Mother Teresa of Calcutta once said, “Let us touch the dying, the poor, the lonely and the unwanted according to the graces we have received and let us not be ashamed or slow to do the humble work.” This quote came to mind after reading a question posted by Julie on NursingVoices. Here is Julie’s post:

“I am a second year BScN nursing student and have my first single client focus. My client is on palliative care and I am hoping to expand my knowledge and therapeutic communication skills of clients on end of life measures. Any opinions, advice or information would be greatly appreciated.

Thanks so much, Julie”

Julie’s question isn’t unique. Nurses have been struggling with the issues surrounding palliative care for a long time. It’s hard to know what to say to someone who is dying. Palliative care focuses on the comprehensive physical, psychosocial, emotional, and spiritual care of terminally ill patients and their families. In the United States, hospice nurses provide care primarily under the guidelines of the Medicare Benefit Act of 1983, a federal program that allows patients to die in their homes, with their families and friends at their side. According to a recent Gallup poll, more than 90 percent of Americans wish to be in their own homes or in a homelike setting when they die.

The first step in caring for the terminally ill is to become aware of your own feelings about death and dying. The dying patient becomes a symbol of what awaits each of us at the end of our life. You will become more emotionally available to your dying patient once you embrace your own mortality.

The ability to communicate with a terminally ill patient hinges on a nurse’s knowledge of the five stages of death and dying as described by Dr. Elisabeth Kübler-Ross in her book, On Death and Dying. The five stages go in progression through denial, anger, bargaining, depression, and acceptance. This knowledge will enhance your ability to understand what your patient is going through. You must also understand that your actions speak louder than words. Sit down when your patient is talking to you. This shows empathy, and it shows that you really want to hear what your patient is saying to you. Speak from your heart, but also understand that sometimes the best thing to say is nothing at all. Sit and listen quietly if your patient wants to talk.

I’ve cared for many terminally ill patients throughout my nursing career and most of them have told me that they were afraid of dying alone or in agonizing pain. I would hold their hand and tell them that I was going to do everything in your power to make sure that they will not die alone or in pain. Taking care of a dying patient can be a spiritual experience. Please join us at NursingVoices. and share your experience with us. We’re waiting to hear from you.

Some things never change. The sun rises in the east, sets in the west, and nurses eat their young. Seriously, there are some days when nurses get so catty with each other, I just want to put out a saucer of milk at the nursing station and call it a day. I’ve been getting a lot of questions and comments lately from new nurses about lateral violence in the workplace. This letter caught my attention:

Hello, I am new to this blog. I barely know what a blog is. I am a brand new LPN. I am also a Trans woman (I don’t like the terms “Transgendered” or “Transsexual”). I have already lost my first nursing job, there were some very nasty nurses there, but some really nice ones too. I am pretty naive, and I trust people, I do my work, and don’t have time for “politics” or shenanigans. I was a manager in another profession for 20 years, and I never experienced anything like this… I think I need some advice from my colleagues out there…

Thanks, Nickie

Dear Nickie:

Lateral violence is a very serious problem because it is insidious, costly, and it drives talented nurses out of the profession. It has also been linked to high nursing turnover, increased illness and absenteeism, and lower quality of patient care.

Researchers have come up with few reasons why some nurses engage in psychological harassment against new nurse, as well as seasoned nurses in the workplace. One theory suggests that nurses use verbal abuse, exclusion, unfair work assignments, intimidation, and other forms of psychological harassment against their colleagues because they feel powerless in their work environment. Nurses are given little control over their work environment while being held responsible for everything that happens on the unit. Most angry nurses are unable to confront their oppressors (hospital administrators), so they take their frustration out on individuals with lesser status. That means that new graduate nurses catch most of the flack. Is it fair? No, it’s not, but it happens all of the time. Lateral violence is symptomatic of unhealthy organizational dynamics.

Martha Griffin, RN, PhD, clinical specialist and program coordinator of nursing professional development at Brigham and Women’s Hospital in Boston spearheaded a research project about nurse on nurse violence, and she’s come up with some ideas on how to respond to peers that are engaging in this type of destructive behavior. Griffin says that communication and confronting passive-aggressive behavior are key components to solving nurse on nurse violence in the workplace. You can learn more about Griffin’s research in this article published by Nursing Spectrum Magazine.

I also think that there are deeper, more insidious things going on in your situation. Unit bullies are notorious for going after people who look different, hold different beliefs, or who live an alternative lifestyle. Many years ago, a nurse manager berated one of my gay nursing colleagues because of his sexual preference. This incident happened in front of at least three witnesses. None of the witnesses could believe what they were seeing. My friend took action. He filed a complaint with state and federal agencies, and the hospital dismissed the nurse manager. Know your rights under the law, and take action if you feel that you are a victim of lateral violence in the workplace.

Do you have advice for nurses taunted at work, or are you a victim of lateral violence in the workplace? Come and join the conversation at NursingVoices. We need to hear your voice now.

I remember my days back in nursing school. The curriculum was tough and the teachers were even tougher. Many of my friends dropped out of school when things got too stressful. My desire to become a nurse was my lifeline, and it was all that helped me make it through nursing school. A reader at NursingVoices recently asked a question regarding our country’s tough economic climate and the nursing profession. She asked:

Here I am, changing my whole life around at the age of 47. I need some advice and some encouragement! I don’t know how to make the story short and comprehensive, so let’s just say I’ve had it pretty good financially for years and years, but we are now on hard times and being in sales just doesn’t fulfill.

Last year, I was fired. I thought to myself (after crying and stomping and moping) “what a great opportunity to change my life!” So, took my savings, prettied up the house and prepared to sell, move and simplify our lives. $170K to 0K in one day.

After 8 months and only $20K left in savings, I knew I had to get back to work to stop the financial bleeding. I also knew I couldn’t afford to stay in the house any longer and if I were going to move, better do it now. I am anxious to get the most marketable, lucrative AND rewarding degree in the shortest amount of time possible. BUT our circumstance will no doubt require that I still produce income during the study. Unless the study itself is just tedious and time-consuming, I think I would be able to do both. That is, unless this reference to clinical time is the time consuming aspect of the study course. We are making it by the skin of our teeth (haven’t been this bad off since after the second child was born!) I am sincerely open to any and all advice on how to pull this off financially.

Sincerely, Too Old to Start Over

Dear Too Old:

Nursing is a great career, but don’t go into it just for the money. If you do, you probably will wash out of the profession. Students spend an enormous amount of time and energy studying for their classes and preparing for clinical, and it’s nearly impossible to get through school while you are working a fulltime job. The only people that I know who have been able to do both were driven by their desire to become a nurse.

There is also a popular belief that nursing is a bulletproof career during hard times, but nothing is further from the truth. There have been times in the past when nurses couldn’t find work. Yes, there is a nursing shortage, but that doesn’t mean that employers are hiring nurses when the economy is going belly up.

During the last big recession, I was laid off from my job as a surgical nurse because people stopped coming to the hospital when they became unemployed and lost their health insurance. The hospital closed my unit and combined surgical and medical patients into one unit. I’ll never forget how the hospital administrators told us they were going to close our unit. I came to work, and was given an ice cream sundae along with my pink slip - nice touch! I’m sorry to sound so negative, but I’m just giving you food for thought.

My advice is to go for it if you really want to become a nurse, but go for it for the right reasons. Many nursing scholarships are available to people that need some help paying their way through school. Good luck!

Come to NursingVoices to ask for advice about your nursing career. We’re waiting to hear from you.

As an old veteran, graduate nurses who are entering into the profession frequently ask me for advice. A newly minted graduate nurse asked the following question on NursingVoices:

“I am about to graduate in December from an ADN program and now I am beginning to wonder if it is wise to take a position as a Graduate Nurse and then take the boards. Or, should I take the boards and pass before I take a position anywhere?“

There is nothing like old fashion experience to help a new graduate nurse get ready for their nursing NCLEX. I advise new nurses to immediately line up a nursing job so they can jump right into nursing after they get out of school. Most hospitals offer extended hospital orientation programs for new graduate nurses, as well as other opportunities, such as nursing intern. Nursing internship programs provide the novice nurse with the knowledge base and skill sets needed to transition into the real world of nursing. This helps new graduates gain nursing competence in a clinical setting while preparing for their state boards. Nursing internship programs also teach new nurses how to work collaboratively within a multidisciplinary team. The programs serve as a bridge that fills the gap between undergraduate education and real life professional nursing practice. Working as a nurse is stressful, and hospitals are doing whatever they can to help new graduates avoid real-world culture shock and burnout.

Good hospital orientation and nursing internship programs last at least 6- to 12-months. These programs are designed to help new nurses feel less overwhelmed as they enter the real world of nursing. A preceptor and a new nurse work in a buddy system. This allows the new nurse to gain experience while building his or her confidence in the workplace. The ultimate goal of the preceptor is to teach their partner how to apply nursing theory at the patient bedside. This experience is invaluable to anyone who is preparing to take his or her state boards. Nurses who work in hospitals also get many other benefits such as tuition reimbursement for academic advancement, tuition for CPR, PALS, and other certification programs, and monetary rewards for receiving specialty certification or academic advancement.

The best way to prepare for the nursing boards is to dive right into nursing. If you’re still looking for your first job, check out NursingJobs.org. Moreover, if you’re a new graduate nurse who needs some advice, come talk to the nurses at NursingVoices. You can always find someone there who understands what you’re going through. We want to hear from you.

I collect campaign pins, and this is my favorite pin from my collection. Its simple message says it all. There are two schools of thought about nurses and politics. Some nurses believe that members of our profession must remain completely neutral in the political arena. They believe that getting involved in the dirty business of politics will put the profession in a bad light. I believe, however, that it is our duty to fight for patient rights. It’s time for nurses to hit the streets during this election year and take action.

I’m not going to tell you what to think, or who to vote for during this election. What I am going to tell you is how to help the candidate of your choice. The first thing you can do is roll up your sleeves. Candidates need volunteers to staff phone banks, help with mailing lists, attend political rallies, and canvas neighborhoods. I was 14 years old when I started volunteering, and campaigns always found things for me to do. If a kid can get involved, so can you.

Money greases the wheels of politics and campaigns are always looking for donors. I really encourage nurses to make individual campaign contributions and donate to a political action committee (PAC). A PAC is a powerful tool in nurses’ arsenal to improve America’s ailing health care system and promote the nursing profession. PACs raise and spend money to help elect or defeat candidates running for public office. They serve to educate lawmakers about health care issues affecting patients, and they make direct political contributions to candidates who support a specific cause. Many nursing PACs routinely contribute to nurses who are running for political office. Do you know that there are three nurses currently serving in Congress? PACs receive funding from supporters and, while PACs may solicit only their organization members for donations, anyone may give to a PAC. Nursing PACs serve a vital role in the development of health care policy, and they are a collective way in which individuals can influence campaigns in the form of financial donations.

What impact can nurses have during this political season? We have a lot of power because there are so many of us in the profession. $5 and $10 checks add up, and any amount of money donated to a candidate is important. When nurses become financially involved in candidates, they’re putting a personal stake in those individuals. I’ve had the good fortune of meeting all the nurses currently in Congress, and they all told me that they are especially grateful to all nursing PACs for their financial support.

I live by this motto: Registered Nurse, Registered Vote. Stand up for what you believe in. Make a contribution and vote for the candidate of your choice. Discuss current political events that affect the nursing profession at www.NursingVoices.com.

A reader posted this question a couple of weeks ago. She wants to know why her former place of employment won’t rehire her. Here’s her question:

I graduated nursing school in 2005. I passed my boards the second time I took them. I began a job at a local hospital. I went and took my test the first time and failed. I returned for my shift the following day. I knew I failed. My nurse manager ask me why did I even come in. My response was “I am on the schedule.” She then told me to come to her office. She then terminated position for RN she gave me. I did pass the second time but how she treated me really crushed me. She is no longer at that hospital. My status is rehirable but every time I submit my app no response. Please advise.

Signed, Disappointed.

Dear Disappointed:

Don’t take these events personally. It’s unfortunate, but getting rehired in your former place of employment has a lot to do with the past relationship that you had with your ex-boss. It’s not always fair, but that’s just how it works. Your boss doesn’t sound like he or she had many people skills and I’m sure that you aren’t the only qualified staff member that he or she ran out the door. Sometimes leaving a job full of negativity is a good career move and you should never look back.
However, if you really want your job back, here are some things that you can do that will improve your chances for getting rehired.

Updating your resume is an important first step when you start looking for a new job, especially a job in your former place of employment. Make sure that you highlight your unique nursing skills, experience, and nursing education. Don’t send out your resume with a generic cover letter. Also make sure that your cover letter is tailored to the position that you want.

Plan to eat crow. Go back and look up all the people that you may have hurt or offended when you worked in your former position.

Network with your former coworkers, and ask them to scope out job opportunities that might be right for you. Focus on people who saw you as a good worker, and ask them to put in a good word for you when you apply for a new job. Find out if your old boss is still employed at the hospital. Many times bad managers are asked to leave, which leaves the door open for former employees to return.

If all else fails, go to human resources and ask what’s been happening with your applications. Frankly, you may not get the truth, but at least you can get a better feel for what’s going on.

Good luck with your job hunt.

If you’re looking for a new job, come talk about it at NursingVoices. We want to hear from you!

I don’t know too many health care professionals who couldn’t sit down and write a book about their job. After all, we have a ringside seat to one of the greatest shows on earth. Now, with the advent of blogging and social networking sites like Facebook, many health care professionals are bypassing book publishers and are taking their stories straight to the Internet. Blogging and having “friends” can be a lot of fun, but remember, what you put out on the Internet can affect your career.

Here’s a case in point. I just read a story today about a Swedish nurse who used her cell phone to take pictures of surgical procedures, and then published them on her Facebook page. Apparently, she did it because she wanted to impress her high-powered Facebook friends. Her employer wasn’t impressed, and now the nurse is facing dire consequences for her actions. An investigation is underway and her employer will decide whether to fire her or turn her over to the police. She’s in deep trouble. Cameras are banned from operating rooms unless the pictures are specifically intended to be used medical research, and for educational purposes. More importantly, she violated patient confidentiality.

Other cases illustrate the pitfalls of writing about what’s going on at work. The blogosphere was buzzing when Dr. Robert P. Lindeman settled a malpractice lawsuit after opposing counsel outed him on the witness stand as Flea, the author of drfleablog. Lindeman, a graduate of Yale University and Columbia University’s College of Physicians and Surgeons, had posted scathing entries on his blog about his trial, and his uncensored comments about lawyers, jurors, and the legal process ultimately sealed his fate. During an interview after the trial, Lindeman stated that this incident has had a huge impact of his professional and personal life — he said that his wife threatened to divorce him — and that he is never going to blog again.

There are certain things you must keep in mind when you write a blog. The first thing to remember is that you can be identified as the author of your blog, even if you write under a pseudonym. There are ways of tracking an author down, so be careful when you put your thoughts and feelings out on the Internet. Keep in mind that your boss and coworkers may be reading your posts. Check to see if your employer has a policy about blogging before you put up your first post. You must also protect patient confidentiality. Do not publish any identifying information such as names, specific times, places, or procedures, and never refer to an exact diagnosis. It’s always a good idea to post a disclaimer on your blog.

If you’re a blogger, or what to learn more about blogs, join the conversation at NursingVoices. We’re waiting to hear from you.

There is such a demand for nurses these days given the tremendous shortage that it’s becoming a very popular move for people to switch careers and go down the nursing path. Conservative estimates figure that there will be a shortage of almost 10,000 nurses within the next ten years which makes the switch a very attractive one for many people looking to change careers. However, there are always drawbacks to any thing that seems too good to be true. We’ve come up with a list of the pros and cons of a nursing career to help someone decide if this rewarding career is exactly for you…

The Pros:

Making a difference in people’s lives — This is the number one reward of being a nurse. You are being counted on to help improve people’s wellbeing and it is right there in the job description. When a sick person is in a position where they cannot take care of themselves they turn to caregivers that know all the tricks to improving their way of life.

Flexible scheduling — Many nurses are able to make a schedule that will work best for their families. Maybe the 9-5 routine doesn’t fit your needs, so you work a couple overnight and pull double shifts to free up your schedule later in the week. You can also choose what type of institution you work in. Do you want to work with the elderly? Apply to a nursing home. Do you love working with kids? Work in a pediatric section of a hospital.

The benefits are phenomenal — Working as a nurse provides you with a very comfortable salary. It’s worth it after three grueling years of post-baccalaureate study. Most institutions offer excellent healthcare benefits and retirement packages that make this career very appealing.

The Cons:

The stress can be overwhelming — The more you get attached to your patients the more difficult it is to deal with their suffering. Many nurses will talk about the burnout they feel after even a year or two in the field because of the recurring stress that comes with each and every patient that comes into your care.

Dealing with difficult people — You’re working with people that don’t feel well and it’s human nature for people in this position to be cranky and irritable. They may be the greatest people but they’re coming to you when the feel lousy and they can make your job much harder just because of their attitude.

There is no time to zone out — You know people that work in cubicles all day and surf the net and waste hours a day doing nothing at their jobs. This doesn’t happen when you’re a nurse. You have to be ready for anything at all times.

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This article is contributed by Heather Johnson, who regularly writes on online nursing schools. She invites your questions and writing job opportunities at her personal email address: heatherjohnson2323 at gmail dot com.

Look at these nursing students from the Capital City School of Nursing in Washington, D.C. In this picture, taken in 1933, these nursing students look calm, confident, and ready to face the world. I’m going to let you in on a little secret. These nursing students were worried, just like you are about passing their state nursing board examination. I got a headache and was sick to my stomach the day I took my boards. Are you nervous about taking the NCLEX-RN? Never fear. With a little preparation, you, too, can pass your test.

The NCLEX-RN tests your nursing knowledge, as well as your critical thinking skills. The test sounds overwhelming, but you can get ready for the test by purchasing a good book. There are many good study guidebooks available online. These books will help you become familiar with test content and format, and topics covered on the exam. Look for a book that includes at least two practice tests, detailed explanations of test answers, and in-depth analysis of NCLEX-RN exam questions.

Studying in a dedicated room of your home, free of distractions, will help you keep your learning materials in one place and will also help you keep in the routine of studying for your test. It’s important that you study everyday in a well lit area so you feel more confident when you take your exam. Study for an extended period and take short breaks. This will help you focus, and improve your ability to concentrate on the test day. It’s also fun to study with a partner. Study partners can keep you motivated, and they can make studying more enjoyable. Change study topics frequently to help keep the material fresh. Also, let friends and family members know what your study hours are so they can give you some breathing space while you prepare for your test.

Reading the answers in your study guide is a good way of preparing for the test, but don’t over analyze everything in the book. This practice will cause you more stress, and it’s counterproductive. It won’t help you prepare for the test. Read all of the answers when you take your practice tests, whether you got them right or not. This will help you understand the questions that you missed and reinforce in the information that you got right. Use flash cards and always keep them with you if you don’t have a lot of time to study. You can flip through them when you’re on the bus, riding the subway or while waiting in line at the grocery store.

Don’t freak out about taking the NCLEX. You’ve study hard while attending nursing school, and you know more than you think. You’ll get through your exam just like all the other nurses who came before you. Come to NursingVoices to find support while you prepare for your test. There are nurses waiting to give you advice and cheer you on as you enter the nursing profession.

It’s that time of year again when student nursing students start asking me for tips on how to get through nursing school. I received this letter from one of my readers.

I am a 25 year old who has decided to attend school and become a nurse. I started taking core courses back in high school, but I changed to computer science when I couldn’t get through my chemistry class. I currently have a degree in computer science and I am entering nursing school this fall. I couldn’t be happier about my decision to go back to school, but I’m really nervous. Could you give me some tips and advice about getting through nursing school?

Sincerely, Nervous Nursing Student

Dear Nervous,

Congratulations on your decision to become a nurse. You’ve chosen a great career. The next couple of years are going to be challenging, but not impossible, if you follow a few tips.

1. Nursing students don’t have to be perfect

Striving for excellence is an admirable quality in a nursing student, but remember, there is no such thing as absolute perfection. Don’t drive yourself crazy by trying to be the perfect nurse. Just take a deep breath and relax if you forget a lab value during clinical or you miss a question on a test. We all make mistakes and you’re going to make a lot of them while you’re in nursing school.

2. Learn to live in a dirty house when you are in nursing school

I hear you laughing, but the person who said that cleanliness was next to Godliness never attended nursing school. I’m not suggesting that you live in filth, but you need to use your cleaning time to hit the nursing books. So what if the laundry piles up? No one died from lack of clean clothes. Ask your family to pitch in and help with the household chores. Even small children can do their part by picking up their own toys. Lowering your housekeeping standards will help you keep your sanity while you are in nursing school.

3. Get organized before your first day of class

Nothing is as stressful as trying to pull yourself together for nursing school at the last minute. Don’t do it! Organization is the cornerstone of a successful nursing school experience. Get reliable childcare in place, and register for your classes early. Moreover, you may not get what you want if you wait until the last minute to sign up for you classes, and don’t forget to shop early for your nursing books. This not only cuts down your stress level, it will also save you money. Remember, finding a good deal takes time, so start shopping! My favorite online book vendor is NursingJobs.org.

4. Use simple study tools to help you study

Sure, I’d like to own the latest and greatest technology to help me get through my day, but sometimes simplicity is the key to studying for a test. Do you have trouble memorizing facts and statistics? There’s no need for a Palm Pilot when inexpensive note cards can help you remember facts about medications, lab values, and nursing protocols.

If you’re a nursing student with other tips about how to get through nursing school, come over to NursingVoices and tell us about it. We’re waiting to hear from you.