Nursepractitionerblog’s Weblog

by Heather Johnson

Not all nurses are content with a stationary job within a hospital or clinic. For those with a nomadic streak, it is a good idea to consider a career as a travel nurse practitioner. What is a travel nurse, you ask? This is a licensed nurse who takes short-term positions all over the country, filling in for vacancies almost like an office temp (albeit, a very well-trained temp).

Such a career choice may not be suited for everyone. Those with a family, of course, may not wish to be away from home constantly. In fact, some travel nurses don’t even have a permanent home anywhere. Rather, he/she rents temporary housing after arriving at each position. The typical travel nurse position lasts from 3 months to a year.

Initially, a travel nurse is brought to a facility in order to fill in for a nurse who has left or is on leave. After the position has been permanently filled or the previous nurse returns, the travel nurse will move on to the next job. In many cases, however, a travel nurse will get somewhat settled into the position and the employers will attempt to recruit the travel nurse for permanent placement.

For those who become a travel nurse in order to see the country, being recruited will not be appealing. However, being a travel nurse is also a great way to discover a permanent “dream” job. How would you like to be a nurse practitioner in Hawaii, perhaps? It is possible to put in a request for transfer to certain locations. Although positions won’t always be available, you will be shortlisted for a position there when one opens.

The best way to enter the world of travel nursing is by contacting a nurse recruiting company. This agency will actively find positions for the nurse, just like a run-of-the-mill temp agency. Be forewarned, however, that a nurse recruiter must be paid a fee. The fee may be worth the convenience of not having to search for jobs, however.

While travel nursing may not appeal to everyone, it can be a great way to find the perfect position or to see the country. Those looking for excitement and travel while pursuing a nursing career will probably be eager to look into this lifestyle choice. Sidebar: While each state has different requirements for nursing licenses, it should be noted that travel nurses could obtain temporary licenses that are valid up to a year.

Heather Johnson is a regular commentator on the subject of Online RN to MSN. She welcomes your feedback and potential job inquiries at heatherjohnson2323 at gmail dot com.

This is a rather broad question.  Although I have only been a nurse practitioner for less than a year, I think that it’s not as hard as I thought it would be.  The one thing that I do find is that I second guess myself constantly.  Even after I calculate a pediatric dosage twice and get the same number, I am finding myself calculating it again after the patient has left.  I hope that this will get better once I have done it for a while and become more familiar with it all.

Another thing that is surprising to me is that I am feeling guilty taking payment.  I think because I have been on the other side of the fence and know how much it costs, especially for cash patients or patients with deductible plans.  They pay an outrageous amount of money and take a day off of work only for me to tell them that they have a virus and need rest, fluids and symptom management which simply consists of over the counter medications.  Patients frequently feel that they have not “gotten their money’s worth” if they do not walk out with a prescription.  This has been a rather difficult issue to deal with.  I mean,  they can either do what I said above and get better in 7-10 days or take an antibiotic and get better in 7-10 days.  Same result either way, and risk of resistance if using an unnecessary antibiotic! This is actually much easier do deal with in adult patients versus pediatric patients with parents who insist on getting a prescription. 

So, back to the question:  Is it hard to be an NP?  I think some areas of it are and they’re probably different among different people.  I think that the hardest piece I’ve run into by far is selling “It’s a virus and you don’t need an antibiotic” .  So, for those of you getting out of school, work on your sales pitch ahead of time.  It will save you a lot of time later. 

I want to start writing based on what you all want to know.  So, if you will, please leave questions in the comments letting me know the things YOU want to know.  I’ll do my best to respond to all of them.  I’ll let you guys write in questions for about a week before I start answering them.

I’m back.  For real, now.  Sorry it has been so long. 

Okay, according to the search engine terms, several people are wondering what are some typical interview questions that have come up for me in my quest for a job.  As it’s almost my bedtime, I will list a few questions that I can remember that I’ve gotten.  I honestly don’t remember what some of my answers were, but the questions were pretty difficult to know on the fly.  So, study up!!

1.  What do you believe are the pillars of nursing?

2. Name a time when you have deviated from policy.

3. Name a time when you have gone above and beyond the call of duty for a patient and describe the outcome.  (I have gotten this question many many times!)

4. Name a time when you have encountered a difficult situation and how you rose to the occassion to resolve it.

5.  Name a time when you have encountered a difficult patient or coworker and how you were able to diffuse a difficult situation.

I will rack my brain and give you all even more questions as I think of them.  It is best to be as prepared as you can possibly be.  Keep in mind that these questions frequently come from more corporate and large organizations rather than solo practitioners who are mostly concerned with clinical competence.  Trust me, the clinical competence type of questions are FAR easier than are the “Name a time when….” questions. 

And Good Luck!!

The hospital that I worked at had a lot of patients with mental health problems in addition to the actual physical problems that they were being hospitalized for.  This made it extrememly difficult to have the “average” number of patients (7).  I was just thinking about how this patient who I had was a “swallower” and had to be one on one with a sitter in addition to having a nurse.  Nothing that was of size that could be swallowed could be in the room.  This patient had come in  because he had swallowed a pencil.  They attempted to get it out with endoscopy and could not, so they were forced to cut him open and SURPRISE!!  They found a watch, batteries, and coins.  This was not the first time that he had been opened up to retrieve objects. 

I believe it was that same night that I had the patient that tried to hit me in the head with a quad cane.  Yeah.  And it hurt.  He was at least sane enough to be scared when the security guys came up.  He thought he was going to jail.  I was able to give him medication (per dr’s order) to calm him down.  Haldol, that is.  We called it Vitamin H.  The vitamin that the insane folks were lacking.

I did not get the “job of my dreams”, but rather the job any new grad typically gets stuck with:  a night shift med surg floor.   But I needed to be employed as I was the only one working in the family.  The hospital was an older one that had double occupancy rooms and older equipment.  They did not have the automatic “nurse on a stick” that I was used to having while in school.  (this was a little skinny cart that had an automatic BP, temp, pulse, Oxygen saturation machine.)  This all had to be done manually (which I later found was far more accurate!)  But the one thing that this place had was a computer system.  Everything that I was used to writing out by hand could now be done in the computer.  I was impressed and a little intimidated too.  But I figured I’d get the hang of it quick enough.  Little did I know that the population of patients would be the thing I’d hate the most.

So, the day came to start the computer training.  I actually CRIED at the lunch break stating that I was either going to have to quit my job or get fired because I could not learn this freaking computer system.  My poor husband, scared, kept reassuring me that if I could make it through college, that I could probably learn their system.  Well, when I came back from the lunch break, there was this older nurse who was learning to transition to the computer system.  The instructor for the class said “Okay, take your mouse and click the black box on the screen.”  Well, the poor older lady picked up her mouse and put it up on the screen on the computer (literally) and began clicking it.  Everyone began to look after a long silence and the instructor trying to figure out what the hell she was doing!  After that, I KNEW I could learn this system!!

I finally graduated from nursing school with an Associate’s Degree (2 year degree).  I was ecstatic.  But now I had to find a job.  And wouldn’t you know that of all of the places that were experiencing a nursing shortage, I’d be in the one place that WASN’T having much of a shortage!!  Yeah, I interviewed for three jobs and got two out of three offers.  I ended up taking the third offer.  It was an hour and a half interview.  I got all kinds of wild questions which included:  “What do YOU think the pillars of nursing are?”  and “Tell me about a time when you have deviated from policy.”  Yeah.  Are these like trap questions or what?!  I bombed the first interview having no idea of how to answer these types of questions.  I don’t believe anything really prepared me for this part.   I wish that my school had given a one day seminar or something of the like to help us with interviewing. 

So, my first job was to work nights on a medical-surgical floor.  I swore up and down I was not going to work on a med-surg floor and I was CERTAINLY not going to work nights.  Guess what….I did both. 

Another patient that I had during my ICU clinical rotations was an older man who pretty much had one foot in the grave.  And the other one on a banana peel.  It was awfully sad as he did not have any family at all except one niece who lived far away and would call occassionally to see how he was doing.  It was my first experience witnessing death as it happened.  I was in the room when the old man passed.  It was so strange to see the flat line on the monitor and then take him off of the ventilator. 

A little while later, we began to clean him up, put a toe tag on him and then get the body bag ready to put him in.  Only, his chest started to move up and down like he was breathing.  I almost had a heart attack right then and there on the spot.  I mean, geez, what if he really was alive and we sent him down to the morgue?? This freaked me out.  I went over very carefully and felt for a pulse: nothing.  I then listened for a couple of minutes with my stethoscope to his heart: again, nothing.  But his freaking chest was going up and down!!! 

 Well, apparently, there is a such a thing as reflexes that make this happen. 

Yeah, you heard me right.  This was my first patient I had as a student in the Intensive Care clinicals.  You would have to understand how timid and shy I was back then to fully appreciate how upsetting getting this patient was. 

So, I came in that morning and got my patient.  Frequently, in the ICU patients get transferred off of the unit to another place as is what happened with the patient that I had the day before.  So, I got a new one.  We’ll call him Mr. Jones.  The nurse always gives the student nurse a full report which includes how the patient’s injury was sustained or a synopsis of their illness.  She began, “Mr. Jones was at home last night and had taken a soda bottle and put in pretty far up into his rectum.  When he could not get the bottle back out, he had to go and ask his elderly mother to take him to the emergency room.  Upon further inspection and tests, Mr. Jones had perforated (torn) his intestine and was seriously septic (infection throughout his body).  He is in critical condition and we are unsure if he is going to make it.” 

 Okay, I turned red, then white, and did not know how I was going to face this person.  A soda bottle up his butt?? I mean, I think, I’m pretty sure I knew what he was doing, but geez……HOW EMBARRASSING!  And now he may die from this?  How would you like to have people ask “What happened?  How did he die?”  I mean, the obvious out was “from an infection”.  But can you believe that he actually had to tell his mother about what he did so she could take him to the emergency room??? 

One other gross story was how a nurse friend of mine ended up in the ICU with a similar story, except he had gotten a gerbil caught up in his butt and hurt himself trying to get it back out. 

What is wrong with people??!!!!!

The third semester was getting to work in the OB/GYN and pediatric units at the same local hospital, with some rotations in a much larger place with a NICU and also had high risk OB patients.  Amazingly, I liked these two areas the least.  I never got to see a vaginal birth in nursing school.  All of my patients had complications and had to have C-sections.  I was taking care of a postpartum patient on Sept 11^th when someone gasped whose mother in law had called to tell them that a “kamakazi pilot had flown a plane into the World Trade Center”.  I remember hanging out in the nurses’ lounge and watching all of the things unfold that day in there and on patient’s televisions.  It was just awful.  Our instructor’s daughter was a flight attendant in New York.  Our instructor had a complete nervous breakdown that day (not knowing if her daughter had been killed or not—which thankfully she was fine), and she never returned to teaching.  That was her last day with the school. 

There were a few babies there born on that day.  It will not be one we forget anytime soon.