1. Chapter 14 Beginning 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 résumé via:
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 Wages
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

51. Political Process
Share your opinions and recommendations with your legislators
Affect the political process by:
Voting
Lobbying
Negotiating
Demonstrating
Keeping informed

52. Collective Bargaining
Nurses’ and health care workers’ unions
Represent nurses
Bargain with employers
Reach agreements acceptable to both sides
Work for the benefit of members
Joining a union is a personal choice

53. Grievances Handle grievances through the proper channels and protocols
Learn the process used at your institution or place of employment

54. Question Is the following statement true or false?
Most jobs are found through employment agencies.

55. Answer
False
Rationale: Most jobs are found through personal contact.

56. Question Employers expect employees to:
Earn the maximum salary for their level of education
Work mandatory overtime in all states
Complete assignments within a reasonable period of time
D. Know how to perform all skills

57. Answer C. Complete assignments within a reasonable period of time
Rationale: Employees should expect to earn the maximum salary for their level of education and experience. Some states restrict nurses from mandatory overtime. Employers expect you to ask for assistance if you do not know how to perform a skill.

58. Question Is the following statement true or false?
First impressions are not as important as how you answer interview questions.

59. Answer
False
Rationale: First impressions are very important and it is not easy to overcome a negative one.

60. Question
Prospective employers may not ask the following question during an interview:
Your education
Your age
Your volunteer experience
Your career goals

61. Answer
B. Your age
Rationale: Employers may not discriminate against an employee due to age.