To attract registered nurses, big time signing bonuses along with flexible working schedules await applicants. Hospitals in Tennessee are in a competition of who among them are offering the best employment package.  Aside from being generous in terms of salary package, employers are re-inventing the conventional way of recruitment by scouting applicants and holding social based recruiting events on malls and other public places.  

An approximation of 800,000 to 1 million nurses are needed by 2020 due to the shortage of nurses, this was a previous forecast. Now, the estimated need may had lowered down to 350, 000 to 400,000, as noted by Joan Creasia—dean of the University of Tennessee College of Nursing that is due to the increase of nursing students and programs overtime. However, nursing schools, colleges, and universities are still facing the problem of increasing their capacity of meeting the over-all demand for health services since having the number is not a guarantee of public health. 

Furthermore, more than 2,000 aspiring nursing students had been turned down by colleges and universities in Tennessee due to insufficient number of nurse educators, classroom spaces and limited funding. Creasia said that among three applicants for the nursing program of UT College of Nursing, only one of them is being admitted in the university. For that fact, the University Of Tennessee Medical Center finds innovation necessary at the moment and should be implemented immediately to be able to address an additional 405 patients daily. This hospital had started the development of aggressive recruitment program to be able to employ not only an adequate number of nurse staff but also a skilled and competent nurse workforce.  

The emergence of online nursing degrees is also another way of dealing with the critical shortage of health professionals. Many hospitals running their nursing schools are offering distance learning nursing programs. These had provided avenues for students who want to earn a degree in nursing while working on their present career in the meantime. Hospitals in TN are also grabbing those nursing graduates who finished a nursing course based on a distant-learning environment.  

Giving you an overview of what safe staffing is all about, safe staffing ensures that the number of healthcare workers is proportional to the number and necessary needs of patients. The health team of a medical facility must be composed of multi-disciplinary health professionals in order to propagate a hazard free work place where patient needs are addressed and satisfied at all times.  

ANA claims that US legislators must come up with a legislature imposing staffing ratios based on the number of RN input required by patient’s needs. Thus, the organization proposed different strategies to assure sufficient nurse staffing. These are:

•   Nurse staffing plans – the number of RN input must be based on the specific and immediate health need of the patient along with other criteria.
•   Fixed mandated ratios – a fixed staffing ratio is set in the law. 
•  Combination of nurse staffing plans and legislated nurse to patient ratio – Information about nurse staffing must be made available to the public.

The American Nurse’s Association proposed a safe staffing approach that will caters to the specific needs of each unit based on the following considerations such as: 

1.  Patient acuity
2. Nursing staff experience
3. Mixture of skills of the staff
4. Available technology
5. Support services given to the nurses 

On top of this kind of safe staffing strategy, nurses are treated as professionals thus giving them to perform decision-making tasks suitable for the excellent delivery of patient care.

ANA had been devoted in their safe staffing advocacy. In fact, the organization is in partnership with the State Nurses Association in promoting legislation. They aim to make hospitals and other health care facilities responsible for implementing safe staffing plans through the power of legislation. One of the laws that ANA had been consistently supporting is the Registered Nurse Safe Staffing Act of 2007 (S.73/H.R.4138). This act has similar objectives and principle with that of the organization. They have similarities with that of the Principles of ANA on Nurse Staffing like the specific rationale of requiring hospitals to consult their direct-care nurses and to establish a safe staffing plan based on patient acuity, experience, skills, unit-level geography and circumstances.

In support with ANA, several US states had passed laws and guidelines of safe staffing in their own jurisdictions based on the principles of ANA.  Why not do the same at this point of time to make a difference in the healthcare system? Join ANA’s campaign for Safe Staffing now!

As said earlier, there were 2, 598 respondents who answered the survey questionnaires disseminated by the Harvey Research Inc.  Of the total sample, 1,910 nurses answered questions about their annual salaries while 1, 720 provided figures for the hourly wages based on a regular shifting schedule. The reader profile study yielded the following results that are classified according to Region or Location.
Southeast
Average Annual Salary: $57,261
Average Hourly Wage: $29.60

Florida
Average Annual Salary: $59,204
Average Hourly Wage: $30.00

IL/Chicago
Average Annual Salary: $58,810
Average Hourly Wage: $32.00

Midwest
Average Annual Salary: $53,759
Average Hourly Wage: $29.10

New England
Average Annual Salary: $61,707
Average Hourly Wage: $36.10

NY/NJ
Average Annual Salary: $73,630
Average Hourly Wage: $37.30

Philadelphia
Average Annual Salary: $61,719
Average Hourly Wage: $33.40

DC/MD/VA
Average Annual Salary: $63,920
Average Hourly Wage: $34.50

South Central
Average Annual Salary: $59,288
Average Hourly Wage: $28.80

Northwest
Average Annual Salary: $59,562
Average Hourly Wage: $32.90

California
Average Annual Salary: $74,950
Average Hourly Wage: $41.60

Heartland
Average Annual Salary: $52,771
Average Hourly Wage: $28.80

Southwest
Average Annual Salary: $59,562
Average Hourly Wage: $32.90

Basing on the numbers above, do you earn as much as the respondents earn?More than 14% of registered nurse has an annual income between $60,000 and $69,000.  Aside from the years of nursing experience, job description and nurse specialty, nurse’s salaries are also commensurate with their level of education. Thus, the higher degree of nursing you earned, the higher is your income. Also, geographic areas matters in determining the salary of a registered nurse. Most of the survey respondents across the United States are graduates of Bachelor of Science in Nursing. One third ( 33.2 %) of them has 20 to 30 years of experience in the nursing profession. Almost half of them, 49.7 % to be exact are working full time in hospitals while 13.9 % has a primary specialty in medical/surgical nursing.Based on the 75% people who responded the questionnaire on salary, $62, 618 is the average salary of an RN. Among those nurses who belong to this percentage are those RN who are providing direct patient care, nurse managers, nurse educators or staff developers, APNs/CNSs and nurse administrators.

How about you? Are you earning near those figures? Benchmark your nurse salary now.

• Establishing the composition and scope of authority for the board of nursing
• Defining the practice of professional, practical or vocational nursing and advanced practice nursingØ  Setting the requirements to obtain a nursing license
• Limiting use of the title, “nurse”
• Listing the grounds for discipline against a nurse’s license.

For all states to be uniform in their rules, a Model Nursing Practice Act was developed by the National Council of State Boards.The State Board of Nursing of each state takes the task of implementing and administering the Nursing Practice Act. This is the state governing body that is given the authority to implement the said law. It is then the nurse responsibility to be aware about their legal duty specified in the Act. There are regulations that apply to the healthcare profession that is not literally written in the Act. However, it is implied. Thus, all nurses must stay in compliance with them.

      Examples of these common legal duties are:

• Confidentiality Requirements
• Mandatory reporting of suspected child abuse

• Infection Control

Multiple States Licenses

In general, a nurse needs to acquire a license to practice in the state of his or her employment or where they are practicing the profession. Upon given the license to practice, a nurse is mandated by law to abide to the state’s laws and regulations governing them.For the cases of travel nurses, they normally have multiple state licenses. Therefore, they need to follow the Nursing Act of each state they are licensed. If a travel nurse is disciplined in a state due to infringement occurred in that jurisdiction, it is possible that all other states may impose another discipline to the nurse as an additional disciplinary measure. In other words, multiple states may impose penalties to a travel nurse who had committed a single violation.

Lately, a number of states signed the Nurse Licensure Compact that allows a nurse to practice nursing in multiple states with a single license. If you want to know who among the states entered into this agreement, you may visit the website of the NCSB. Since the nurse is bounded to the Nursing Act of the state of employment, all complaints against the travel nurse is addressed by the state where the violation happened. However, his or her home state must also be informed about the violation.

Ignorance of the Nursing Practice Act is not an excuse. Thus, aside from being knowledgeable, as a nurse, you need to be aware of recent amendments of the law if there are any to avoid committing violations in the future.

The nursing career had expanded through time to different specialties for the benefit of people needing various types of nursing care. Aside from the popular nurse practitioners, or nurse anesthetists, travel nursing is a fast-growing nursing job today. This is presently the newest type of nursing practice in order to accommodate patients who are residing in varying areas in the United States of America. Travel nurses are convenient for patients who find relief in their own homes rather than staying in the hospitals for recovery. In return, nurses who are in travel nursing are seeing a more promising career.

In travel nursing, RNs has equal chances of making a name in the field of medicine. It is a type of job where workers have the opportunity to explore the world, meet different people and adapt in a community of diversified culture. By doing so, a part from delivering quality care to the comfort of their patients, they gain memorable experiences that had been a learning process for them. Of course, travel nurses get a more competetive salary than an average registered nurse.

Though women dominate the population of travel nurses in the U.S, men RNs too has equal opportunity in this type of nursing practice. All it takes to be a travel nurse is to complete proper travle nursing training program. The training program will equip you with the appropriate skills and knowledge that a travel nurse should have in order to perform well its task for the benefit of patient’s health.

Today, there are many travel nursing agencies who are recruiting travel nurses to staff different clients from all geographic areas in the United States and around the globe. They offer signing bonuses to qualified candidates. As soon as you start working as a travel nurse, you will be enjoying the perk of your career with attractive salary, benefits, bonuses, and allowances to cover expense of your travel.

Permanent Residency (Green Card) 

A foreign RN is allowed to work in the U.S. under an immigrant status through sponsorship. By having a green card, an RN can even sponsor his family in the long run. However, there are cases wherein the family can go at the same time with the nurse provided that it is in the contract agreed upon by both the nurse agency and the applicant. 

II.            NON-IMMIGRANT VISAS 

TN Status for Canadian Citizens

 The NAFTA or North American Free Trade Agreement permits Canadian nurses in a simplified US entry. NAFTA states that all TN visa applicants must meet the criteria or credentials   to be considered as a professional. The credentials are established if a foreign RN has a state or provincial license to practice in the intended state of employment. The TN status will only be granted after such license is acquired. Under the TN status, entry to the US may be permitted with a temporary or interim license. Workers wishing to enter the US under a TN category can even submit a TN application at their port of entry prior to finally stepping on the US land. All it takes is a properly completed application and the worker will just hang for minutes to know the result.

TN workers are given an initial stay of one year in the US which can be extended upon request.

H-1B Visa for Non-Canadian Citizens

 All other nationalities seeking employment in the US qualifies for the H-1B category provided that he or she will work in the “specialty occupation.” Also, the job must show that someone in specialty occupation must fill it. If it does, the H-1B worker must also satisfy the job qualifications and requirements.The nursing occupation is considered as a specialty occupation. Thus, a foreign nurse must possess the following before he or she can be eligible to H-1B visa. a.    full state licensure, if required b.    either of the following:                                       i.        completion of a bachelor or higher degree (or its equivalent) in the specific nursing specialty; or                                     ii.        experience in the specialty equivalent to the completion of such degree and recognition of expertise in the specialty through progressively responsible positions relating to the specialty.Before a U.S. employer can hire an H-1B nurse worker, his or her compliance to labor requirements is a must. One of these labor law is that the employer must give higher compensation to the h-1B worker than those workers of the same job and it must be higher than the prevailing rate in the area. This type of visa has initial validity of up to three years and can extended for a maximum of three years with a maximum stay of six years in the U.S. Before the worker can apply again for the H-1B visa, a one year absence in the U.S. is necessary.

Ample Nursing Experience 

To be able to establish a life and career in the US as a nurse, you need to have ample experience in the field of nursing preferably in acute care environment in your own country. A minimum of one-year experience is a must before any foreign nurse can practice his or her profession in the US. Nurse staffing agencies assess the qualifications of any foreign nurse applicant and offer them programs that matches their nursing education and experience as a process of their employment as a nurse in America.  

Pass the NCLEX-RN Examination  

Before you can legally work as a nurse, you must be able to acquire a license to work. Passing the NCLEX-RN Exam will guarantee you a unrestricted RN license. You don’t actually need to fly to the US to review and to take the test. Several programs are available in most countries that cater to the needs of nurses who wanted to acquire a US nurse license. International testing centers are also located in London, Seoul, and Hong Kong, thus, you may take the exam in any of these locations that is nearest you if taking it in the US will give you constraint. Visa  

A nurse staffing agency may give visa sponsorship to qualified applicants who have earned a US Registered nurse license through the NCLEX to finally legalize their employment. Qualified applicants may be granted a Permanent Residency Visas or Green Card where they can take their immediate family members.  

Job Placement 

The nurse agency who had sponsored the visa will find an appropriate work setting for you. Your nursing clinical skills will be a very big determinant whether you will be placed in top caliber American hospitals or to other work settings. Of course, your work preferences and location will also be considered aside from your skills and experience.   On the whole course of your partnership with any nurse staffing agency, you will be awarded with competitive salary and benefits. On top of it all, most nurse staffing agencies provides refresher’s course and continued nursing education for the propagation of competency and professionalism among their employees.     

•  
  • ·         Orthopedics
  • ·         Neurosurgery
  • ·         Vascular Surgery
  • ·         Ob/Gyn Cases
  • ·         General Surgery

Hospitals are employing an increasing number of CRNAs to complete their medical team. The more that a hospital is in a rural community, the more they recruit for CRNAs. Aside from becoming employed, CRNAs can also practice their profession independently.  As long as you meet the requirements, considering a nurse anesthesia specialty is a great option for career advancement in the field of nursing. Just scout for the best CRNA program and be licensed on the state and national board to kick-off a better career.    

 1.    Administration  and Office Management

In administration and office management part, you must define the operation control and management of the private duty home care. The role of every member in the administration department of the organization is identified. Example; Planning and on-going management is the task of the administrator. The office staff has the responsibility to maintain efficiency in the agency by updating schedules, updating time and cost of giving home services to each client.

 2.      Documentation and Record Keeping

State your standard operating procedures in all documentation and record keeping processes to be done. From the start of the admission of the client, up to his or her time of discharge, every documents involved must be well kept and maintained. Record keeping will help in assessing the health need of the patient since from time to time; every given care is being noted.

3.     Education

In the education part of the manual, educational programs to be given by the agency to its employees are discussed. Educational programs serves the rationale of giving continued education to staff in order to keep them competent and abreast to new health care developments that they can apply in their work settings.

4.     Finance

Provide information on how you will stabilize your finances. Your drafted financial plans and processes must be detailed in this chapter. This will serve as your guide in effective business planning and management.  Examples: Processes on business start-up, billing, collection, tax compliance and expenses monitoring

5.     Legal Issues

A part for legal issues must be included in the manual. In here, the services and/or responsibilities of both agreeing parties, i.e., the agency and the client must be well defined.  This will guarantee protection of the rights of the client during the whole course of receiving care from the private duty home care.

6.     Human Resources

Even a chapter for Human resources must be read in the manual. This states how employees are hired and how they are assessed. This will manifest how the agency values the needs and welfare of their clients through recruiting and hiring only competent and skilled health care professionals. The number of your staff must also be listed in this chapter in proportion to the number of clients for the purpose of effective care.

7.     Marketing

Information on business promotional activities needs to be discussed on the marketing chapter. Identify your marketing plan and strategies on how to draw clients.

8.     Quality Assurance and Risk Management

Strategies on how to maintain quality care and how to manage risks must also be defined in a quality assurance and risk management part of the manual. State your standards of quality care and how you are able to guarantee them.Example:  Infection control and disease prevention

• Hospitals
• Nursing homes
• Home health agencies
• Hospice
• Ambulatory surgical centers
• Renal dialysis facilities

 Furthermore, workloads of each health worker must be specifically defined and broken down. That is, to include the total hours of nursing care given by the RN, LPN or nurses aides to each patient on each shift. The health organization must also report about risk-adjusted patient mortality rates by identifying the statistics for these.  Transparency is always adhered in the act. The Centers for Medicare and Medicaid Services (CMS) would give public access to the report of each facility by publishing it on journals or on the CMS website. Also, these reports will be disseminated to licensing bodies of the state and to public and private accrediting organizations as their basis of granting license renewals and accreditation to these medical institutions.   Nurse staffing is indeed a sensitive activity in the health industry due to its impact on public health. Thus, adequate staffing should be guaranteed by any health-related business for them to justify their own objectives.