Questions to Ask During Your Nursing Interview

Questions to Ask During Your Nursing Interview

When preparing for an interview, it is important to not only focus on what questions you might be asked, but also questions to ask the employer. Your inquiries will help you determine whether the job will be a good fit for you and give you insight into what it is truly like to work there. Your questions should cover three main topics: unit basics and training, the working environment, and the employer’s management style.

Unit Basics and Training

A lot of employers will outline the basic job details in the job application or during the interview, but if they do not, then go ahead and ask! It is important to know the unit and training basics such as: patient-to-staff ratio; hours; call shifts; holiday work expectations, scheduling, and weekend requirements; training length; and probationary period.  If you would like to go above and beyond to learn more about the unit try asking these questions:

  1. What is your unit’s retention rate for new graduates and employees?
  2. How would you support a new employee who was struggling after their training was over?

Work Environment

Most nurses will tell you that the biggest aspect of their job satisfaction is their work environment. Daily interactions with nurses, doctors, and techs has a huge impact on retention rate and overall happiness. Focus on asking questions that will help you understand if the unit uses teamwork and supports one another. Try asking these questions:

  1. What is the culture of your unit like?
  2. How do you help new nurses adapt to the unit? Do you have a mentorship program?

Management Style

Your managers are there to support you and help you succeed as a nurse on your unit. Asking questions about the unit’s management style will help you gauge how well you will fit in and be supported. Try asking questions that reveal how the managers deal with conflict and struggles that the unit faces:

  1. What have been this unit’s most notable successes and failures over the year?
  2. What are the biggest challenges that your nurses face daily and how do you help them overcome them?
When Necessity Results in Invention: Jean Snyder and the ERMA

When Necessity Results in Invention: Jean Snyder and the ERMA

When Jean Snyder, DNAP, CRNA, read a story about a vibrant boy who went in for routine surgery and instead of coming home, died during, she knew she had to do something. The cause of the child’s death was a medication error. “As a mother and as a nurse anesthetist, my heart grieved for this loss. I knew that if we had a safe means to keep our syringes and vials, the mistake may have been recognized earlier, and perhaps that child may have had a different outcome,” says Snyder, owner of Jean F. Snyder CRNA Inc. and co-owner of Goodwin and Snyder Anesthesia Associates, PLLC, who also works full-time for Bon Secours DePaul Medical Center. “I knew I had to invent ERMA [Error Recovery and Mitigation Aide].”

“I developed an ERMA prototype in 2008 but had no means to refine and market it. In 2016, as part of my doctoral program at Virginia Commonwealth University, I wrote a whitepaper discussing medication errors within the context of error critical systems. ERMA was a means to provide early recognition and, hopefully, mitigation of medication errors. I then submitted my whitepaper and prototype to Innovation Institute, a medical device incubator that is affiliated with my hospital system. Innovation Institute worked with me to refine ERMA and obtained a provisional patent. We are presently working to market ERMA,” states Snyder.

Snyder explains what ERMA is and what it does:

The ERMA

“ERMA is a clear reservoir inserted between the re-entry proof top and opaque terminal disposal portion of a traditional needle box. It allows a practitioner in any high-risk area (OR, ED, ICU) to have visualization of all the syringes and vials used during the course of a procedure, anesthetic or surgery. At the end of a single procedure, a trap door in the bottom of the reservoir is released to allow those sequestered vials and syringes to drop into the bottom of the needle box for terminal disposal. Providers now have a means to refer back to any medication delivered for an individual patient. ERMA allows us to recognize errors in a timely fashion and address the untoward events that may arise from the error in a timely fashion.

“Research has revealed that medication errors occur despite concentrated efforts to prevent them partly because medication administration has become increasingly complex. In addition, providers are distracted, tired, [and] face environmental barriers such as low lighting as well as production pressures. In anesthesia, the normal system of checks and balances in the administration of medication are eliminated as one person prescribes, prepares, administers, and charts the medication. A single anesthetic often administers several doses of up to 20 medications. Nanji et al determined that 1 in 20 perioperative medication administrations and every second operation resulted in a medication error and/or an adverse drug event. ERMA allows medical personnel a second chance—a method to make sure that the medication they thought they were giving is actually the medication they gave. If an error was made, it buys the practitioner precious time that would have been spent in trying to figure out the precipitating cause of the medical crisis.”

Some of the biggest rewards that Snyder has had in inventing the ERMA is that she has learned she has both the heart and mind of an inventor. In fact, she says that she’s already given two more ideas to the Innovation Institute and already has others “simmering on my backburner.”

Her biggest reward, though, hasn’t happened yet. But she hopes it does. “I would be extremely gratified to hear practitioners in high risk areas tell me that ERMA helped them recognize and mitigate a medication error. My biggest reward would be meeting the mother that lost her child to tell her that her loss was not in vain. I want to let her know that her story motivated me to change the way we recognize medication errors and that my product may prevent another family from suffering such a great loss,” says Snyder.

She also has advice for other nurses who have good ideas about improving something in health care. “I believe all nurses are inventors at heart. We develop workarounds every day at work. We innovate every day. We don’t have the power and means to move our ideas to reality. My advice is to find a mentor. I have some amazing mentors at Bon Secours, VCU, and Innovation Institute,” she says. “Read about other nurse inventors and reach out to them. By definition, nurses are nurturers and delight in the ideas and successes of our colleagues. Reach out to your hospital system to see if they are affiliated with a medical incubator. Google scholar and Google patent are amazing resources because sometimes your idea is so good, it has already been invented or patented! Read the research to look for inspiration.

“I encourage all nurses to innovate. Through nursing innovation, we will improve patient safety. Innovation is a positive feedback loop; as we innovate and take our places as experts in the medical field, administration will reach out to us as the experts.”

Spotlight: Long-Term Care Nurse

Spotlight: Long-Term Care Nurse

Tina M. Baxter, APRN, GNP-BC, has worked in both acute care and long-term care. A board certified gerontological nurse practitioner, she now teaches through HIS Solutions Health Care and works as a legal nurse consultant for Baxter Professional Services, assisting attorneys in nursing home litigation cases. Baxter took time to tell us what nurses can expect when working in long-term care.

Describe a typical day in the life of a long-term care nurse.

A typical day depends on your background. As an RN, you are responsible for the assessment and care plan for the resident. You may be responsible for staffing the unit and completing assessments in the hospital to determine if the resident is appropriate for admission to the facility. You may also function in the capacity below as is described for the LPN. As the director of nursing, you will be responsible for the day-to-day operations of the nursing unit by supervising other nurses, nursing assistants, and volunteers. You are responsible for making sure you stay within budget for care, approving the allocation of resources, and providing guidance to the staff.

As an LPN, you will begin with shift report, round on your residents, and morning med pass. After med pass, you usually begin your wound care treatments, breathing treatments, or other treatments needed. You also will begin your documentation of your assessment of the resident, field phone calls from the MD/NP for orders, review labs, fax pharmacy new orders or requests for refill medications. You then get ready for noon med pass, help monitor the dining room, and repeat the above. Afternoon med pass is anywhere between 2 p.m. and 5 p.m. You will document your assessments of the residents, attend to any resident urgent needs such as injuries, sick complaints like a headache or pain, and make additional phone calls as needed. Also, you will answer any family or resident question or concern that may come up during your shift.

As an advanced practice nurse and nurse practitioner, the NP will round on the residents similar to rounds in the hospital or for a primary care visit. The NP will assess the residents, address any medical or psychosocial concerns, document the findings, recommend treatment, and write orders for medications and treatments. The NP may meet with the staff, residents, and/or family to discuss the overall course of treatment, review any proposed changes to the plan of care, and discuss the best therapeutic options. The NP will also review and interpret laboratory and radiological testing and sign off on recommendations from other disciplines, such as dietary and physical therapy.

What kinds of nurses would do well in this role?

Nurses who love a challenge, can practice autonomously, and have a solid background in nursing across the lifespan. You have to be a generalist, as you will use your medical-surgical nursing, mental health nursing, community nursing, and nurse educator skills on a daily basis. You have to be comfortable with knowing that your resident may not ever become discharged from your facility until death.

What are the biggest challenges?

One of the biggest challenges is managing family and resident expectations. Often, residents come from the hospital and the ratio of patient to nurse is very different. Also, the expectation of the length of stay at the hospital is temporary. Residents come to long-term care (LTC) to live and therefore, they are in their “home.” The resident and family need to understand those changes in the dynamics. Sometimes, you have to have the difficult conversation of discussing curative versus palliative care. The goals of being in LTC is to keep the resident safe, provide for the best quality of life as possible, and to provide an enjoyable living environment.

What do you love most about what you do?

I love working with the residents and knowing that I can make someone’s day by just giving a listening ear, giving a cup of water, or explaining to a resident’s family a complicated procedure and having them appreciate the care that we give to the resident.

What do you wish more people knew about the job?

I wish more people knew that, while maybe not as glamorous as working in the critical care unit of a major hospital, LTC nurses are required to utilize a lot of the same skills as those in critical care. LTC facilities have come a long way and they are not the “sad prisons” for the elderly as they are portrayed in the movies and on television. There are many nurses and nursing assistants who work hard to care for the residents and do so with grace and dignity.

If a nurse is thinking about working in a long-term care facility, what kind of training should s/he have?

They should have some training in medical-surgical nursing and/or rehabilitation nursing.

Getting Millennial Nurses to Commit to Your Organization

Getting Millennial Nurses to Commit to Your Organization

We know firsthand what it’s like to be a parent to a millennial nurse. My millennial daughter is married to a travel nurse. They are out living the dream in their “tiny house” on wheels with a beautiful cream-colored golden retriever named Arlo. Jennifer, a nurse herself for 43 years, is a mother to a millennial travel nurse living the good life in California. We each understand the challenges of raising millennials and the challenges of keeping millennials engaged within your organization.

Millennials have a different view of the world than previous generations. Gauging what’s important to them and how to keep them engaged can be daunting. According to the Advisory Board, engagement for a millennial is not a predictive index of intent to stay with a company. Most people think engagement equals loyalty. This is not the case with the millennial nurse. The millennial nurses of today have witnessed their parents go through the ‘great recession’ where they witnessed their parents struggle as loyalty was thrown aside by their employer. The millennial nurse enters the nursing profession with student debt unseen in other generations, creating the desire to move ahead financially to pay down these debts. The millennial nurse is technologically savvy and enjoys being intellectually challenged in new ways; they will resist outdated training and onboarding methods. The millennial nurse also prefers a set schedule, so they can plan their “experiences,” which is more important to them than owning a big house or a nice car.

As professionals in the health care industry and parents to millennial nurses, we suggest switching engagement tactics to drive loyalty from millennials. Deciphering what engagement tactics will work is not as complicated as it sounds. Our best advice: think like a parent and be open to trying out our several tactics below.

Provide a platform for opinions

Millennial nurses want to have input on some issues and appreciate when their opinions are valued. This makes millennials great contenders for a shared governance model. Giving millennial nurses ownership over projects allows them to have a voice in their practice. During staff meetings, millennial nurses have the opportunity to provide input and voice their opinions on the projects that they own. Their peers also have the chance to give feedback, so that the nurse feels valued and respected.

Giving the nurse decision-making influence sets them up for future career advancement and anchors them to the organization.

Understand the environment millennials have grown up in and adapt

As mentioned previously, millennials are burdened with student loan debt more than any other generation before. The average student loan debt for Class of 2017 graduates was $39,400. Given this financial pressure, millennials are looking to advance more quickly in their careers to earn a salary that will offset the added loan payments. Due to the impracticality of quick career advancement, millennials will often take alternative routes in nursing such as travel assignments to earn more money faster.

Since millennials are flocking toward travel nursing, it’s essential to offer bonuses and paths to career advancement within your organization to get them to commit.

Get rid of formal critiques and establish mentorship programs

Millennials also prefer coaching or mentoring over formal critiques and reviews. Constructive criticism is the preferred method of addressing concerns and improvement among employees. However, millennials are more open to receiving feedback from an ally—someone who is championing for their success.

A well-matched nurse preceptor has much power in determining the loyalty of a millennial nurse. Nurse preceptors have the responsibility to address any concerns of the millennial nurse and offer guidance to any problems. This role requires a lot of empathy and intuition to establish a relationship of trust and mentorship among millennial nurses.

Ask what’s important to them

Asking a simple question could be the defining line of what determines a millennial nurse’s decision to stay with an organization. Ask these types of questions in one-on-one meetings with your nurse:

  • What is most important to your job satisfaction here?
  • What are your career goals?
  • How can I help you achieve them?
  • What type of recognition do you like to receive?
  • What is one thing I can do today to make your work more enjoyable?

Asking these questions will show a millennial nurse that you are committed to their success and happiness. They, in turn, will commit to you and the organization if they know you have their best interests in mind.

Tailoring engagement tactics to bring forth loyalty does not have to be a significant project, nor will it require extra time. Following the above guidelines and tracking retention will provide a great baseline to see if your millennial nurses become more committed to the organization.

Working as a NNP in a Level 2 Special Care Nursery

Working as a NNP in a Level 2 Special Care Nursery

I am privileged. I have been to the other side and experienced that the grass is greener. The majority of my career as a Neonatal Nurse Practitioner (NNP) has been in a Level 3 NICU with all the bells and whistles of high acuity, ECMO, high-risk deliveries, transport, and high patient volume. However, I then gained the privilege to also work as a NNP in a Level 2 Special Care Nursery (SCN). What a difference! But also, how similar!

The job tasks are identical … morning signout, collection of data from the medical record, physical exams, and writing notes. I touch base with the bedside nurse, case management, social worker as needed, and any ancillary staff. Consults are typically by phone. Sporadically, we may physically see an ophthalmologist, ENT, or cardiologist; but these occasions are not usual and customary. In addition, I can stand in one spot with full visual assess to all patients; as long as the census does not exceed 7 in the ‘main unit.’ The unit has evolved from a one room unit with one light switch, where either all lights were on, dimmed, or off equally. The SCN now is a state of the art unit of 7 individualized spaces to offer developmentally appropriate care, more patient privacy, and family-centered care. It is phenomenal!

Now, one may be thinking what a piece of cake. Well before we slice the cake, the grass really is not always greener. You see, regardless of the nursery level, the families are all experiencing a crisis. Acuity and level of nursery does not matter! The hopes, dreams, and vision these families had for their pregnancy, birth, and hospital experience are all shattered in the blink of an eye. The level of medical acuity has no direct correlation to the level of crisis for families. Due to lower medical acuity and lower patient volume, I am afforded the privilege of being able to take more time with families. I have the pleasure of sitting next to them, listening with my ears and eyes, to be in the moment with them. I can truly experience what the crisis or fears are. I feel a great sense of connection with the families. Regardless of the nursery level, these families become our family during their infant’s hospitalization. The communication, both active and passive, are vital for these families to emotionally survive this experience.

I have never experienced cross-trained nurses prior to working in a Level 2. This certainly is another privilege! This has positively enhanced my perceptions of the significance of the staff nurse presence in the delivery room, nursery, and postpartum area. In a Level 2, there is a staff of one NNP per 24-hour shift with attending back-up. The attending does rounds and meets with us daily, is present for all high-risk deliveries, and is always just a phone call away. This was a change coming to a Level 2. I realized how much I depend on my colleagues by just randomly shouting out to a fellow practitioner … ”What do you think?” Here, there is no one to just ‘bounce’ something off. However, it does afford me the opportunity to strengthen my knowledge by needing to know the answer ‘why’ and utilizing resources to confirm, learn, or discover answers. Because of the lack of colleague presence, the cross-trained nurses are a life-saver. They have a different level of competency, assessment, and confidence. It was awkward at first coming from a staff of 20 nurses per shift to having only 1 or 2 nurses. It truly reinforces the impact of communication and establishing rapport with others. Since there are fewer nurses, you work with people more infrequently, so communication, planning, and evaluating are essential—especially when those emergent situations do occur.

I still have the privilege of experiencing transport in a Level 2. The exception is that instead of going to receive the infant, I am sending them out. What an eye opener! This is where experience, confidence, and collaboration are vital. I remember my first meconium that clinically decompensated and overhearing, ‘I can’t remember a baby being this sick here.’ What a powerful lesson! This has afforded me another privilege of truly understanding the significant impact on providers and staff in managing these infants in an environment where resources may be more limited or staff may not be routinely used to managing these infants. I feel I have gained a level of inner strength, confidence, and resilience in handling distress in the clinical setting. It also reinforces the magic of nursing. Just like a Level 3, in a Level 2 the level of teamwork is there with everyone pulling together to do what is needed. Though a sick patient who requires transport is not usual and customary, the nurses are able to stabilize and do what is needed to optimize patient outcome. As a NNP, it is a humbling experience. Typically, as I stated previously, on transport I would pick up these infants to ‘give them what they needed.’ Recognizing you can’t fix this and need help is a character builder and essential professional trait.

In summary, I am privileged to experience the green grass on both sides of my world. I am so appreciative for my Level 2 experience because I am more proficient in looking outside of the box. I am not only a better practitioner, but a better listener, communicator, and mentor as well. I certainly have gained more than I can ever give back. And with that …I will go slice that piece of cake!

Why It’s Great to be a Nurse in 2018

Why It’s Great to be a Nurse in 2018

Whether you’re caring for patients, assisting physicians, or talking with families, you love what you do. No day is ever the same. We asked nurses why they love being a nurse in 2018. They gave us many different reasons, but they all agree on one thing: being a nurse rocks!

Thanks to all who contacted us. Here’s what some of your fellow nurses had to say.

“I get to help celebrate new life with mothers/fathers and family members by working in the Mother/Baby unit. Where else can you celebrate a new beginning, literally every day?”
—Teresa Kilkenny, DNP, APRN, CPNP-PC

“Being a nurse is great because I can focus on the holistic care of the patient—taking care of their physical, emotional, social, and spiritual needs.”
—Kim Hinck, BSN, RN

“I’m excited to be a nurse in 2018 because as health care evolves and improves, our ability to make a difference in our patients’ lives improves as well. Every day that nurses go to work, they have an opportunity to make a difference. That difference can be with lifesaving interventions or it may be providing explanations to our patients and their families in their times of need. Every day as a nurse is different and exciting, but also incredibly rewarding knowing your actions matter.”
—Megan Meagher, RN, CFRN, Care Fight Flight Nurse Truckee Base Supervisor

“With all the changes in health care over the past few years, I look forward to nursing in 2018 to bring innovative partnerships with community members, focusing on enhancing healthy lifestyles and preventive patient care through REMSA’s outreach programs in community and rural health.”
—Kristine Strand RN, BSN, REMSA-Care Flight Clinical Services and Quality Manager

“As more and more evidence confirms the high-quality care that nurse practitioners provide patients, 2018 is a great time to be a nurse practitioner (NP)! NPs are recognized for delivering patient-centered, comprehensive care, and meeting the health care needs of patients in more than 1 billion visits annually. NPs are improving access to primary care nationwide and consistently demonstrating excellent patient outcomes.

With CARA, NPs have stepped up to the plate to help combat the opioid crisis. Beyond primary care and our work to provide care to the nation’s most vulnerable populations, NPs working in acute and specialty care are also meeting the growing the needs of health care systems and the demand for mental health services as mental health NPs. The opportunities to make a difference for patients, families, and communities have never been greater—making 2018 a great year to be an NP—and a great year for states to enact full practice authority so that all patients can directly access NP care.”
—Joyce M. Knestrick, PhD, CRNP, FAANP, President, American Association of Nurse Practitioners

“I think it is great to be a nurse in 2018 because the different ways in which you are able to help patients is endless. From floor nursing to rare disease education, from a cruise ship to an elementary school, from the beginning of life to the end, and every phase in between, there is a nurse who is willing to listen and do all they can to make your day a bit brighter.”
—Shannon Ambrose, RN-BSN, Clinical Nurse Educator at Horizon Pharma

“As I look back on my career, I realize my practice has spanned four decades! It has been great to watch our practice change from routine to evidence-based (EBP) and the application of technology to both diagnostics and patient teaching. As an OB nurse, one of the most gratifying moments is when a new life is delivered into a mother’s waiting arms. Being able to help families identify their baby’s signals can give a new parent the confidence they need to get through the first night at home. As a nurse, I have so many tools to utilize for parent teaching, and we can customize them to our families’ needs and language—such as teaching them comfortable breastfeeding positions or practicing mindful diapering to promote bonding and protect sleep (something every new family cherishes!).

I remember my first months as an OB nurse in the 1980’s and feeling conflicted when some of my colleagues taught patients based on their opinions that babies could be held ‘too much.’ Fortunately, science has proved hugging your baby improves brain development, so nurses can encourage bonding. I can hardly wait to see what the future of nursing holds and will get to watch it unfold through the eyes of my daughter-in-law, Becky Faifer, who chose the NICU as her nursing home.”
—Felicia Fitzgerald BSN, RN, RNC-OB, C-EFM, CLNC, Perinatal Outreach Educator and Huggies Nursing Advisory Council member

“It’s not every day you hear that someone loves what they do after doing it for 35 years. I can say that I have the opportunity to live my passion every day and have for 35 years in the NICU. I get to observe and listen to the language of babies and even sometimes speak for them. Many medical technologies have changed the course of premature infant lives over the past 10 to 15 years, but one of the most powerful is simply listening and observing the language of their movement, cues, and cries. I love teaching parents and the health care team about the uniqueness and language of the premature infant and how every touch and relational experience we have with the premature infant can have impact on who they will become.”
—Liz Drake, RN-NIC, MN, NNP, CNS, NICU Clinical Nurse Specialist at CHOC Children’s and Huggies Nursing Advisory Council member

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