursing Homes • Rise in number of elderly Americans has led to increased need for nursing and convalescent homes. • Need for nurses has increased. • Nursing home: • May be privately endowed • May be funded by local or state money • May be a for-profit or not-for-profit institution

15. Career Opportunities in Nursing (cont.) • Nursing home (cont.) • Must be licensed by the state • Provides services that range from simple custodial care taking to complete medical and rehabilitation care supervised by an RN • LP/VNs often employed as charge nurses • Direct day-to-day delivery of nursing care

16. Career Opportunities in Nursing (cont.) • Federally operated hospitals caring for veterans of the US Armed Forces • Offer wide range of job experience • Offer potential for travel

17. Career Opportunities in Nursing (cont.) Other Employment Opportunities • Homeless shelters • Boarding homes • Group homes for mentally challenged • Prisons • Outpatient psychiatric clinics • Neighborhood health clinics • Day care centers for children and older adults

18. Career Opportunities in Nursing (cont.) Other Employment Opportunities (cont.) • Rehabilitation facilities • Insurance companies • Managed care businesses • Medical equipment and supply companies

19. Employer Expectations • Have a theoretical basis and understanding for what you do • Complete assignments within a reasonable period of time • To ask for assistance if you do not know how to perform a skill • Function within the law and according to your job description • Participate in contributing to the organization

20. Employer Expectations (cont.) • Maintain required skills • Be loyal and fair • Know how to keep records of your activities • Assume responsibility for your work

21. Transitional Challenges • Student Nurse • Controlled learning conditions. • Assignments selected to contribute to students’ educational development. • Clinical instructor is legally responsible for students’ performance. • Clinical instructor is there to help resolve problems and answer questions.

22. Transitional Challenges (cont.) • Graduate Nurse • Receives assignments based on patient and employer needs • Responsible and accountable for own actions • Carry out assignments within the allotted time • Increased workload and pace • May or may not receive help from experienced members of the nursing team

23. Transitional Challenges (cont.) • Techniques to Ease Transition • Be honest about limitations • Don’t shirk your share of work • Let your supervisor know if you are getting behind schedule • Ask experienced team members for organization suggestions • Observe experienced nurses organize

24. Transitional Challenges (cont.) • Techniques to Ease Transition (cont.) • Ask supervisor to evaluate your performance daily or weekly • Learn about patients’ medical conditions and nursing needs • Admit your mistakes and learn from them • Put in extra time if needed

25. Self-Assessment • Lack of self-esteem and poor skills can undermine confidence • Review clinical strengths and weaknesses • Assess personal health and physical condition • Assess work habits • Assess personal and interpersonal characteristics • Use assessment results to alter aspects of yourself that need to be changed

26. Finding a Position • Start 1 to 2 months before graduation • Determine area of nursing you prefer • Check list of potential employers often • Network • Use your program’s placement services • Check Web sites of local health care facilities • Check newspapers, nursing publications, and job announcements mailed to your home • Internet and employment agencies

27. Finding a Position (cont.) The Application Process • Informal by visiting and applying • Formal by submitting letter and résumé The Letter of Application • Should be simple, direct, and objective • Introduce yourself • Announce your interest in employment

28. Finding a Position (cont.) The Letter of Application (cont.) • State your qualifications • Express your availability • Use good-quality white paper in standard business letter form • One page long • Free of grammatical and spelling errors

29. Finding a Position (cont.) The Résumé • Résumé means summary and should include: • Summary of previous education • Summary of work experience • Can send your résumévia: • E-mail • From an electronic bulletin board • Use of an electronic application form

30. Finding a Position (cont.) The Résumé (cont.) • Web sites to teach how to prepare and submit an electronic application and resume • Must be typed • Standardized format categories: • Name, address, and telephone number • Immediate goal • Career goal • Education

31. Finding a Position The Résumé (cont.) • Standardized format categories (cont.): • Licenses • Work and volunteer experience • Memberships and honors • Reference availability • Permission to use personal references

32. Finding a Position (cont.) The Interview • First impression is important. • Prepare by role-playing in front of a video camera. • Learn about the employer and prepare to meet expectations. • Dress appropriately. • Be well-groomed. • Be pleasant and polite.

33. Finding a Position (cont.) The Interview (cont.) • Act like yourself. • Don’t be concerned about nervousness. • Open-ended interview questions. • Illegal questions. • Special accommodations due to disability. • Prepare a list of questions ahead of time.

34. Finding a Position (cont.) The Job Offer • Review each offer before accepting or rejecting • Plan to stay a minimum of 2 years on your first job

35. Evaluating Positions • Weigh all information about each job offer before making a decision Wages • Should earn the maximum salary or wages possible for level of education and experience. • Regional salaries and wages will be similar. • Inducements. • Evaluate a salary or wage above a regional average.

36. Evaluating Positions (cont.) Wages (cont.) • Study salary ranges in your area • Find out what prospective employers’ wage increase policies are Hours and Shifts • Employers set conditions to maintain continuity of services • Usually based on three 8.5 hours or two 12-hour shifts per day • May require or offer rotating shifts

37. Evaluating Positions (cont.) Hours and Shifts (cont.) • Understand work schedule before accepting a job • Know state regulations and law regarding mandatory overtime for LP/VNs • Caregivers are mandated to work overtime. • 15 states have restrictions for nurses. • 16 states have enacted laws regarding mandatory overtime.

38. Evaluating Positions (cont.) Employer Reputation • Good and bad reputations are earned for a reason. • Don’t accept hearsay. • Ask opinions of those who have worked or received care there. • Ask the employer to provide verifiable references.

39. Evaluating Positions (cont.) Opportunities for Advancement • Look at employment opportunities with employers who offer or encourage employee advancement Benefits • Can be a decisive factor in choosing a position • Include: Insurance plans, overtime pay, pension plans, reimbursement for tuition, employee credit union, in-service educational programs, meals and vacation, leave of absence, and holiday policies

40. On the Job • Most people feel apprehensive when starting a new job. • Expect highs and lows and insecurity will be replaced by poise and self-assurance. • Maintain high standards. • Accept the responsibilities you are given. • Be punctual and reliable. • Notify employer if unable to report to work due to illness or other circumstances.

41. On the Job (cont.) • Ask questions when uncertain. • Share when someone comes to you for help. • Abide by regulations. • Don’t snipe, gossip, or complain. • Leave personal problems and concerns at home. • Demonstrate professional behaviors and attitudes. • Your first obligation is to your patients. • Do not misuse or misappropriate equipment or supplies.

42. Resignation • Give 2 weeks’ notice in writing to the supervisor. • Letter of resignation should: • Be simple and direct • State the fact that you are resigning • Give the effective date • Give reasons • Close on a positive note

43. Dismissal • Based on: • Economic and budget cuts and other administrative changes • Dishonesty, improper performance of duty • Insubordination, illegal acts • Excessive lateness or absences • High standards is the best defense against charges. • You have the right to appeal.

44. Your Budget • Two major divisions of a budget: • Income • Expenses • Personal • Professional or business • Local, state, and federal taxes

45. Your Budget (cont.) • Other money matters: • Savings • Investment programs • Planning for retirement • Personal life, health, liability insurance • Establishing a good credit rating

46. Your Career • Goals are incentives to self-fulfillment. • Maintain and improve clinical skills: • Conventions and workshops • Refresher courses • Continuing Education Units (CEUs): • May be required for license renewal • NAPNES and continuing education record keeping system

47. Your Career (cont.) • Accredited course or program offered by a college or university • Know the cost of credits and can they be transferred • Clinical certification validates your clinical knowledge • NAPNES programs in pharmacology and long-term care • Becoming a registered nurse • Look for programs offering advanced standing

48. Nursing Organizations • Intention is to benefit the membership through activities that advance the occupation. Practical/Vocational Nursing Organizations • National Federation of Licensed Practical Nurses (NFLPN) • Membership limited to LP/VNs, students, and affiliated members • Primary purpose is to promote the practice of P/V nursing • Attempts to influence legislation

49. Nursing Organizations (cont.) • National Association for Practical Nurse Education and Services (NAPNES) • Membership open to LP/VNs, students, faculty, directors, and other interested persons • Promotes an understanding of practical/vocational nursing • Develops continuing education opportunities for LP/VNs

50. Nursing Organizations (cont.) • National League of Nursing (NLN) • Membership opened to anyone interested in promoting health care through nursing service • Primary concern is education of nurses and improving quality of health care • American Nurses Association (ANA) • Professional RNs and students in professional nursing programs • Code for nurses