I reentered as a RN without a good knowledge base

[andrea1994]

I am out of the clinical setting and was asked to assess a child and find my skills aren't as sharp as I want them to be for my skill set. What is the best move here in NY? Should I take an assessment module online, pick up a book or the best bet would to find a class offering? Do you know where I would look?

[Frankreich]

I am out of the clinical setting and was asked to assess a child and find my skills aren't as sharp as I want them to be for my skill set. What is the best move here in NY? Should I take an assessment module online, pick up a book or the best bet would to find a class offering? Do you know where I would look?

1. Be honest with your employer.
2. Do an Internet search for possibilities.
3. Pick up a book on pediatric assessments.
4. Check to see if there is a refresher course near you.

[andrea1994]

1. Be honest with your employer.
2. Do an Internet search for possibilities.
3. Pick up a book on pediatric assessments.
4. Check to see if there is a refresher course near you.

Please explain the 'be honest with your employer.' You must be aware you don't say certain things or risk losing your job. You do realize that at this time there are many out of work and there is one better or one worse than you. 2 through 4 is exactly what I said on my own. Unfortunately, you didn't shed any light.

[Frankreich]

Please explain the 'be honest with your employer.' You must be aware you don't say certain things or risk losing your job. You do realize that at this time there are many out of work and there is one better or one worse than you. 2 through 4 is exactly what I said on my own. Unfortunately, you didn't shed any light.

If my specialty for the last few years was let's say orthopedics I would not accept a position working in OB or expect to be offered one.

If I interviewed with a potential new employer I would be honest and discuss my current clinical skills.

Yes, there may be "one better or worse than me" but morally and ethically you need to work within your knowledge base. Not to do so would be a dis-service to your patients, the healthcare facility you work for and yourself.

To work in an area that you are not prepared for because of financial reasons is fraud.

As far as shedding light I agreed with your other options. That's what you were looking for validation. My opinion.

[Button2cute]

Hello,

I would do a lot of observations (on my own prior to applying) and/or intership in a pediatric unit or medical facility.

Check in your area for a pediatric facilities and speak to the director for intership. This will give you the basic foundation and clinical skills of working in a pediatric unit.

Do you know anyone of importance in the field? If so, pull your strings and get into the unit and learn.

Sit in several pediatric classes for nurses, nurse practitioner, or physician assistance. Someone gave you a great ideal by looking on the internet.

A. This is Free sign up before the end of august. http://www.pearlsreview.com/Pediatri...-Lectures.aspx

B. American Academy for Pediatrics (AAP) Developmental Stages
http://www.aap.org/healthtopics/stages.cfm#early

C. Plotting Pediatric Growth Percentiles
http://www.accd.edu/SAC/NURSING/math/plotting.html

D. General Pediatrics
http://www.generalpediatrics.com/

E. Pediatrics Web Based Curriculum - Virtual Preceptor
http://wbc.babiespeds.org/logon.php?redir_url=index.php

F. Welcome to COMSEP: Educational Resources: Multimedia Teaching Resources
1. COMSEP Curriculum Support Resources: CLPP, Pediatric Physical Examination Projective
L.I.V.E.
http://www.comsep.org/EducationalRes...iaTeaching.htm

Those are several examples of resources found on the internet.

[squirt70]

If I were you I would watch your back big time.. try to find out what you can on your own. trust no one until you are under contract.. nursing is cutthroat now more than ever.. read is the best look up what you can.. find ou of there is a refresher course but do not go in to management and tell them you do not know.

[bunnymomjulie]

I am in CA and have been out of practice since 1999, although I still maintain an active license. I am disgusted to see many search results on the internet for IMMIGRANT RN re-entry programs, but NONE for someone like me. Has anyone had any luck in CA with re-entry?

[Edson!]

I agree with FrankR and others. Really you need to be honest in order to get more "precepting" experience. Did you not have a strong peds background before you came back in? If you had, after a couple of weeks and the nerve issues, your confidence should come right back. Not saying that you will feel overly confident, for really no nurse should--especially with kids and babies in my view. They just turn on your too darn fast. You may often not get the progressive warnings over time that say you may see in adult patients. Fine one second, down the tubes the next. Really it can be quite scary at times.

A number of children's hospitals will take in new grads, so you may find you can get in with them as well. You just really, really have to zip your mouth up and learn and, well, do what you are told. Hate to say it, but that is a big part of it--at least in the beginning. It takes time for people to feel confident with your practice in the adult world--it is like 2 to 3 tiimes that in the pediatric world many times. Usually it is for good reason, and you can't take it personally. Find a children's hospital that will take you into their orientation and preceptor program for a particular area of pediatrics. You may not make the money that you feel you should. When I went into pediatric's critical care, I took a significant pay cut. And you have to accpept that you will either have to work full-time nights or full-time day/night rotation--they may work with you for say 32 hours per week or so; but with being out of nursing and not being strong in pediatrics, don't bet on them going much below that. Best bet is to take a full-time position, accept the off-shifts (frequent), you may not even get every third weekend if you work 12 hour shifts. (If the children's hospital feels it's wonderful, and you will take what you get or else, well, that is their culture-set, and you have to work within it.) You also have to be prepared to face the fact that you may submitt you vacation time for approval many, many times before and in some cases "IF" you do get approved for your time.

In many of these places, especially if they are really big and renowned, if you want to be a long-timer there, well you have to deal with this sort of thing for literally years before things may change. They do b/c they can, and/or they need to , and b/c I think they want those that have decided to stick it out and make the longer-term commitment there to receive more of the cream and incentives for the commitment. At least this is what I 've seen. I am not judging it one way or another; I am just trying to give you a heads up about the culture--plus, it is generally a much younger crowd--nurses in their young 20's.

If you can deal with that culture and all it may or may not entail, well, definitely go for it. A lot of folks after 30 however aren't always up for that kind of culture. But if you can accomodate to get the experience, that's fine. Just know what you may be getting into ahead of time.

If you are near a strong children's hospital, I recommend you get an interview and go and check it out. They will watch you like a hawk in the first few months or so, and really it is for good reason--even though there always seem to be some people that can really start trippin in such roles. But learn what you can about the position, the assessment and nursing process skills required--the developmental issues in dealing with children as well as their families. Remember, you are not just working with kids. You must relate well with all kinds of families, and these places are 24/7 family-centered care, which personally I didn't usually have a problem with--except for some parents that are just way out there in left field. LOL In fact, I am open to family-centered care for all age groups, adults included--so long as there is respectfulness and no one is harming or interfering with the care of the patient. My point is, just b/c you are dealing with kids does NOT mean you won't be dealing with adults--and dealing with and teaching them a lot. You will be. And some can hover like nobody's business, while others can be abusive, while others can be, well, I'll just say down right "unusual." Usually even the unusual ones I get along with, b/c I try to accept them as they are realistically. Often you have to work with what you have, so to speak.

Anyway, it is an adventure. Just be sure to go somewhere that will take the time to give you a thorough preceptorship--and I'll add this, though realistically it isn't as prevalent throughout nursing as I feel it should be. That is, find out about how you are evaluated--what kind of tools are there in place--how much is based on more objective measures versus subjective measures. This is huge to me, and it is a huge problem in nursing IMHO.


In order to do right for your patients and to feel a wise level of confidence in practice, you really need some strong precepting. In order to get this, you have to be frank with your manager. And I believe this is what Frankr is talking about. If they like you, generally they will give you the extra time needed to grow. Yes, there is quite an economic crunch right now. But really what I have found in nursing is that a lot of your success will depend on whether your managers and others in the unit like you--believe it or not. You would think competence and knowledge and critical thinking and experience would rate higher. . .but nope. Often, especially in peds, what I have found is much of it is all about, of all things, being well-liked. And usually that means being very, very quiet and never getting more attention than those that have been there. Not always so. . .but often enough. . . yep, it's true. It's hard to be low profile enough, while progressively growing in accpetance and showing that you really do have much to contribute. As a female, IMHO, you have to be careful with this balance. I find it may be a bit easier for men in these settings. This is only what I've witnessed--my experience. The females can get, well honstly, catty and controlling over the attention. So you have to show competence but be quiet and wait to show your expertise as you have developed it--and you must be careful to do so at the right time, in the right place, in the right manner, and with the right people, etc. It's tricky.

Personally I like working with an open, forthright crowd of folks that aren't all hyped up on being the center of attention but work together with others and not in an exclusive cliquish manner or by way of factions. I prefer more of a coalition culture. I do best in coalition environments. I think this is the most professional and collegiate model for practice. It's not as easy to find or develop as one might hope.

Anyway, Good luck.

[Button2cute]

Hello,

Follow-up:
Andrea, what is your status now?

Recently, I found out by an instructor that re-entry nurses are treated as graduated nurses from a nursing program by many hospitals. A re-entry nurse may be hire in area of choice or the need of the hospital and work with a preceptor. The re-entry nurse will have a probationary period to learn the skills, knowledge and expectation of the position in a certain amount time. Then the re-entry nurse will be told after probationary period if hire or not. Therefore, a re-entry nurse will be given the time to learn on the job like the non-experience graduate nurse from a nursing program.

There is a light at the end of the tunnel. There is an opportunity for you to receive a position with guidance by a preceptor and probationary period for you to learn your task in the specific area.
Andrea, take the offer if given an opportunity by an employer. The employer will be able to see on your CV or Resume’ the re-entry to the career and during the interview prior of hiring. The employer will understand your status and see cheap $ to obtain your services, too.

[Edson!]

I disagree Button. Re-entry nurses are NOT treated as graduate nurses. They are assessed on an individual basis. It all depends on many factors--and primarily what is the overall background and strength of the experienced "re-entering" nurse. It's apples and oranges for any nurse with strong experience that has merely been away for a while. Not the same as a GN, at all.

They might use that to try to talk down the re-entering nurse's salary.

Every new hire is given a probationary period, period. Generally each place determines what they will allow the learning (or re-acclimating time) to be for the particular nurse--unless specified otherwise after they are in a union contract.

I believe the OP needs advice specific to the OP's particular situation. I would recommend trying to talk to the nurse career advisor here, Donna Cardillo. Every person's situation and needs are different.

[Button2cute]

Edson,

I agree with your post, too.

Every situation and individual is different and hospitals will talk down the salary for the re-entry nurse. That is business today and everyone wants something for cheap. (I am an advocate for nursing students to take two courses in business of understanding the business world and how to negotiate their salaries.)

Unfortunately, sometimes one must make a decision in a give or take situation with the lack of experience - to go for the experience/less salary or to go for the experience/same amount salary for the yrs of possessing a nurse licensing & having the same salary as a RN working in the same area for X number of yrs.

Edson, it is a challenge either way and it does depend on which hospital one encounters (hospital treating re-entry nurses and GN nurses the same or hospitals that do not and hospitals looking at each re-entry nurse individually).

Edson, here's a situation and tell me your thoughts....

Nurse X is applying to Edison Hospital as a Nurse Manager/Nurse Supervisor. Nurse X has possess the BSN, five yrs experience of floor nursing and meets the criteria for the position. Nurse X is a re-entry nurse after three years and you are interviewing her. You asked Nurse X the reason for the three year absent from the workforce as a nurse. Nurse X explains the question is violate the employee rights but I am going to respond by the following: During my three years absent, I maintain my CEUs, attending seminars and conferences for my specialties. I was indirectly involved with my specialty parse and not in the acute setting. I have learned and increased my knowledge and skills in a different entity of my specialty. I am valuable to those who have worked those three years during my absence as I have learned new information to share with my coworkers in the specialty.

What would you are your thoughts?

These are some challenges employers of acute, clinic, intermediates and other employment settings will be facing with some re-entries nurses.
(If the health care reform goes through…POSSIBLY nurses’ jobs will be reduce and the lowest on the pole will go first as well as the highest paid MAYBE. Then this will be a hypothetical situation in reality.)

[Edson!]

I'm not really sure. But I will say it is beyond stupid and a major smack to treat a nurse, with say strong clinical experience over many years, as a GN b/c he or she is now in re-entry mode. It's nonsense.

They put GN's in all kinds of positions. Nowadays they justifiy with some kind of internship that is glorified precepting/orientation and the addition of stuff that is generally unfamiliar to GNs. They make it seem like it costs them so much. They have ways of writing around it. The bottom line is they are reserving those positions for a select few upon temporarily lifted hiring freezes--this all in order to get the cheapest nurses in there. Plus they add idiotic stuff like, we "trained him/her 'just' the way we want them," and "They don't have anything to 'unlearn.'" It is generally stupid and rather nauseating. It's a game that has saving bucks as its bottom line, period. And to them there is added value many times with things like:

intimidatation regarding things like scheduling

no peeping about working off-shift/s

assignment dumps, etc

Face it. It's much easily to push most GNs around--especially in the first year or so--and especially in this market. I can say that I've seen this first hand.

I don't mean to make places seem all so sinister; but this kind of thing does happen more than a little.

The bottom line is still to get the cheapest nurses. A number of places have loved the savings they get on picking up foreign nurses. Yes, they get various breaks with that.

And since even the GN spots are limited due to very strict boundaries on their hiring freezes, they will tend to take the following more often:

High GPA
BSN,
younger--b/c many of them will not just yet be opening up their childbearing years. As some go out by way of attrition, one way or the other, just hire more new grads. The longer you keep someone without breaks in perpetual employment, the more you have to increase salary over time. Well limit that by opting for those with a good chance of attrition---if they don't stop entirely, they will try to go to PT or per diem. Still cheaper.

So watch why they don't have anywhere near the job fairs that they used to. Sure it's the economic state of affairs. But also along with that, what they do is centralize their HR focus on to be GNs from four year universities and such.
They don't advertise big on these--that money is saved too. They post it university in-house. You have to find out which universities with nursing programs are having job fairs for them. Then you have to be able to get in. And then of course, should they find out you are not a GN-to-be, it may depend on how things roll. I personally haven't tried t his approach. Maybe it's my general disgust with the whole situation. But it has come to mind. Maybe one day I'll crash one of these, hushed, "in-house" only university events--just for kicks and curiosity.

And is there a role more closed than that of the HR person's. I mean really their function is to act as an employment bouncer or ticket checker/clicker. The ticket has to say "cheap GN or experienced nurse, non-stop, under 10 years--if their GN internships aren't open for budgeting at the particular time. If you get too far a head of 10 years, well, in general, you may have to pay them more--or offer than less and see what happens; but it may not be worth it since many experienced nurses will say, "Oh come on." (Well, they probably won't verbalize that, but you know what I mean.) Then there is behind the scenes nonsense from one HR person, that happens to run in similar HR circles, to the other. The games. . .and who is the wiser? I sort of feel sorry for HR. Their's is a dispicable game-playing job. I can't say I would care for the role myself. Personally I preferred the days when you didn't have to deal with these go-betweens, and you petitioned the NM, interviewed w/ him or her directly and got the job. But you know, HR has it's marching orders, and they include keeping the salary amounts down--and whatever that entails.

Here's the other reality. In general, nurses, Magnet status or not, do not bring direct revenue into the hospital. As such they continue to be viewed as somewhat limited and disposable.

squirt speaks truth too: nursing has become not merely more competitive. It has become even more cut throat than ever. And on the inside, there can be all kinds of games going on--from staff through NM on up to the top. The higher you go, the more it is about someone trying to climb or make a name for himself or herself. So, I take off the white noise when they talk about "teamwork," etc. Because when the noise blocker is off, you can hear the truth. When the rose colored glasses come off, you can see the truth. It's about people trying to climb and get ahead in nusing anymore. It's about people trying to make names for themselves. The patient REALLY isn't always number one, except as it looks good for certain folks. There was a time when true nurse advocacy meant something--not just for patients but for nurses to and with other nurses.

All these games are going to jump up to bite these places in the butt; but I do kind of understand the major crunch they are feeling right now, economically speaking.

If there is some decent recovery, more nurses will feel free to retire, and more nurses will feel freer to move into other options. When the full impact of that hits these places, along with other inescapable factors, all those positions that they have torn down from displaying will be there in multiples of multiples. If they are not careful, it is going to hit them really hard eventually. But modern economics has little to do with planning or looking ahead a bit into the future.

My view is, as the government gets more control, the standards will drop, b/c competition will be less, and there will be less money for trying to be "the top." You need feed-in for competition. That may level off the upcoming nursing crisis--but perhaps only to a point.

I think it is a good time to explore steps toward getting out of nursing entirely--or at least going into options that may be further removed from the current cut-throat nonsense and other not-so-pretty things to come.

To me, at this point, it has become very difficult to encourage people from pursuing nursing. And I've recruited a fair number of students from a sense of trying to be encouraging to the them, as well as from my passion for certain aspects of nursing. It's tough to try to keep that up now--FOR them or from my perspective. It just doesn't seem like the a top field to go into anymore.

And salaries will freeze or in some cases go down. Benefits will continue to drop off. And the negativity and lack of truly collegial support along with all these things are getting worse. I can't muster the passion in class for them as much anymore. I don't bad-mouth it to them; but I can't justify the energetic position and rallying I used to make for nusing.

I can't help it at this point. Without jobs and the selection that there used to be--all the internal and external games, the games of adminin/managers/support-manager/ and the HR specialist/manager games,--all of it has made me quite queasy.

[Edson!]

You know, it was one thing when nurses had more places to go. But with such limitations for mobility, I feel like we are relegating nurses to "professional" prisons.

We also are producing a huge class of butt-kissing nurses that are glad to put nurse advocacy on the back burner for the sake of their jobs and possible promotion. Along with that, we are producing nurses that will one-up or knock down a fellow nurse in order to get a leg up faster than any of us can say NCLEX. Nurses are more and more collusive with each other against other nurses. It's horrible. The whole concept of teamwork is a farse--it may be present, but selectively so.

This is not what it was when I entered the field. Advocacy was number one. And it's even more than that. Yes, you needed to be bright--not a genius necessarily. But you needed to be seen as a person of genuine compassion and empathy along with the ability to think things through. It wasn't a matter of one or the other--the so called "dumb or less critically-thinking nurse" that was more compassionate versus the sharp, truly bright and quick-thinking nurse that knew empathy was something that was supposed to be there--but it just gets in the way.

For many it was a matter of both of these coalescing. It was a matter of having both and making it work for the patients and for each other. I miss working with people that really, deeply care about what's best for the patients and that also deeply cared about each other--not just what the other person could do for them so that they could get ahead. I miss real teamwork and true support in nursing from the top down.

Not too long ago I heard a recently graduated nurse reply to a question at a party that was a joke. It was as to whether or not she would wipe his feces-soiled crack if he were sick. Now, OK, the guy is a jabber. And he was drunk. So, you know, you do have to laugh off some stupid comments. Still, she was quite serious in her reply.

She stated, "No. That job is for the nurse's aides."

Personally for me, feces, urine, vomit, and blood spurting have been the least stressful components of my role as a critical care nurse. And for various reasons, I've been hit by more blood than I've cared to be hit with. Nonetheless, with techs or aids or not, I've always tried to work as a team and never took the whole, "Ill dump that duty on to the tech or aid" or someone else. Sure I've had to prioritize. But when I have time or can honestly make time, I'm not too damn important or good to get in there and help provide for the basic care of a patient in need.

I was offended by her comment. This new nurse was serious and stone-cold sober. My thoughts were that one day she is going to be in a crises and a family member is going to be screaming about his mother or dad or son or whatever and the particular condition of basic needs. Then she is going to realize how that stupid attitude has screwed her over--or sadly, maybe she won't. But she's going to run her butt off and then try to figure out how to get in there and roll that patient over with no to minimal help by herself, while people are screaming on the phone for her--the blood bank has yet another problem and she's already way behind the eight ball with the other patient's hgb and other issues. She ll run from code to quazi-code from pre-code state to hurried, and the "are my meds behind?" state. She will be wondering how she is ever going to catch up on all of her documentation--computer and otherwise. And then that family member that for some reason can't move his/her son or daughter will be angry and tearing up and complaining. And the aides and others she has alienated are somehow nowhere to be found.
And if she is really lucky, she will remember what it is to be human and in need, if she ever really knew what that was in the first place.

Or maybe one day she will not be there and she will have to think about the unnecessary discomfort and dehumanization that her loved one went through--or one day it will be her, alone, calling out, waiting. . .

I really wanted to say to this person, "If you think you are too good and you have minimal empathy, get the hell out of the field. It's about the patients and their needs."
She wouldn't have really "heard" it. More's the pity. But I would not be surprised if I saw her in at least midlevel admin position one day. She has all the currently desireable tools for gameplaying that are needed to climb up the ladder. The tragedy is that really excellent managers end up leaving or are pushed out b/c they have brain, compassion, and a real sense of fairplay. I hate to see this, but this too I've seen often enough over the year.

[NurseEducator]

Several suggestions: How about calling your university and asking if you could sit in a assessment course or skills day? Talk to an educator at the facility for help. There are some good videos/DVDs out by Springhouse and Lippincott. Ask a physician or Nurse PRactioner to mentor you to let you do some assessments with them at their practice. Volunteer at a local indigent clinic explaining your needs as well. Take an assessment refresher.