Registered Nurse Career Job Search

What a successful ride! I just completed my first Student Nurse Extern hire under the new program that I launched on January 1. The ease of the process, the quality of the candidates, and the fluidity of the collection of required documentation far exceeded my expectations! I couldn’t be more excited to see the fruits of my labor, nor could I have asked for a better collaborative team to help me “pull off” my vision. Today is a good day, I love my job!

Julie Ruschhaupt, BS, RN, Clarian Health Nurse Recruiter
JRuschhaupt@clarian.org
317-278-7082

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

Recently we began the final phase of a very long process to change out all of the pediatric code carts. Honestly, two pregnancies were not nearly as long or challenging as this project! As a part of the last phase, all of the nursing staff on the affected 4 floors needed education as to the differences that the new carts would bring to their lives. The Clinical Educator and I accomplished this through great teamwork in 6 short days.

As is often the case, change is met with a variety of interesting responses. They are not always along the lines of, “Oh, I am just so glad that you have brought this new piece of technology into my life!” They are more likely to continue with, "Line it up next to the 7 other things that I have to learn to save the lives of patients, document properly and soundly to hold up in a court of law, and do it all with a smile on my face so that my patient and his family will love this place, want to come back, and tell other people the same thing.” Then they have a look like they are looking for a sharp object.

Our job is to provide them with the knowledge and skills to learn to use new equipment, and time to vent that, yes, we understand your frustrations. Once they get on board, they are actually begrudgingly glad to have new equipment. Nurses are asked to do a lot of things, and do them all well. It is really amazing when you step back and look at the big picture. Safety is at the forefront of all that we do. Compassion and caring have to be present in every interaction, because they are significant to our families, no matter how small they may seem to us. I know we ask a lot when we “turn loose” another new project on our staff. But they are outstanding, and they always rise to the occasion to deliver excellent patient care.

Always glad to say I’m part of the team.

Tracy

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

One of the things I love about working on Neuro Critical Care at Methodist is our TEAM WORK. My co-workers are always there to help out and especially in a pinch. A few weeks ago I was asked to take a patient that had just come in that day. It was my first day back after being off for a few days and sometimes you just want to have a nice “even keel” night. Well this patient starting having high heart rates then high blood pressures and finally a change in their neuro status.

Luckily for me one of the attending ICU docs was just outside the room. I was able to get him in there quickly and from there it all went “full speed ahead.” We decided to intubate the patient, put in a central line and an arterial line besides slamming in blood products... and this was happening ALL AT THE SAME TIME! Thank goodness for all my teammates because they were all in there helping and if they weren’t they were checking on my other patient.

Even with 22 years experience you can feel like a fish flopping on dry land when these things happen. Team work and a good working relationship with your co-workers are some of the most important aspects of nursing. I love my co-workers... Thank God for them all.

Happy Nursing

Teri

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

Indiana Poison Center, this is Gwenn RN, how may I help you?

8:00 am “My 20 month old, 19 pound daughter just took the medicine we had laid out for my 12 year old son. That’s Concerta® 36 mg, 2 tablets. Will she be OK?”

“Well, she’s going to need to come into the Emergency Room and be monitored for awhile. This is a pretty strong medication and it can affect her heart and her neurological status. But I think with appropriate care she’ll be just fine. What hospital will you take her to?”

08:05 am I called report to Community Memorial ER about the child who ingested the Concerta®. Talked to Kylie RN and suggested Activated Charcoal PO, EKG monitor, benzodiazepines if symptomatic, monitor for at least 6-8 hours for this SR product.

08:07 am “My 2 year old son just drank some cologne! He’s spitting and carrying on something awful! What should I do?”

Cologne has a lot of alcohol in it and it tastes horrible. However, a little bit of it’s not going to harm him. Wipe his mouth out with a clean wet cloth and start him on some juice or Koolaid, then bring the bottle back to the phone …

08:32 am I’m 79 years old and I do NOT have dementia. But I think I just took a double dose of my Tylenol Arthritis Extra Strength. I usually take 2 tablets 3 times a day, at 7 am, 3 pm, and 11 pm. But I got up early this am and took my Tylenol at 7 am and I think I took it again just now!”

One time a double dose of Tylenol®, even Tylenol Arthritis Extra Strength®, should not harm you. But you will need to restrict the total amount of Tylenol® that you take for the day, so you don’t take too much for the 24 hour period. I suggest you skip your 3 pm dose and resume your dose at 11pm, OK? Or you can check with your Doctor’s office and see what they say.

08:44 am This is Officer Mitch Jones calling from Happyvale Police Dept. and I want to identify a pill confiscated at a traffic stop. There has been no exposure. It’s a round yellow tablet with the imprint TL 177.

This is cyclobenzaprine, common name Flexeril; it is a prescription but not a Scheduled drug.

0851 am This is Deb RN calling from Memorial General ER. These parents just brought in a 7 month old who chewed on a paint brush that had been dipped in oil based paint, wrapped in tin foil, and stored in the refrigerator. He is coughing and spitting. He seems to be oxygenating OK, as his color is good and his biox is 98% on RA.

OK, oil based paint is a concern because it is a Hydrocarbon and if even a few drops are aspirated into the lungs, it can cause a nasty hydrocarbon pneumonitis. Treatment is basically symptomatic – O2, RT treatments, CXR, biox, ABGs – the usual. Real rarely these kids will require mechanical ventilation. Antibiotics only if there are signs of a secondary infection and no need for steroids…

Gwenn

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

When Clarian Health received its initial Magnet designation in 2004, ethics was identified as an opportunity for improvement. In 2009, Clarian earned Magnet re-designation at Methodist, IU, and Riley hospitals. In the re-designation process, the Magnet appraisers cited ethics resources as exemplary sources of evidence, first for the force Quality of Care and second for the force Consultation and Resources, and identified the program in ethics as a “national model.”
 
At the upcoming October National Magnet Conference in Louisville, Kentucky, Maureen Hancock, clinical director at Riley for pediatric special care and former Fairbanks Center Ethics Fellow, and I will do a presentation highlighting part of our Unit Based Ethics Conversations (UBEC) program.
 
The mission of UBEC is to create an environment with morally open space where participants feel free to express concerns, give and receive feedback, and reflect on their experiences. The goals of the program are to increase participants’ abilities and confidence in dealing with ethically-challenging situations. The focus is on helping those in attendance reflect on their experiences and develop skills to manage the distress they feel when facing ethically-challenging situations in clinical practice.
 
In 2009, we conducted a formal evaluation of the UBEC program. Nurses who work on units that have hosted UBECs for more than six months were asked to participate. Nearly ten percent of survey respondents said they had attended a UBEC. When asked, 86 percent of attendees stated the UBEC helped them to address ethical issues they faced in their clinical practice, and 67 percent stated they felt better-able to manage ethically challenging situations after attending UBECs. Overall, 93 percent would recommend the program to a colleague. All our evidence suggests this is a valuable program that helps nurses deal with ethically-challenging situations.
 
Our Magnet re-designation puts us in the top two percent of hospitals nationwide. Nurses from other hospitals look to Clarian for ways to improve their practice. Sharing our experience with UBECs at the Magnet conference is one way for Clarian to lead by example and provide a benchmark of quality for others to strive toward.
 
The availability of UBECs is one way Clarian is working to be proactive in helping nurses deal with ethical issues in clinical practice. If you would like more information about UBECs, please contact me by replying to this blog.
 
Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist
 
To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.
 
You can also search for available Nursing Jobs at Clarian Health by Nurse Specialty.
 

What does it say about an organization that has a mechanism (and a policy) for reporting compliance-related concerns, better known as the Trust Line?

Clarian is an organization that knows it is not perfect, but it wants to provide employees with resources that help it stay true to the values that are at the core of its foundation.

Trust is the belief in and reliance on the moral character of another. The Trust Line is a tool that employees can use to hold each other accountable to do the right thing.

While Clarian asks us to trust people in positions of power and report any concerns (speak truth to power), that trust comes with risks, namely vulnerability.

As employees, we may feel we are the vulnerable ones. But consider this: One individual who persists in behavior that is unbecoming a Clarian employee ruins it for all of us. Turning a blind eye to this type of behavior violates the trust Clarian has put in each of us to demonstrate our moral character and help maintain Clarian’s core values.

Transparency is essential for ethical practice, open discussion of difficult issues and the establishment of a culture of mutual respect and trust. When open discourse is not possible, people in positions of power must do what they can to minimize the risks inherent in speaking truth to power. That is what the Trust Line is all about.

Doing the right thing is not always easy. Sometimes even the best of us slips up, intentionally or accidentally. Contrary to popular myth, Big Brother is not watching and waiting for a chance to either cover up these circumstances or use them as an easy way to thin the herd.

Trust is based on mutual respect. The leaders at Clarian rely on each of us to maintain fidelity to moral norms, to internalize Clarian’s values and, when necessary, defend them.

Policies can’t change things. That is up to us. Are you up to the task? And what does your organization do to enhance trust and transparency?

Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

You can also Search for Available Nursing Jobs at Clarian Health by Nurse Specialty

The beauty of nursing is there are such a variety of options to choose from in terms of specialties. In some career fields, that is truly not the case. We are so blessed to have so many arenas to choose from, whether it is inpatient or outpatient; neonatal nurse to geriatric nurse, there is something for everyone. I cannot begin to tell you the number of times I have heard over the years, “Oh, I don’t know how you do what you do. I could never take care of critically ill children.” And my answer is always the same. I love what I do and would not want to take care of any other age group or patient type.

We take care of parents at a highly stressful time. Often they have just had their world turned upside down, all in the blink of an eye. Life was just going along fine, and in an instant it was changed forever. We all really enjoy that type of crisis intervention. I fully realize pediatric nursing is not for everyone. But I feel it is what I was put on this earth to do.

We had a particularly rough week last week, in terms of patient acuity and losses. When you deal with a large trauma population, there are times when it comes in waves. I have always been so proud of the way we as co-workers have supported each other through these sad times. I watched a darling nurse, who had stayed over her shift to fight valiantly to try and save a child’s life, start to leave with tears rolling down her face. Just as soon as a few of us had seen it and moved towards her, another nurse stood to embrace her with a long hug. We all talk with each other to debrief after tough weeks such as these. It is a testament to the power of togetherness and the strength of support one receives from those who know exactly how you feel.

I had come in during one night as admissions had come fast and furious. I saw the devastation around me, of families whose lives had been changed forever, and I felt punched in the gut for the families in their grief. And two days later, as I was washing my scrubs and found some blood on them from that night in the battle to save the lives of these children, I had an epiphany. As silly as it may sound, it is often at the washing machine that I reflect on the week that has just passed. While I know that OxiClean will get rid of the stains I bring home from work, I am glad that after all of these years, I still feel punched in the gut when I see a family in pain. I do not ever want to just go through the motions of patient care, and miss the bigger picture around me.

This work, and this staff, is far too important to ever let that happen. So for now, we keep pressing on, thankful for each other and quality detergent.

Tracy

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

You can also Search for Available Nursing Jobs at Clarian Health by Nurse Specialty

Fridays for my Service Line are usually just as chaotic as Mondays! I think most people who work Mon – Fri expect Mondays to be a bit trying, but not usually Fridays. I came in looking forward to "winding down" the work week, clearing the piles on my desk, getting things organized and ready for the next week, then maybe spend a little time checking in with my teammates. It seems more often than not though I leave a bit frazzled and sometimes frustrated by people’s lack of planning. There are always "emergencies" that creep up from the lack of planning that now has Friday "staring someone in the face" and the problem that I am supposed to solve "stat!!" I guess this element of my job is really no different than many of my experiences as a former Manager, but the best part is this time it doesn't follow me home with pager and 24-hour accountability.

Everyone wants to master their position. whether it is as a bedside clinician, a Nursing Manager, or at this juncture in my career, as a Nurse Recruiter. I’ve been in this role since January and every month I am feeling more confident, but as is normal in life, no matter how much mastery you feel you have obtained there is always going to be a new "fly in the ointment." My latest fly came on Friday at 3:40pm when I needed to leave at 4:00p to pick up my daughter from day care 37 miles from my office! Needless to say, after another "learning opportunity." I managed to turn off my computer by 4:10p and made it there right at 5:00p - only breaking the speeding laws by 8 miles over the limit. Tee hee.

Just another Friday for me in Nurse Recruitment :)

Julie

Julie Ruschhaupt, BS, RN, Clarian Health Nurse Recruiter
JRuschhaupt@clarian.org
317-278-7082

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

I personally do not know many people that get really pumped for the Track & Field season. Few people speculate during the week about the next great pole-vaulter or the hottest shot putter on the planet. There are not packed stadiums and cheerleaders but the fans that do partake are never disappointed. These events all seem to showcase during tournaments or the Olympics. Individual Track & Field events have always intrigued me, particularly the hurdles. First of all, I cannot, and never could imagine how one could co-ordinate the speed, steps, rhythm, efficiency and technique that hurdles require. Timing is everything. There are many factors that slow a hurdlers performance and I have seen some nasty falls that end the race in a second. The higher the hurdle and longer the race, the more impressed I am. My legs hurt and I am out of breath just writing this paragraph!

I was thinking about hurdles last week in the context of what we have to overcome in life in order to finish the race. I was thinking about nursing specifically as I watched the new grads prepare for the State Boards. They had overcome many obstacles and endured many sacrifices to get to this one big hurdle that all registered nurses have to clear. Everything depends on one test! Until one passes that test, there is no moving forward! It is demanding and stressful. It is the culmination of years of preparation. Each one runs their own race in their own time and waits for the results. I have seen the exhilaration, relief and sense of accomplishment that comes with one word: "Pass," and the total devastation that accompanies "Fail." Completing this one hurdle means that EVERY nurse begins their career as a success, with endless opportunities to develop and own their own practice.

Kudos to all of you who have completed the challenge, and welcome to the nursing profession.

Sherry

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

Tuesday was a very difficult day for me on 4-medicine. The emotional high & low provided such a contrast I will have to go into a mulling phase to put it all in perspective.

It all has to do with the intricate nuances of our units: the patients, the staff, the delicate balance it takes to maintain… The challenges, obstacles, personalities, and stressors are overwhelming. It is interesting over time to look at how our units evolve. Who decides to combine certain patient populations and who decides what type of individual is best suited to manage that creation, and how does that person decide who will be the best people to keep the thing running. Somehow, at some point in time, everything clicks and somehow it all works quite nicely.

And, then of course, things change.

On Tuesday, one of our finest left, and, one of our finest returned. What an emotional dilemma! Selfishly, I was very sad to see Miss M. depart. We knew when she arrived it would be for a season and then she and her husband would pursue their careers beyond IU. But over the months, relationships develop and Miss M. was a vibrant part of our unit. She is a very kind and gentle person whose presence calmed and cured not only the patients but the staff. She brought us a fine combination of professionalism, fun and laughter. On the day she left, there were tears. Miss M. was a person who made an impact in a short period of time. It is hard to let go but we are all excited for her because she is on a wonderful journey and is someone we are not going to forget. She left a void.

Last year, Miss E. left us and pursued a dream of travel. She did some nursing along the way and covered the country and beyond. I oriented Miss E. as a SNE, SNEM, SNG. She provided 4-medicine with a personality like none other and developed into a very good charge nurse and excellent team player. I was sad to see her leave but have an album of pictures with details of her adventures. It has been wonderful staying connected with her.

Now, she is back. It was Tuesday. In the midst of a busy, busy day, she asked me what she could do to help me, and in an instance, I realized now much I had missed her and how very, very glad I was to have her back.

In the scheme of things, it is all about people. Ask any nurse why they work on their particular unit and they will respond, "because of my patients and my colleagues." We have strong unit bonds that go far beyond the borders of the workplace and forge timeless friendships.

Sherry

To join and bond with the Registered Nurses at Clarian, visit Registered Nurse Career Job Search

What do I do if I think a physician is not competent? This question was posed to me recently, and I think the suggestions outlined here are worth repeating.

Most people could probably give the “correct” answer – report it – but that answer is both reactionary and premature.

What behaviors suggest a physician is not competent? Two examples were given: “The pharmacy said we haven’t done that for years” when the nurse called to clarify an unusual order; and “We always have to call the resident to get the orders fixed.” So on the face of it, this is more than a one-time event, and there is potentially a pattern.

First and foremost, focus on the patients who are in the physician’s care. If there is an immediate patient safety issue, any nurse caring for a patient should be aware of the workplace policy for resolving clinical concerns. In a hospital, policies apply to all who give care.

The purpose of a policy is to ensure that concerns about patient care are resolved quickly and accurately by the most appropriate staff. At Clarian Health, the policy includes both a nursing and medicine chain of authority. After discussing this policy with Dr. Richard Graffis, Chief Medical Officer for Clarian, he reinforced, “No one is exempt from this policy” – not the resident, attending staff physician or chief medical officer.

The most frequent reason cited by staff for not reporting concerns has to do with the perceived power of the physician involved. Known as an authority gradient, the power is either related to the status of the physician or fear that the physician will somehow punish the nurse. In either case, the code of conduct for medical staff also has no exceptions and provides a mechanism for giving physicians feedback.

Talk over your concerns with your charge nurse, shift coordinator or nurse manager. Do it in a respectful, professional manner (not in the lounge over lunch). Put your concerns in writing, and send them to your supervisor, who should be obligated to send the concerns forward for evaluation by the medical staff committee. If the concerns continue with new examples, continue to put them in writing.

Nurses are not in a position to evaluate the competence of physicians, any more than physicians are in a position to evaluate nurses. However, each is responsible for providing feedback to those who are in a position to evaluate competence.

Focus on the patient. If this were your loved one, what do you hope the nurse would do?

Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist

To join the Clarian nursing team, visit Registered Nurse Career Job Search

The majority of our training as registered nurses is geared toward promoting health and caring for people when they are sick with the hope of restoring their health. When it is clear to a patient that they have a condition that will certainly limit their life expectancy, they may choose to forgo resuscitation, which requires a “Do Not Resuscitate” (DNR) order to be placed in their chart.

It may be confusing when a patient comes to the hospital to receive an aggressive life-prolonging therapy such as chemotherapy when they have a DNR order on their chart. How is this possible?

At Clarian Health, a policy for “Withholding or withdrawal of life-prolonging procedures” provides clarification of this point. Other hospitals have similar policies, I'm sure.

DNR is a very specific order that requests withholding of any one or a combination of treatments in the event of a cardiac or respiratory arrest. A cardiac arrest occurs when there is an absence of a palpable pulse. A respiratory arrest occurs when there is no spontaneous breathing or there is agonal breathing. The treatments considered “resuscitation” include endotracheal intubation and initiation of ventilatory support, chest compressions, electrical countershock, external cardiac pacing and bolus administration of inotroes, vasopressors or antiarhythmics. 

A DNR only limits the provision of cardiopulmonary resuscitation (CPR). A DNR order does not limit or restrict the use of any other medical treatment, diagnostic test or intervention. In fact, we are obliged to provide the clinically appropriate standard of care to all patients, regardless of their code status. 

Resuscitation is one type of treatment that patients may choose to forgo. Patients, their families and physicians also may choose to forgo other treatments, such as dialysis, blood transfusions or an organ transplant, but these limitations are not automatic when a patient chooses to forgo CPR.

Clarian policy defines circumstances when it may be appropriate to consider withdrawing or withholding certain treatments for patients. However, until a physician’s order is written that defines the patient/family preference and consent to limit treatments, nurses must assume that patients want and should receive all treatments. 

What does your hospital's policy say?

Nurses who feel a patient meets the criteria for consideration of withdrawal or withholding treatments as defined in policy should discuss their assessment with other members of the health care team and, when appropriate, the patient and/or patient’s family.

Lucia Wocial, PhD, RN
Clarian Health Nurse Ethicist

To join the Registered Nurses at Clarian, visit Registered Nurse Career Job Search.

At Clarian Health, we use the Synergy Model for Patient Care as our care delivery system. This is a very rich model based on the nurse-patient relationship. VULNERABILITY is one of the tenets of the patient side of the model-referred to as a characteristic.

I have always found vulnerability to be quite fascinating. I believe that every patient that enters the hospital has a certain degree of vulnerability. My favorite definition of vulnerability remains this: susceptibility to actual or potential stressors that may adversely affect patient outcomes.

Thinking about the present patient population on my unit, I would be inclined to believe the man with cerebral palsy who had an ERCP and requires a sitter for several reasons is more vulnerable than the one who is independent and is here for a work-up of elevated liver enzymes.

Nevertheless, that is merely an assumption unless I “know my patient”. Developing a relationship of honesty and trust with a patient is established through communication. Unfortunately, we have evolved into a society that uses blackberries, cell phones, computers, texting and i-everything  to communicate. 

We are loosing that “direct contact” interaction that allows both patient and nurse to bond on a higher level: one of awareness and understanding.  If that “Synergy” does not occur, vulnerability becomes a two-way street. Communication is definitely the challenge.

If you visit Clarian's Synergy Model, you will find a wealth of information that might peak your interest regarding this delivery system.  I have a great appreciation for this model and like toying with its concepts. So I challenge you to think about vulnerability not only in the context of the patient but in the context of oneself.

Sherry

Clarian nursing positions available at: Registered Nurse Career Job Search

We are currently getting all fired up here for our Magnet visit next week.  It is for our redesignation, and I expect the site visit by the American Nurses Credentialing Center to go very well.  After all, it is to showcase what we do best here, and that is take great care of our patients and families. 

We have had meetings the past few weeks of the Ambassadors, the “tour guides” for the Appraisers. I always think any opportunity I have to get together with colleagues from other areas at Clarian is well-spent and fun.  We always seem to find a way to make any work fun.

Learning about what others do in their respective areas is just amazing and inspiring.  Everyone has their area of expertise.  I love listening to others tell stories about their recent patients.  Mostly because they are usually very different from my world, and because it is obvious that everyone has such a passion for their patient population and their nursing practice.  It is why when the parts come together, they make up an awesome whole!  And I think the Appraisers will easily see and hear that through the voices of all the nurses they interact with. 

We are ready.  Let the visit begin!

Tracy Davis RN

To join the fun, start your Registered Nurse job search here: Nursing Job Employment Positions