Substandard wound care can create legal risks for nurses

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Providing the best possible care for patients is the goal of every dedicated clinician.

Whether you’re an experienced or brand-new wound care nurse, are certified in wound care or not, work in acute care, long-term care or the ambulatory environment — you have an ethical and legal obligation to provide optimum care, along with personal pride in your practice.

Providing substandard wound care cannot only harm patients, it can result in a patient or family members taking legal action against you and other clinicians involved in the patient’s care plan. Another concern for clinicians is a new legal wrinkle some face when treating elderly patients.

Wound care also is an area of healthcare seeing a large increase in malpractice cases, Balestra said. Some of the high-risk areas usually examined in wound care-related cases include:

  • Treatment and care: Patient did not receive the appropriate treatment or care
  • Communication failures: Clinician to patient and family, or clinician to clinician
  • Medication administration: Failures in administering medication
  • Informed consent: Not obtained, and/or not charted
  • Documentation: Errors and omissions

Know your evidence-based treatments

Click here to download and read our wound care legal risks info graphic.

One way to expand your clinical knowledge and skill, according to Brent, is to become certified in wound care.

“Even if certified, it’s extremely important to keep up with the latest standard of practice by reading journals, taking relevant continuing education courses, and recertifying when required,” she said. “Once certified, you will be held to a higher standard of care. However, don’t be afraid to get certified, as it’s a badge of honor and shows a commitment to providing exemplary care.”

All wound care nurses, according to Balestra, should maintain their own professional malpractice insurance.

“Sometimes employers will want to settle a case you’re involved in to save themselves time and money – even if you did nothing wrong,” she said. “However, you may not want to settle. When you carry your own insurance, you can obtain your own attorney to represent you.”

 

Prescribe smarter with advanced practice nurse pharmacology courses

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Keeping up with the fast-changing medication landscape is important for nurses at all levels of care.

For advanced practice nurses, staying abreast of pharmacology is required, and nurse practitioners and clinical nurse specialists need to take an advanced practice nurse pharmacology course every two years to renew their licenses and national certification.

The rationale for requiring nurses to update their knowledge of medicines and be aware of trends in new drugs and biological agents is important, said one of our advanced practice nurse pharmacology course authors, Paul Arnstein, RN, PhD, FAAN, a clinical nurse specialist at Massachusetts General Hospital.

That importance is stressed by the lay media and direct-to-consumer advertising always touting new therapeutic options.

Drugs are always changing, and there are always new drugs coming to market. There are new black box warnings of existing drugs. There are new generics and therapeutic alternatives.

Older, unfamiliar drugs may make a comeback. Common medicines may be found to be unsafe or less effective than originally thought, or some may be repurposed for off-label uses.

Ketamine, for example, was used for a long time as an anesthetic. When using it in opioid-tolerant patients, it was found to be an effective analgesic at lower the dose of opioid needed to be effective.

Subsequently, it has been shown to be effective in low doses for intractable chronic pain, while another line of research demonstrates its utility for difficult-to-treat depression.

So, the rapid expansion of drug-related research is providing new insights into the potential effects and side effects of medications.

Cost is always a factor. Prior authorization is another. What often happens is patients who are prescribed medications in the hospital sometimes can’t get those medicines when they’re back in the community because of regulatory reasons or prior authorization.

In hospitals, there was an intravenous (IV) opioid shortage last year. Right now, there are immunoglobulin shortages and looming heparin shortages. That really creates a conundrum for prescribers trying to meet patients’ needs with different types or combinations of drugs.

What do nurses need to know about the opioid crisis?

Everyone’s concerned about the dramatic rise in opioid overdose deaths and the rates of opioid use disorder. Since 2012, we’ve seen a steady decline in opioid prescribing, which accelerated with the release of the 2016 CDC opioid prescribing guideline for primary care treatment of chronic pain.

Since then we’ve seen a 37% to 65% reduction in opioid prescribing. With regulators and payers codifying the guidelines as policy and going beyond the CDC’s original intent, many have stopped prescribing opioids.

This practice of involuntary tapers and abandonment has left many patients with no legitimate access to care or sub-optimal therapeutic alternatives.

What a lot of people don’t realize is that 0.02% of patients will die from opioids if they’re using opioids as prescribed, whereas 1% of patients who take nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen) will die of a heart attack, stroke or major GI bleed when taking these medicines as prescribed for a year.

In Massachusetts over the past two years, 90% of opioid overdose deaths had illicit fentanyl in their system, compared to 14% whose toxicology showed the presence of prescription opioid drugs.

There’s no perfectly safe drug. We have to view all medicines as a balancing act. How do we treat the disease or symptoms while also improving function and minimizing toxicity or the side-effect burden?

What should nurses know about newer biologic medications becoming available?

We’re seeing a rapid expansion of biologics, which raises a whole host of learning needs. As with any medicine, nurses need to understand the mechanism of action that may be more theoretical than factual. When biologics are manufactured and studied, researchers eliminate patients with comorbidities.

There are also some “me-too drugs” coming up in the form of biologics. They’re not being produced in the same way, and it’s really hard to say they are therapeutic equivalents.

There’s a growing appreciation that we need to study effectiveness trials in the real world, as much as we need to study and efficacy in carefully selected groups.

Effectiveness trials are needed that span several years to understand the late effects of specific drugs in real-life settings. This includes gaining a better understanding of both the desired and undesired effects.

 

Nurses ramp up efforts to lower U.S. cesarean rates

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In the United States, cesarean births have increased from 20% to 32% over the past 22 years.

The Centers for Disease Control and Prevention reports cesarean rates as high as 37% in states such as Florida and Louisiana. Studies also have shown rates vary widely from hospital to hospital.

While C-sections are medically necessary in some cases, researchers estimate that almost half of these procedures performed in the U.S. are not necessary.

Cesarean sections are not only more costly than vaginal births, but also increase the risk of obstetrical hemorrhage, anesthesia complications, injuries to the bladder, bowel and vascular system, postpartum pain and other problems.

The procedure also can cause placenta accreta — a serious condition in which the placenta grows too deeply into the uterine wall — in future pregnancies.

Several years ago, Lesser noticed more women were being referred to her hospital for abnormal placental attachments, and the perinatal team knew that avoiding the first C-section was one way to decrease the risk of these complications.

To tackle the problem, the team decided to steer away from elective inductions before 39 weeks gestation. Even for patients who reached this milestone, “we started asking ourselves and mothers whether we could wait a little longer for labor to start naturally,” she said.

They also stopped putting time limits on deliveries. Rather than giving mothers 12 or 24 hours to deliver a baby after their water membranes had ruptured, mothers could wait for labor to begin naturally while nurses regularly checked for signs of infection.

Lesser’s team also ramped up interdisciplinary communication between patients, nurses, neonatologists, anesthesiologists and physicians to ensure everyone was more aware of the mother’s progress throughout labor.

After implementing the new strategies, the overall C-section rate at the hospital dropped from 30% to an average of 25%. For first-time C-sections, that rate dropped to 13.5%.

The power of whiteboards

Improved communication between physicians, nurses and patients helped South Shore Hospital in Massachusetts reduce C-section rates. In 2018, the labor-and-delivery unit started placing a whiteboard in each room listing the mother’s birth plan, medical history and names of care team members.

This strategy is part of a new initiative known as Team Birth Project, a program that aims to improve the patient experience and provide a safe and dignified birth for all women.

The hospital also has started using an admission decision aid in labor and delivery, which helps providers decide whether to admit a laboring mother, send her home or move her to the early labor lounge. The lounge includes dim lighting, soothing music, birthing balls and other items that support the labor process.

Patients also are pleased with the changes, Powderly said. “In the surveys, patients are more specific than in previous years about what they appreciated, and people who have had multiple children here say the most recent birth experience was different,” she said.

If a patient is not coping, the care team can suggest non-pharmaceutical options such as yoga balls, an upright birthing chair or nitrous oxide.

Howard also started teaching a 10-hour workshop to train nurses how to promote relaxation, comfort and confidence in laboring women. Nurses learned how to use guided meditation, essential oils and acupressure.

The program, which launched two years ago, helped the hospital decrease the epidural rate in first-time, low-risk mothers by 20%, and the C-section rate 5%.

Aware that labor-and-delivery nursing can be emotionally and physically exhausting, Howard incorporated lessons on self-care and self-compassion into the training.

The nurses learned about deep breathing, guided meditation and how to be present themselves. So far, she’s trained 200 nurses, and participants describe the workshop as incredibly helpful.

“It’s been rewarding to see that nurses feel empowered because they have more techniques at their fingertips to create a comfortable space for patients,” she said. “It’s helping them reconnect to why they became nurses.”

 

Are surveillance cameras privacy issues in school clinics?

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A health services coordinator submitted a question about the use of surveillance cameras in school-based clinics.

She was concerned about surveillance cameras privacy issues on students and staff who seek medical care there.

In addition, the nurse was concerned that RNs working in the clinics were being constantly watched.

One ethical and legal obligation of RNs and school nurses who work with students is protecting their rights of privacy. I wrote about this topic in my blog, “When School Nursing and Student Privacy Laws Clash.”

Which laws apply to student privacy protection?

The 4th Amendment to the United States Constitution prohibits an “unreasonable search or seizure.” If either occurs, a warrant is necessary and based on “probable cause” when a student attends a public school.

The Health Insurance Portability and Privacy Act (HIPAA) and its Privacy Rule does not, in most cases, apply to a school setting — whether elementary or secondary school — because it is not a covered entity.

If it is a covered entity, the records kept about a student’s health information are an “education record” under FERPA and therefore not subject to the HIPAA Privacy Rule.

If a staff member bills Medicaid services for a student under the Individuals With Disabilities in Education Act, for example, that transaction must comply with HIPAA’s rule.

Surveillance cameras privacy issues in schools

According to the National Center for Education Statistics, more than 80% of public schools and more than 94% of high schools in the U.S. used security cameras to monitor students during the 2015-2016 school year.

Their use for these purposes have been upheld and determined not to be an invasion of privacy in locations such as classrooms, hallways and the perimeter of the building, according to National Center for Education Statistics.

Bathrooms and locker rooms — where an expectation of privacy is greater — create constitutional and general invasion of privacy difficulties.

Does school safety require cameras in clinics?

One answer that would justify their presence is the fact the clinic houses medications, including controlled substances, syringes and other healthcare equipment that could be stolen and sold.

The medications and equipment also could be used in an adverse way against students and school personnel if the school was taken over by an intruder.

Even if this were a strong argument for having cameras in school-based clinics, is it strong enough to override a student’s privacy?

How surveillance cameras co-exist with student privacy

Although FERPA does not directly address surveillance cameras privacy issues in the school setting generally or in a school-based clinic, it provides guidelines that can help use them in a responsible way.

The consent should be kept with the student’s education records, especially if the school system is the keeper and maintainer of the surveillance system.

For staff who seek treatment at the clinic, they need to know the policy and provide written, informed consent.

For both groups, the consent should include information as to who or what entities will have access to:

  • Any camera footage.
  • The roles and responsibilities of those who have access to the cameras.
  • How long any footage will be kept.
  • How any footage will be destroyed.

What about nursing staff surveillance?

Employers have been using cameras in the workplace for some time, and the courts have upheld their use there. Employer-based rationales include security and risk management.

Employee anxieties with electronic surveillance include a mistrust of the employer’s motives and a reduction in their privacy.

 

6 facts about pressure injuries nurses need to know

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Nurses are challenged every day to stay up to date, especially when it comes to wound care.

Whether it’s learning about a new treatment or product, the numerous wound types and multiple best practices, clinicians provide patients with the current standard of care thanks to a strong knowledge base.

Managing pressure injuries is something many nurses encounter regularly because of their pervasiveness across the healthcare continuum, whether that’s in home health, acute care or long-term care.

1 — Pressure injuries are dynamic

Click here to download and read our pressure injuries info graphic.

Care practices from the past, Wollheim said, may not be what is done today. And what is done today may not be considered a best practice in the future. Simply put, wound care is always changing.

One example is the timing of conducting a Braden Scale wound assessment for predicting skin breakdown in patients.

“For many years, the practice was to conduct a Braden Scale assessment within 24 hours upon admission to a facility,” he said. “The new guideline now is conducting a Braden Scale risk assessment within eight hours of admission. This is the new standard of care and the result of scientific findings that pointed out that 24 hours may be too late for some patients as necrotic tissue can present much sooner — and as soon as six hours. Timely administration of the Braden Scale, along with using it correctly, is essential.”

Another common wound care practice in years past was wet-to-dry dressings. This is now considered outdated and no longer considered the standard of care, Wollheim said.

2 — Terminology and documentation changes

Just as care practices change, so does healthcare terminology. And when clinicians are caring for wound care patients, using the current terms is essential to ensure proper required charting, according to Wollheim.

Pressure injuries used to be called decubitus or pressure ulcers. In 2016, the National Pressure Injury Advisory Panel recommended the name change to pressure injury.

Another recent change has been an update to the staging system of pressure injuries, along with their numbering. Roman numerals are no longer used. Instead, clinicians are now using Arabic numbers, Wollheim said.

3 — Pay attention to the healing rate of wounds

Nurses caring for a patient’s pressure injuries will want to monitor how quickly a wound is healing.

“We want a wound to heal as quickly as possible,” he said. “The goal is to see a wound reduce in its size by 50% (in length and width) within three to four weeks of initiating treatment,” Wollheim said.

So what if a wound isn’t healing as quickly as expected? At that point, a change in treatment should be considered.

4 — Use TCOM to predict who will likely respond to hyperbaric treatment

A new trend in wound care is the use of transcutaneous oximetry, also known as TCOM.

If the TCOM level is at 30, there is a good chance a wound won’t heal, according to Wollheim. But if the TCOM is 40 or higher, the wound likely will respond to hyperbaric oxygen therapy.

5 — Educate colleagues, as needed

When knowledgeable and certified wound care clinicians encounter an order for the wrong materials or treatment — or see a colleague practicing an outdated or unproven practice — be proactive in educating them, Wollheim said.

“When differences arise, it’s best to approach an ordering clinician or colleague in a non-judgmental and collaborative way,” he said. “You’ll likely get less resistance, and the other person may realize they can learn something from you.”

Another approachable method to help healthcare team members learn about wound care is to schedule lunch-and-learn webinars or educational sessions. These often can be provided by company reps for the various products used in your organization.

Promoting wound care dialogue also can be accomplished with monthly patient care meetings with all disciplines involved in wound care is another way to encourage a dialogue.

For example, ordering physicians, nurses, physical therapists, dietitians and even assistive personnel can be on-hand to collaborate with staff such as:

  • Discussing current treatment approaches
  • Making suggestions if something is not working
  • Ensuring everyone is using the same terminology

6 — Ensure everyone knows how to use new products

Changing from one brand of a wound care product to another can involve different sets of instructions for the use of each new product.

“Anytime you change brands, you need to make sure all staff know how to use the new products,” he said. “This may require an in-service to make sure all staff are on the same page and using the current products correctly — as the manufacturer intended — to achieve the best outcomes for patients.”

 

What Constitutes Unprofessional Conduct in Nursing?

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What does “unprofessional conduct in nursing” mean to you in relation to your own practice?

Many of you may respond that you rely on the phrase’s definition by referring to your state nurse practice act and rules for its meaning. Relying on your practice act and rules’ definition is correct. And ideally you should be able to cite examples of unprofessional conduct that the statute and rules include, such as:

  • Diverting controlled substances from the workplace
  • Practicing outside the scope of your employment and/or your scope of practice as defined by your state nurse practice act
  • Breaching nurse-patient confidentiality
  • Falsifying records kept in your nursing practice
  • Crossing professional boundaries
  • Being rude or insubordinate to others in the workplace

It is important to remember, however, that such examples are not all-inclusive, but provide instances where the conduct is seen as unprofessional. Unprofessional conduct in nursing is a broad term and is  also fluid, meaning other examples can be added to its overall definition.

Recently, the COVID-19 pandemic has raised many issues that you as a nurse have had to struggle with. Not only have you had to deal with workplace safety (PPE shortages), adequate staffing, and long hours, the media coverage has spurred additional distress for nurses and the public at large.

One particular problem has been the spread of misinformation and conspiracy theories about COVID-19. Often, these distortions are voiced by individuals and even state and federal government officials. The fabrications can be found on social media, blogs, at press conferences, and other media related forums. At times, the distortions of COVID-19 are asserted by medical professionals, including licensed nurses.

As a nurse, you are entitled to your own personal view of COVID-19, its effects, and its treatment. But you are also bound by your ethical and legal obligations not to disseminate misinformation.

Misinformation is defined in a 2021 policy statement published on the National Council of State Boards of Nursing (NCSBN) website as “distorted facts, inaccurate or misleading information not grounded in peer-reviewed scientific literature and counter to information being disseminated by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).”

The statement clearly says that U.S. boards of nursing, the profession, and the public expect that nurses “uphold the truth, the principles of the ANA Code of Ethics for Nurses, and highest scientific standards when disseminating information about COVID-19 or any other health-related condition or situation.” Not doing so, the statement continues, threatens public health.

The statement informs all licensed nurses that providing incorrect or misleading information to the public pertaining to “COVID-19, vaccines, or associated treatment” in whatever form, including social media, may face disciplinary action.

You may say this is an unfair approach to dealing with misinformation about COVID-19. You may also say that your First Amendment right to speak your beliefs are being infringed upon by boards of nursing. However, know that no federal or state constitutional right is absolute, including freedom of speech.

Your ability to practice nursing carries with it the obligation to conduct yourself in a professional manner at all times, whether at work or otherwise, and to provide competent and safe care to your patients.

Competent, safe care includes informing your patients and their families of vital and accurate information concerning medical and nursing treatment for their diagnoses and their well-being.  Because the public trusts you, they will more likely than not follow your recommendations or lack thereof.

Because of the obligations you took on when you were granted a license to practice nursing, you cannot share misinformation about any diagnosis or treatment. To do so may not only cause harm or death to those for whom you provide nursing services, it may also cause you to lose your job and the ability to practice your profession.

Moreover, it is your responsibility to correct misinformation about COVID-19 treatment, as many of your colleagues have done with patients and in wider audiences, such as social media blogs and webinars.

Think carefully about the ramifications of whatever information you impart to your patients about their care and treatment surrounding COVID-19 or any other malady to avoid being accused of unprofessional conduct in nursing.

 

Travel Nurses Need To Be Prepared for Anything

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Growing up in Nashville, Makaya Carter, BSN, RN, CCRN-CSC, always wanted to work in the medical field. She began her college career studying to be a physician but eventually chose nursing because of the one-on-one impact she could have with patients.

After working as an ICU staff nurse in her hometown, she had the urge five years ago to see more, thanks to a familiar TV show. “I watched a lot of ‘Grey’s Anatomy,’ and I thought, ‘How awesome would it be to travel and see the world and go to Seattle, maybe meet a McDreamy,’” she joked, citing the popular Seattle-based show’s fictional surgeon.

She researched how to become a travel nurse, reached out to other travelers she met as a staff nurse, and has now spent the past five years working various assignments on the East and West coasts.

“For me, it was more about the adventure, the experience, the opportunity,” said Carter, who currently works as a cardiothoracic ICU nurse in Seattle.

Besides appealing to nurses with a taste for adventure, becoming a travel nurse has plenty of benefits, most notably the recent pay increase sparked by the COVID-19 pandemic and staff shortages around the country. But being a travel nurse is not a walk in the park. Travel nurses, according to Carter, must be able to work hard, adapt quickly, be willing to learn, ask questions, and prepare to uproot themselves as often as every 13 weeks.

Challenges for Travelers

Having a good grasp of your personal finances is a must for travel nurses.

“One of the biggest things that new travel nurses are sometimes naïve about is the financial implications of being a travel nurse,” said Emma Pointer, a former travel nurse who now works as operations manager for Trusted Health, an organization that matches nurses with travel jobs. Pointer recommends that nurses have a savings nest egg before traveling. “At any point, this job could be cancelled. A start date could be pushed back. So be financially stable before you take that leap.”

Insurance and taxes also are potential issues. Carter said she prefers the convenience of getting insurance through her agency and noted that a tax adviser can be a big help. Her career began in Tennessee, which has no state income tax. When she arrived in other states, paying state taxes was an adjustment.

“Pay attention to your paycheck stubs,” she said. “Make sure you have all [documents] together when you file your taxes. It’s really important. If you need help, your company offers resources on its website on tax information and the type of insurance they provide.”

Updating Onboarding

In a 2019 study published in the Journal of Nursing Administration, researchers from Arizona’s Banner Health identified more streamlined, organized onboarding as an area of needed improvement.

The researchers surveyed 306 travel nurses across the country. The nurses said onboarding and competency assessment checklists should be specific to the unit and healthcare facility where they are working. In addition, information such as unit patient ratios, an onboarding schedule 7-14 days before an assignment, and access/login IDs on the first day of work are critical.

Carter encouraged travelers to ask how to obtain information regarding hospital policies, protocols, and procedures to review.

“For example, you may come from one hospital [which is] titrating a medication or doing a dressing change a certain way but learn it can be completely different at another hospital,” she said. “You may have more or less autonomy depending on the hospital, so it’s important to ask questions to protect your license and for patient safety.”

For nurses with a compact license traveling to a non-compact state, Carter stressed the importance of completing continuing education requirements in that state to maintain licensure “because some states, like California, require it for license renewal.”

Perhaps the most important advice is simple.

“Read your contract,” Carter said. “Read it all the way through. Know what you’re signing before you sign. You may be an ICU nurse that has to float to an acute care floor. Some people are refusing to do that, but per your contract, it says you may float. As a traveler, you have the opportunity to ask questions when you interview with the unit manager about floating, scheduling, patient ratios, etc. Never take an assignment you’re not comfortable with.”

Traits of a Traveler

Travel nurses constantly have to adjust in a new role and then move on, making an adventurous spirit and flexibility paramount.

Those traits will help travel nurses fit well wherever they go. “There can be some instability as a contracted employee,” Pointer said. “So definitely know what you’re getting into, be very well researched, be able to go with the flow and adjust where needed.”

Carter said her upbringing helped her successfully network at various stops and make plenty of new friends.

“Being from the South, we’re huggers and ‘bless your heart’ kind of people,” she joked. “When you are a travel nurse, you have to be adaptable and flexible. Have a positive attitude, a strong sense of teamwork, and a strong work ethic.”

Carter said traveling helped grow her confidence on a personal and professional level, so much so that current and former colleagues were among those who wrote recommendation letters for her recent acceptance to graduate school.

“As a traveler, you have to be comfortable with change,” she said. “Be open to learn because that is the only way you will evolve as a traveler.”

 

Three Nurses Challenge Former Employer’s Noncompete Agreement

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You may think that contract law does not affect your nursing practice, but that’s far from the truth.

In fact, contract law permeates nursing practice in many ways. For example, you can use contract law to challenge an employer’s breach of an express or implied employment contract if you were terminated from your position.

Another area where contract law and your practice can often intersect is when an employer requires you to sign a noncompete agreement (also known as a covenant not to compete), either as a stand-alone document or as part of an employment contract.

An employer sees a noncompete agreement as helpful in decreasing competition after an employee’s employment period is over — either by keeping you from sharing information with a new employer about your former employment or enticing your former colleagues to join you at your new place of employment.

However, many feel that such an agreement is in direct conflict with the valued U.S. principles of the right to make a living and free enterprise.

In the following case, three Wyoming RNs challenged the noncompete agreement they signed with their former employer, a home health agency, and became employed with a competitor.

Details on the Noncompete Agreement

The home health agency where the RNs worked required employees to sign a written noncompete agreement, which stated that:

  • They were at-will employees.
  • The agency had the right to hire or fire them at its sole discretion.
  • Post-employment restrictions were in place, including “directly or indirectly” competing with the business by providing home healthcare services “similar or to which could be substituted for [its] services.”
  • Restrictions were effective for 24 months after termination of employment and applied “in an area covering in all directions 50 miles from the office or locations” where employees worked.
  • Agency information was to be treated confidentially.
  • There was to be no solicitation of employees to work for a competitor.
  • The agency was authorized to seek an injunction if conditions were violated.

Two of the RNs were already employed by the agency when they were asked to sign the noncompete agreement. The third RN signed her agreement when she was hired.

After leaving this home health agency, all three RNs went to work for one of the agency’s home health competitors.

The former employer filed a lawsuit claiming the nurses violated their respective noncompete agreements and asked the court for a preliminary injunction prohibiting the RNs from working at its competitor during the litigation.

The nurses contested the injunction, arguing that the covenant not to compete was unenforceable.

The district court ruled that the agreement was “valid and enforceable” and prohibited the RNs from working at the competitor’s agency. The RNs filed an appeal of the ruling.

Appellate Court Rules in Nurses’ Favor

The appellate court carefully pointed out state law and court decisions surrounding covenants not to compete. Because freedom to contract and to work are in conflict with a covenant not to compete, a court must strictly interpret and closely examine any such covenant.

If a court determines that these principles are hindered, the restriction to compete must be declared void unless such a restriction is necessary for the reasonable protection of the employer.

A covenant not to compete is valid and enforceable only if it is:

  • In writing
  • Part of a contract of employment
  • Based on reasonable consideration (offering and accepting something of value)
  • Reasonable in duration and geographic limitations
  • Not against public policy

Additionally, such an agreement is supported by consideration when it is agreed to “contemporaneously” with the employment itself.

Here, the court held that the two RNs who signed the agreement after being employed by the agency for some time were not given consideration.

Separate consideration, in the form of a raise in pay or a promotion (as examples) is required. Continued employment is not adequate consideration.

Even though the third RN signed her agreement at the time of her hiring, which would satisfy the consideration requirement, the court evaluated the other factors required for an agreement not to compete to be valid and enforceable.

 

These Nursing Associations Connect You to Fellow Pros and Valuable Resources

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Regardless of specialty or skill level, nursing associations are an ideal resource for professional growth, networking, and lifelong learning. Associations exist for a variety of interests and career paths, and can help you connect with fellow professionals and obtain new certifications. Many associations offer research grants, scholarships, and award programs to help nurses recognize their peers. What are you waiting for? Join a nursing association and broaden your career today! We’ve made it easy with an extensive list categorized by specialty and state. Don’t see your association or specialty? Let us know in the comments and we’ll add it to the list!

Ambulatory Care

American Academy of Ambulatory Care Nursing (AAACN)

aaacn.org

Created in 1978 as a nonprofit educational forum, the AAACN works expand the reach of ambulatory care nurses to achieve a greater positive impact for patients. The organization offers several professional development outlets, including an annual conference, online resources, webinars, and a career center. The association also provides study resources and member savings on certification exams. Scholarships and grants are available to nurses and student nurses at multiple levels.

Anesthesia

American Association of Nurse Anesthesiology (AANA)

aana.com

Boost your learning and professional development with the CRNA Knowledge Network, offering CE courses and other resources. The association also offers volunteer opportunities and a Member Advantage Program with a variety of benefits, including savings on practice tools and student loan debt consolidation or refinancing.

Assisted Living/Rehabilitation

American Assisted Living Nurses Association (AALNA)

alnursing.org

Representing assisted living RNs, licensed practical nurses, and licensed vocational nurses, the AALNA works to promote safe, effective, and dignified nursing practice in assisted living, in an era when the number of older adults needing this type of care is increasing. Among professional development opportunities are an annual conference, webinars, and training resources.

Critical Care

American Association of Critical-Care Nurses (AACN)

aacn.org

The AACN promotes lifelong learning and professional growth. Members also grow professionally through national conferences, a webinar series, and certification programs geared toward nurses who care for high acuity and critically ill patients. The association offers continuing/professional scholarships  and a scholarship to attend the American Association of Critical-Care Nurses’ National Teaching Institute & Critical Care Exposition.

Dermatology

Dermatology Nurses’ Association (DNA)

dnanurse.org

Founded in the 1980s following the creation of the first education program for dermatologic nursing, DNA has a vision of becoming the global authority in the field. The nursing association offers certification resources, advice, and connections for professional growth. The association also provides awards to recognize fellow members as well as a scholarship program and grant opportunities.

Diversity

National American Arab Nurses Association (NAANA)

n-aana.org

Created in 2003, NAANA serves as a voice, network and resource for Arab American men and women in their pursuit of employment and advancement within the nursing profession. Members can earn contact hours at continuing education events and seminars, network, and access online job postings. The association provides annual scholarships of between $500 and $1,000, depending on funds available.

 

The Nursing Resume and Cover Letter: Make a Statement When Applying for a Job

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As your nursing career evolves — through different specialties, roles, skills, and achievements — so should your resume.

A strong resume tells the story of your path through the profession and showcases what you’ve learned and accomplished along the way.

Nurse.com compiled the what, how, and why of putting together a resume and cover letter that are sure to wow nurse recruiters and hiring managers.

Top Tips and Best Practices for Nursing Resumes

Each nursing job you apply for is unique. Make sure your resume matches the particulars of each job.

Target your clinical experiences and achievements to that specific opportunity and highlight how you fit in that organization. Do your homework on a facility by examining its website for information about its mission and vision. This will show your interest in not just a job, but also in becoming part of a facility’s culture and goals.

In its resume writing guide, Yale University’s School of Nursing offers these best practices:

  • Limit your resume to one or two pages, depending on your experience level.
  • Avoid packing in too much text, which will make it appear cluttered.
  • Focus on your accomplishments in previous jobs and clinicals, rather than just listing the duties of each position.
  • Use plenty of active words to describe how you analyzed, communicated, improved, collaborated, managed, assisted, created, etc., in your previous roles.
  • Share other skills and accomplishments that enhance your clinical knowledge such as different languages you speak, public speaking experiences, affiliations with professional or student organizations, knowledge of various software systems, etc.
  • As a last step, don’t forget to edit your resume, as well as asking a friend, colleague, mentor, or family member to look it over.

How to Structure Your Nursing Resume

When building a resume, start with who you are. List your contact information so a hiring manager can reach out directly for an interview. This also lets nurse recruiters know if you’re a local candidate.

The next sections include:

  • Introduction: This short section can include a career objective statement, no longer than three sentences, and a professional profile statement that describes what you offer.
  • Work experience: List all relevant jobs, even outside health care, that showcase skills such as communication, conflict resolution, educating the public and more. Do this in reverse chronological order.
  • Education: Explain your educational path and any unique career-focused experiences such as clinical rotations.
  • Certifications and associations: These will exhibit your interest in continuing education, along with a dedication to being part of professional nursing groups.
  • Volunteer work: Adding current and past volunteer experiences at a church or school or within your community shows your well-rounded interests in health care in and outside the workplace.

Are Cover Letters Still Relevant?

A cover letter might seem archaic to some nurses. In fact, a 2021 survey by ResumeGenius.com found that less than 30% of job seekers still include a cover letter with their resume.

With that in mind, including a cover letter automatically puts you ahead of 70% of the field when seeking jobs.

Think of it as a complement to your resume that acts as a sales pitch or a marketing tool to showcase your value. It also allows you to tell hiring managers why you want to work at their facility.

A cover letter offers you an opportunity to introduce and sell yourself as the candidate that a nurse hiring manager can’t do without. It is also a vehicle for you to share a personal story or experience that describes why you fit the qualifications of the role, while expressing your strong interest in the position.

The Value of Keywords

Because nurse hiring managers are trying to fill numerous positions at once, many rely on software known as an applicant tracking system.

This software scans resumes for keywords that fit each job. The best advice for nurse job seekers is to start with a healthcare facility’s description of the role it is seeking to fill. Look for important keywords and phrases — like patient care, patient education, leadership, and clinical research — and strategically add those if they’re not already there.

Another way to make sure your resume successfully makes it through a tracking system is to use an online optimizer, which will analyze your resume and offer suggestions on where you can improve its effectiveness. There are numerous free options online.

Social Media Snafus

Social media can be a great place to share your interests, professional achievements, and family fun. But there are also plenty of pitfalls for nurses.

Hiring managers often peruse the social media accounts of potential candidates. What are they looking for?

According to a 2020 Penn State University study, how you portray yourself on social media outlets such as Facebook, Twitter, Instagram, and TikTok could change how potential employers view you.

Researchers surveyed 436 hiring managers, including those from health care, to view a hypothetical job seeker’s Facebook profile. Among three categories that were judged by survey participants, the most negative perceptions were created by posts that exhibited self-absorption.

Researchers said results showed these candidates could be considered “less likely to sacrifice for the benefit of other employees and the organization.”

Negative perceptions among hiring managers also were tied to portraying oneself as being overly opinionated, defined by posting divisive subject matter that can be viewed as argumentative and less cooperative. The negative effects were least prevalent among hiring managers for social media posts that suggested alcohol and drug use.