"Nursing Solutions" in Need of Changes.

Nursing solutions to overloaded patient censuses, staff shortage, uncompetitive pay, longer hours, and increased work processes by nurses is to make it work and get the job done. This is actually a great solution for employers as the work needs to be done, but when the gap is closed the deficient isn't easily recognizable. And for those nurses putting in the work, this can equal more stress, decrease in morale, less time to do the much needed bedside care, and poor job satisfaction. A reality, for me as a nurse, is that the very core of what nurses do is to “put the needs of others before our own", but this is without consequences and it can actually eliminate the support and changes we need. My ultimate thought is, in situations where patient safety is compromised gaps in work processes and nursing care have to be seamless to avoid poor outcomes. However, those processes that are non-life threatening and of lower priority, employers have to be given the opportunity to see where the problems lie so they can take a role in fixing what needs to be done or allow the experts to do so (i.e. electronic charting systems, billing, HR issues, etc.). These gaps may create changes that are beneficial to nurses and our profession. A prime example, my first job as a nurse, I worked with an older nurse who had been on the floor for 16 years, being a jack of all trades. She did anything from patient care, staff education, precepted new nurses or new supervisors, helped in the planning of new changes on the unit, and so much more. She became so frustrated because I believe she was burnt out and there was no support from upper management that eventually she resigned. The irony was once she left, no other person was expected to do all that she had done, upper management realized it was too much for one person and the duties were split amongst a group versus one individual; so once the gap was recognized it was quickly fixed. We as nurses can't always create nursing solutions that don't allow much bigger changes that only employers can initiate, we have to allow them to take their part as well so that nurses can get back to the essentials of patient care and improving healthcare outcomes. What do you think employers can do to close the gap in the working conditions of nurses?

 

Empty Hospital Beds...

I have been thinking about the new changes under the Affordable Care Act and how it would work effectively not only for health care professionals, clinics, and hospitals but also for the patients. I came across this article at the NY Times Health Provider Strives to Keep Hospital Beds Empty , about a system in Chicago that is attempting efforts to improve health care outcomes without increased health care costs. I am particularly interested in the ways that they are looking to coordinate care for the patients who have statistically shown to have higher health-related costs associated with care. I truly do not believe that there is going to be a perfect system in moving forward, but I am hopeful that organizations are looking into creative ways in keeping patient care as priority, while managing health care costs . What do you think about the efforts of this organization?

Spirituality in Healthcare: Does it Belong?

I recently read a blog about spirituality in health care, what interested me about it was that I have never thought about the topic and how I felt about it as a nurse. Generally as a nurse, the bulk of the time that I am inquiring about spirituality is as it is related to practices that interfere with health care and when the question is asked patients are very puzzled (in a new light I understand as it is almost as if we are asking if there is any competition). I have never thought about it, although not surprised, as a means for being a protective factor that may even enhance the experiences of modern medicine. As I reflect on the scenarios where doctors gave timelines on patient life and patients surpassed them; I have also seen patients with the best odds of overcoming a condition die because of it. Now, what I have taken into consideration are those patients who used their spirituality to balance their mental and physical being regardless of the diagnosis. I found in these moments, ideal times to acknowledge and to support them (which does not have to interfere with my own spiritual beliefs) in how they saw their walk of life and how they felt about it or how they got through it or how life ended with it. I realized that I can allow my patients to have their first, last, or all those days in between spiritually so that they are themselves fulfilled. As a nurse, if I have to smile as my patients or their families pray, stop as I enter a room so that they can finish a prayer, or remove myself from the room while they pray; I want to create a atmosphere that spirituality is important and is not and should not be in competition with health care. How do you feel as a nurse/doctor respecting and/or acknowledging a patient's spirituality?

On Trial at the Doctor’s Office...

How many times have you dreaded going to the doctor's office because you just felt that you would be judged? Have you even been asked questions like, why aren't you performing this medical task or ridiculed because you had not followed through with the plan from the last visit. How does that make anyone feel when they have yet to develop a relationship with their healthcare provider? Let me say I do believe that when you are already comfortable with whom you are seeing and the relationship is established there is more room for direct conversation, but still respectful and honest. But the problem for me is when that relationship is not yet to be established. Don’t get me wrong there still has to be honest, respectful medical conversations sometimes with bad news or things that you need to do immediately to improve your health, but can it be done in a way that patients don't feel like they are being judge or labeled the "bad patient"? As a patient I have had the similar situations where I felt that I was being judged (whether real or perceived) and it just didn't make for a pleasant healthcare experience for me. So I thought about it and here were some things that I did to improve my healthcare experience because I too have to play my part:

 

· Changed healthcare providers (after two visits)---I wanted to give the previous healthcare provider a chance because maybe I was a little more sensitive on the first visit.

· Asking, open and honest questions---No matter how uncomfortable they made me feel to ask because as a nurse I don't know everything about everything; but that was my issue with being judged that I also had to address with myselfJ

· Participate in dialogue and initiate it---I don't have to make it a you ask me a question and I answer session.

· Listen and clarify---Listening is important to learn anything, but I also learned to clarify statements that I perceived as judgmental; sometimes it was a misunderstanding on my part and this cleared it up immediately.

Tell me about times that you felt judged at the MD office. What did you do to improve your future experiences?

Nursing Retention: When It's Broke, You Must Fix It!

Nurse retention. The system of nursing retention, is broken and it must be fixed to remain sustainable as American grows older and healthcare for all becomes a priority. Many facilities are thinking of ways to address the nursing shortage, but what about the nurses who are top-notch and will not be retiring, what are you doing to keep them? So often, we either are so focus on looking into the future or either looking back to see how we can improve things, both not bad business models, that we forget about what is in front of us. There are nurses in front of us who are working everyday and too making a difference in patient lives and patient outcomes, what would it mean to lose them? And don't get me wrong, finding ways to close the nursing shortage is important but it does not focus on retention in the least. Here is a bit of free advice, that I have about nursing retention:

• Have a working nurses at the table, depending on who you want to retain you need to know what makes them stay at a job and figure ways around providing those opportunities, when feasible.  The question, is you have so many people at the round table looking at nursing retention, but make sure you have a key player at the table maybe more to speak up for the "working nurse". Working nurses will provide you valuable information about what it would do to keep them and their colleagues on the job; we have these conversations everyday far from what may be thought.
• Provide incentives, the reality is everyone likes these and it doesn't have to cost alot either. On Nurses Day provide your nurses will a small token to know they are appreciated. At a staff meeting recognize a staff person who has gone the extra mile and is the "A list Employee" for the month or year.
• Listen, sound simple enough; well it is not that easy as many employers forget the basic skill of listening. Nurses are on blogs, we are having conversations on the floor, if you stop long enough to hear what we are saying you may find valuable ways to retention.
• Look at "model" agencies. Some places have nursing retention down to a science, these are the places you almost never see posting a nursing job unless someone does retire. Find out what they are doing and how their strategies may be of assistance to you.
• Look at work processes, I would say this should be a yearly priority and a plan in place to how to address needed changes with the less bit of disruption. As work process are constantly evolving, but that being said some agencies are not looking into ways to streamline the busy work so that nurses can focus on what we like "hands on patient care."
• Have competitive pay,  I know the dollar is what is a driving factor for many healthcare agencies and I can't say that it is always the priority for most nurses, but it is important that your nurses can also meet their basic needs as well and if they are being paid appropriately or you are trying to save a buck you could lose them to a more competitive company.

Nurses..........I need you input as those are a few ideas I have about nursing retention, tell me yours, how can they keep us?

Why Not Focus on the Bigger Issues?

I recently read a blog about the differences between a doctor and a nurse. It appeared that doctors were concerned that the role of the doctor was being down played by a blogger, who stated that the difference between a nurse practitioner and MD was ultimately responsibility.  One comment that stuck out for me was made a by a doctor who stated "doctors diagnosed and nurses attended to the needs of the patients.” My interpretation was the realization that some doctors really view nurses (in all practicing roles) to be “the help” nothing more, nothing less. They don’t value the education, training, experiences, and the fact that some of them can go home at night because a nurse (in some cases a intern as well) is up all night caring for their patient and being their eyes and ears in their absence, which means nurses have to do more than just attend to patient needs in my eyes. As I read through the comments section, this conversation sounded very familiar in that nurses are having to fight for the title “nurse” as a profession, which has been evident through reports that some certified medical assistants or nursing assistants introduce themselves as nurses to patients. I wonder how many of these physicians who didn’t want the importance of the physician to be down played actually allow the role of the nurse to be done just that by allowing those in their offices, who are not credentialed, to be called nurses or present themselves as such. I believe that the sustainability of health care may be in trouble because it appears to be us vs. them at various angles, even though we are all interrelated in providing patient care. In my opinion, what we really should be focusing on is that doctors and nurses have different roles and responsibilities, and there are somethings we cannot perform successfully without the other.  The health care industry is in a major crisis, while politicians and insurance companies are making decision for physicians and nurses, we are having discussions that are irrelevant to the bigger issues at hand. I respect good physicians, I know as a nurse I am not a physician nor do I want to be. I like being able to meet the daily needs of patients through care and education, as a trained registered nurse. What do you make of the doctors vs. nurses discussions?

Who's the Blame? Lawmakers say FDA fell short in policing pharmacy

I was reading a recent article about the meningitis outbreak back in September which is classified as one of the deadliest medication-related outbreaks. It looks like the problem may be multi-faceted in Lawmakers say FDA fell short in policing pharmacy. The one thing I didn't see in the article is the anticipated plan in moving forward, now that we know what we know; are are we just going to keep pointing the finger? I personally think in moving forward that there should be agency standards in place that will protect the people, and alert lawmakers of problems faced that compromise public safety. What do you think the solution(s) should be?

10 ways to Stop Being Unaccountable for Your Profession.

"Stop Being Unaccountable for Your Profession"...Huh? Yes it may seem to be a bit off the map, but is it really? I can remember in nursing school, how eager my classmates and I were in learning any and everything about the nursing profession, it's practices, and standards, but where the struggle ensued is when we went from students to nurses in working environments that don't always seem to mesh with nursing practice and standards? The day to day busy work can remove us further and further away from the bigger picture that we as nurses are all accountable and have ownership in the direction that our profession takes. To remain or become more accountable in the nursing profession, one that will eventually take care of every person at some point in life in some capacity, I have found the following helpful for me in my journey of accountability: 

1. Listen-Knowledge is gained when we are open to hearing it. 
2. Speak Up-Use your voice, every different perspective offers a unique solution.
3. Know the Nursing Laws/Standards-You have to be aware of what governs you in order to follow or challenge to improve them.  
4. Hold Each Other Accountable to the Laws/Standards-To maintain integrity and trust, you can't turn you head to what we all should be doing to make great strides within the profession.
5. Develop Solutions-When you know the problem, that's half of the equation develop the remedies as well.
6. Remove Personal Preferences/Personal Benefits-The profession isn't about individuals; you may have great ideas but when it appears to be only beneficial to you the genuineness is challenged by others.
7. Share your Solutions-Don’t be afraid, your solution can only be considered if it is known.
8. Be Constructive-Valuable feedback gets far better results than just complaining or negativity.
9. Develop a Plan-You have the solutions…you’ve shared them, now you need a plan, bring the data and present it via the proper chain.
10. Stand United-When there is a consensus, support the spokesperson and the profession. If you don't agree with a point, don't wait until the end of a process to share, use those opportunities to share early on.

Please share, if you have other ways to stop being unaccountable...





 

What Parents Should Never Forget: After the Boston Marathon Explosions

I saw this article After the Boston Marathon explosions, what parents should do first . Check it out as it may help parents deal with the recent event that is all too sad and still very shocking. God bless us all and especially those directly affected by the Boston explosions.

A Lifestyle Far From My Own....Caring for Diverse Patients.

Have you ever had a patient where their values differed so much from your own, that it really challenged your core beliefs. I remember in my first job, I had a patient with dementia, he was constantly making inappropriate sexist comments each time I entered his room. I have to admit it was very uncomfortable for me to be treated this way, but the reality was I chose to be a nurse which meant I would care for diverse patient populations with different value systems from my own. But did that make me any less human? Absolutely not, it just challenged me to look at this person at a very vulnerable point in life who needed me to look beyond who he was to what he really needed from me, the nurse. I realized in that moment, that it was not important to me if he never learned a thing from me, but more of what I could learn from him and how I wanted to be seen as  the nurse. From that point to this, almost 12 years later, I told myself that no matter the difference that I may have as a person it should never interfere with my ability to care for my patients or to use my interactions with them as opportunities for me to grow and learn something new about who it is that I want to become, as a person and as a nurse. I think as nurses was have great opportunities to not only show how much we truly care for human life, but to grow each day and show that we can care for diverse patient populations in spite of the percieved differences. It is what makes us who we are and truly displays what we stand for as nurses and as the most valued profession.

Do you have any experiences as a nurse, where you cared for a patient with a different lifestyle than your own? What did you do to ensure that this difference was not evident in the care you provided?

Health care Savings: How to See the Doctor and Save Money

How can you save money and still remain healthy? In this economy, it seems almost impossible to do both; as pay goes down or remains the same, copays and deductibles increase and more healthier foods are costly.  I decided to develop a list from what I know as a health care consumer and what I have heard others say have made the most differences to them.

Savings at the Doctor's Office or Pharmacy

• Use urgent care offices or your regular doctor for non-life threatening issues. Ask your doctor's office if they offer sick, after hours, or weekend visits or ask where they would encourage  you to go during those times for non-life threatening issues.
• Review office billing policy make sure you know the rules; know if you will be charged for after hour calls, or when your doctor returns a phone call, or spends phone time talking to referral sources on your behalf. 
• See the same doctor, whenever possible. This will help you develop a relationship with your doctor which may mean that they become more in tuned with past or current problems and easily are able to pick up on new problems. This will also help you feel comfortable and more willing to share your thoughts and wishes regarding your health care plan.
• Educate yourself, so you can ask questions and get answers. The more you know the more you can prepare and do what you need to do to stay healthy.
• If you are diagnosed with a medical condition, ask about all of your options and the costs.
• Make sure you keep in contact with your insurance company so you can ask questions and know your benefits.
• Go to the your yearly wellness appointments, the healthier you are able to stay the less it will cost you, plus most of these appointments are covered by your insurance so the cost to you is little to nothing.
• Ask for itemized bills from whomever you see, look it over and make sure what you are charged for what was actually done.
• Ask your doctor's office what services they provide, some offices do their own x-rays, EKGs, and other tests that may cost more if you have to go to another facility.
• Talk to your doctor's office about payment options and possible discounts. Some healthcare agencies may give you a % off your bill in you are able to pay in full or if you need a payment plan, ask you may be surprised at what your options are {I would add ask first, when you are scheduling new appointments.}
• Ask about generic medications vs. brand names
• Ask about low price medication lists; some pharmacies have a list of medications that you can get some times cheaper than through using your insurance.
• Look into any store reward deals for using their store for pharmacy benefits
• Shop around for the best prices for eyeglasses and other medical equipment/devices when possible; ask health care provider and other agencies about lower prices {they are out there}.
• See about having labs and the appointment performed on the same day or ask if labs are done earlier what the charges will be.
• Be prepared, always prepare for your doctor's appointment--have your list of questions or symptoms you are having. Make the time spent useful and worth every penny.
• Look into health care flexible spending, it is pre-taxed and it allows you to plan for those unexpected medical expenses.

Saving at the Grocery Store

• Use your rewards savings cards at the grocery or coupons.
• Shop around online for the best savings; now a days there are so many online resources/blogs/etc. to help you determine the best deals that are more cost effective and healthier.
• Use farmers markets for fresh fruits and produce.
• Plan your meals, look at healthier options/recipes that suggest ingredients that are budget friendly.

Tell me how you save and stay healthy? We could all use the extra bucks:)

Reveal or Not? Airing Medical Mistakes.......

I saw this article Airing medical mistakes and was amazed! It gave me hope; I think that hospitals/clinics that take ownership in their part in improving patient care/patient outcomes is one I wouldn't mind working with and working for. We all have to do our part.

Violence: Are We Safe Anywhere?

Week after week, news and social media headliners highlight gruesome stories of violence. We are all vulnerable, as it is unpredictable when and where it will occur next and no place is immune. My question becomes how can Americans advance technologically in so many areas and lose greatly in our ability to create safe living environments for our children and ourselves? Now I am not oblivious to the fact that violence exists, as it has always been a part of our history, but it appears that this is different. In my reality American is at war with severe mental illness, but instead of being armed with the appropriate tools to address the complexity of the issue, it appears that we only focus long enough to support victims affected, then we move on to address more tangible solutions (i.e school safety, lock down procedures, etc). America has got to become passionate about regaining the safety of our country within our own borders, in my opinion one way to do so is by being held and holding Congress accountable to making mental illness a health care priority. In the meantime, headliners about violence will continue to post and the threat to the well-being of all will remain evident until frustrations become so strong we confront this reality and look at realistic solutions and resources that will be target the mental health crisis. What do you think is the reason for the increase in violent attacks in America?

 

 

Minority Rules!

Have you ever heard the saying "majority rules"? In my experiences as a nurse, I cannot always say this is a reality. I have been in situations, working as a staff nurse in the past, where I did not voice my views/opinions about a situation that I clearly disagreed with, and when it was approved I somehow felt as if "they" should have known we couldn't do that. Now I see the opposite end, I have witnessed situations where a particular person or groups presented an idea related to an interest or passion that they had and as they went through the proper channels for seeking approval, things continued to progress even though it did not seem to be what was best for the whole. Some concerns are voiced to management, but as feedback was sought from frontline nurses, it appeared to be no real opposition. Later, when nurses are questioned as to why they had not spoke up, they voiced things like “it wasn't worth it”, “we didn’t know we needed to”, “we were just too busy”, or “upper management should know that it was not feasible to being done as part of our already demanding work processes”. I understood where they were coming from, because I too have been on both sides of the table, as a staff nurse and management, and as a result I have shared with them the importance of taking an active role in the decision making process, especially when they were being asked and to find other ways to give feedback when they are not being asked directly. In my experiences over the years, I have learned that silence is more likely seen as approval or support versus disapproval. Silence has the potential for allowing the ideas of the minority to become the work of a majority. As nurses we are great advocators for others, but we have got to carry that over to ourselves. My challenge to nurses is not to assume that "they" will be able to provide the support what we need when we don't give the feedback that "they" need. 

Have there ever been instances where minority ruled in your work environment but it was not in the best interest of the majority?

 

 

Second Amendment vs. Doctors and Nurses???

I continue to see/hear so much talk about gun rights, whether it is on social media, in the news, at the beauty salon…it is definitely a HOT topic. I just read an article regarding gun violence from a nursing standpoint. After reading, I looked at the comments section as it was a great article to me; I was shocked at the responses, as they were highly focused on good ole 2^nd amendment. I even saw a few comments stating that “doctors and nurses kill more people in the country in a year than guns” which was quite appalling. My first thought was “how did healthcare professionals get into the politics of gun control from that angle,” the author was just attempting to show the humanitarian side of gun violence. Then human nature kicked in and I had a plethora of thoughts, like “can’t find a better argument than to attempt to demean the frontline healthcare workers that care for those who are injured regardless of the source?” “How ungrateful to the work of healthcare professionals!”  Then I thought about what really matters, and that left me with this “physicians and nurses do what we do, not because of the laws or the politics, we do it because we genuinely care about people. People with or without guns we care for all the same, but our hope is prevention to unnecessary suffering, we see it all too often firsthand because we are at the bedside…and that is all.”

 

 

Unsafe Healthcare Practices: Who Will Speak Up?

I was reading the news about a situation that is alleged that a doctor was practicing in ways that was detrimential and harmful to patients. When I read further, it appears that the doctor is not alone as he worked in a clinic with other healthcare workers. This lead me to wonder, what happens when healthcare professionals and other office staff persons see practices that are questionable or wrong. Why aren't we speaking up and exposing the situations at hand before someone gets hurt, or worst dies. I have found in similar cases such as this, many times the reasons given were that in a sense people believed that they are helping the doctor and/or the patients. It is not uncommon, however, when things are in the open and the wrongdoing is evident, and that those who witnessed such acts become just as guilty that they are able to really understand why it was wrong.  I think as healthcare professions, we have to be willing to be uncomfortable when situations are compromising to the health and well-being of our patients or when they are just not the standards of care. I believe that the the cost spent in litigation is huge for the healthcare industry on cases such as this when the easier and more inexpensive remedy should have been to speak up against a harmful or unsafe practices of healthcare professionals. Wrong is wrong...right?...Who will speak up? Have you ever witnessed an unsafe healthcare practice?

The Nurse Practitioner's Place: Nurse Practitioners Walk The Line

The Nurse Practitioner's Place: Nurse Practitioners Walk The Line

A Doctor or Nurse who Listens Goes a Long Way in Patient Care!

As a nurse, I have wondered occasionally why patients seek medical care but do not follow through with the "doctor's orders.” It was not until I became the patient, that I knew what that really meant and why I too was not the best patient with follow-up compliance. I believe that one of my issues, was I was told what I needed to do, and never was the question asked of me as to what I could do or wanted to do. I remember the nurse saying my blood pressure was high and the doctor coming in to confirm that, then she ordered, without asking me as she quickly left the room, an EKG (heart test) and as I walked out the door I was given a prescription for blood pressure medication all within about 30 minutes. I remember thinking, "that doctor doesn't even know me how is she looking out for my best interest, she hasn't even considered my thoughts or discussed with me the least restrictive alternatives, and I am a nurse." Well it was no surprise, at least to me; she was quite shocked that when I went for a follow-up appointment three months later that I was not taking the medication, but instead  I had my new diet and exercise regime. In that experience, it allowed me to reflect on how important as a nurse that I acknowledge my patients’ ability to make decisions over their lives or at least listen to their priorities and intentions; after all it is their lives and I am not moving in with them to ensure compliance. This lead me to reflect on the term “doctor’s orders” I think it may be best stated as a “patient’s plan of care”, as I realize now as a nurse if/when health care professionals don’t address or include the patient when making decisions over their lives, they won’t listen when it’s time to follow through. In my personal interactions with doctors, I have learned to value a doctor who listens to me and generally those are the ones who have better health care outcomes and compliant patients. So would you follow through with the “doctor’s orders” if you were allowed to be involved in developing the plan of care, why or why not?

Should Healthcare Agencies be Transparent?

Should Health care Agencies be Transparent? I thought about this, after talking to my cousin, who is also a RN and she told me that her floor at the hospital she works was having open interviews, after the top nurse manager candidates were picked, to allow nurses to have direct input in the hiring of a new nursing manager. I have personally never worked for an agency that allowed this practice, but it sounded like a great opportunity to allow those who will be directly impacted to have a say, whether real or perceived, in such an important decision. I think this was a great way to start or maintain a trusting nurse-employer relationship. Health care agencies that leave nurses in the dark when reviewing or strongly considering important proposals for nursing changes/new products or other nurse-related issues are often accused of not being transparent. The reality is, nurses realize that they are not privy to all information that takes place in making health care decisions and nor do they always want to be included in the small details, but when questions can't be asked or answered and it appears that there is a "secret project" it can be perceived by many as negative or unreasonable changes because those are the ones that no one wants to share until it is time to "enforce them". Many times the lack of transparency can also breed gossip and "grapevine" talk which may further impact the response to the change or diminish the trust in the nurse-employer relationship. Transparency is a great way to build a trusting nurse-employer relationship and create loyal nurses in a time when nurse retention is so vital for agency success and positive patient outcomes. In remaining transparent it does not mean that nurses need to know all the details behind all the nursing-related decisions, like who sat that the table, who disagreed with what, or who said what. It just means letting them know that the conversation will or is taking place and information will be shared from the appropriated channel {i.e. supervisor, nurse manager, nursing executive, etc} when it is available to be shared. A transparent health care agency for this nurse is a respected one by its nurses, but not always agreed with, but that is discussion for another post  Share how your agency remains transparent with it's nurses?

 





 

Seeking New Nursing Employment: When Is It Time to Move On?

Have you ever thought about leaving your current job? There comes a time for most nurses, when they have accepted the fact that it's time to move on to something different, something better, or just plain something else. The question that is never easy to answer is when do you know it's time? It becomes harder when there are so many factors to consider; the stability of your family, the great team of nurses/health care professionals you work with, the job/retirement benefits, the job is comfortable and you know your role/responsibilities, or the thoughts/stress of starting a new job is just too much. However, the older I am, the more I believe that as a nurse my best work is when I am the most happiest. I believe that every job is a prerequisite or stepping stone to that "dream job", but sometimes we can become too afraid to step out of "our routine" and follow our hearts. So I found the following list to be very helpful factors, for me, in deciding when to seek new, nursing employment:

You:

• Dread going to work
• Can't wait for the weekend/vacation/a day off
• Have no desire to learn anything new and no longer take the initiatives to learn new things
• Feel like your job is a dead end and has no room for growth
• Don't feel like you are not making a difference or are not appreciated
• Get upset over the small things at work
• Feel like you are always overwhelmed
• Begin looking a other job opportunities
• Talk/think about quitting {even when you don't have other options lined up}
• Can't make financial ends meet
• Are okay with getting laid-off or a severance package
• Begin having anxiety attacks or health problems related to stress

I believe it is always best to make a list of pro and cons when considering if it time to look for another job, but the reality is you have to be happy in your role to make the greatest impact in patient outcomes and maintain your own job satisfaction. Ultimately I believe we have the answers on when it's time to move on, and once we trust ourselves the decision becomes so much easier. If you are seeking new, nursing employment or your time is now; GOOD LUCK, YOU CAN DO IT!

Please share other factors that alerted you of the need for a job change?