Of course, when you’re in your scrubs and ready to tackle the shift, using mobile apps to get information on drugs to anatomy to conditions is a no-brainer way to better treat your patients and keep reference materials easily accessible. Here’s a look at 20 top clinical apps for nurses in 2012!

Not all of these apps are free, but when you think about the great services they provide—such as keeping you on top of ever-changing medical data—it’s well worth the money.

1. Davis Mobile NCLEX-RN Med-Surg: If you’re still a student and studying for your boards, this app will give you questions to answer while you’re waiting for the bus, sitting in front of the television or hanging out between classes. The convenience of questions by phone was unheard of only a few years ago. Now you can study in your downtime.

2. Pill Identifier by Drugs.com: Oh no! Your patient accidentally drop his pills on the floor. Unfortunately, you have no idea which medications they were! When you call the pharmacy for new ones, what will you tell them? Pill Identifier lets you look up pills by their common features to find out which ones you need to reorder.

3. Skyscape Medical Resources: This app is a great bundle of useful tools for nurses rolled into one. The free version includes comprehensive info on prescription drugs, a medical calculator by specialty, evidence-based clinical information on hundreds of diseases and symptom-related topics and timely content that nurses need to know on-the-go such as journal summaries, breaking clinical news and drug alerts.

4. Instant ECG: An Electrocardiogram Rhythms Interpretation Guide: With more than 90 high-resolution images of ECGs, this app is perfect for the telemetry nurse who often needs to interpret rhythms. Let’s face it, some of them are just plain tough to remember, and this app makes them easily accessible when you’re stumped.

5. Critical Care ACLS Guide: In addition to laying out the ACLS algorithms, this app has such helpful information as the rule of 9s for burns, chest X-ray interpretation and 12-lead EKG interpretation. This will come in handy for any nurse who is working in the ICU or other critical care area.

6. Fast Facts for Critical Care: In keeping with the critical care theme, this app offers even more in-depth knowledge you need when working in a critical unit. Based on the books by Kathy White, this app includes information on managing sepsis, heart failure and 16 classes of critical care drugs.

7. Pocket Lab Values: Sure, you have the lab values that come along with lab reports nowadays, but sometimes you aren’t at your computer to know the specific values of certain labs. This app helps with that by keeping you up to date on numbers, such as ABGs, lumbar puncture and immunology values.

8. Pocket Body: Musculoskeletal by Pocket Anatomy: For nursing students, memorizing the names of bones and muscles is often one of the most challenging parts of school. With this app, you will have the names and structures available to study—either on the job or when trying to prepare for that all-important test.

9. Sleep Sounds: Need to relax? On your lunch break, you can play the soothing sounds of a thunderstorm, the wind or a cat purring to calm your mind and escape from the rigors of the floor. Just don’t get too relaxed—you need to finish your shift!

10. IDdx: Infectious Disease Queries: This handy reference of more than 250 diseases allows you to type in the symptom of an infectious disease and see a display of all the diseases that contain that symptom. You’re sure to find the reason for your patient’s problem.

11. Harriet Lane Handbook: If you work in peds, this app is just the one you need. It focuses on the conditions of childhood, how to dose medications for children and immunization schedules. When working with kids, you have to know a different set of rules, and this is the handbook for that.

12. MRSA eGuideline: MRSA is a big problem in hospitals today, and you need to know the information that’s going to help keep your patients safe from this condition. This app talks about vancomycin dosing, drug information and how to deal with MRSA in infants.

13. Symptomia: This is another app that allows you to input a symptom, and it will return for you all possible diseases that have that symptom. It includes information on abdominal distention, vertigo and coughing, among other common symptoms.

14. The Color Atlas of Family Medicine: This app comes with a hefty price tag of $95, but is worth the investment for the full-color pictures on your phone or iPad that show common skin conditions, rashes and other conditions in a glorious multimedia presentation.

15. Anesthesia Drugs: Fast: If you’re working in the OR or studying to become a nurse anesthetist, this will come in handy for calculating your drug dosages. Simply enter a weight and the proper dose is given to you for a wide range of anesthesia drugs.

16. Med Mnemonics: We all need help remembering the vast amount of information that comes at us in nursing school and on the job. One of the easiest ways to remember is with mnemonics that help to jog your memory. This app lists all the common aides to studying in a simple format.

17. Heart Murmur Pro: The Heart Sound Database: Sometimes it’s hard to know what sounds are important when listening to the heart with your stethoscope. This app has a collection of the common and uncommon heart sounds so that you can learn to identify them.

18. palmPEDi: Pediatric Emergency Medicine Tape for the PICU, OR, ED: When working with children in critical care areas, you need to know the equipment sizes, drug doses and other peds-specific knowledge to act fast. This app puts all of that information on your phone and at your command.

19. Medscape: This app gives you the latest in medical news right at your fingertips. You can also look up unknown drugs, conditions and procedures directly from the app. The icing on the cake? It’s totally free!

20. Davis’s Drug Guide 2012: This is the go-to guide for nurses when they want to look up the actions of a medication. This app is a little more pricey than some other apps, but the fact that it is made by Davis and has such a great reputation as a guide for nurses makes it worth the price.

Source: Scrubs

The results will play a major role in determining how much insurers will ultimately charge consumers for these policies, which will be offered to individuals through so-called exchanges in each state.

The upshot: Many plans sold on the exchanges will include smaller choices of health-care providers in an effort to bring down premiums.

To keep costs low, the insurers are pressing for hospitals to grant discounts from the rates hospitals usually get in commercial plans. In return, participating hospitals would be part of smaller networks of providers. Hospitals will be paid less by the insurer, but will likely get more patients because those people will have fewer choices. The bet is that many consumers will be willing to accept these narrower networks because it will help keep premiums down.

Tenet Healthcare Corp., one of the biggest U.S. hospital operators with 49 hospitals, Tuesday said it had signed three contracts for exchange plans that would involve either narrow or “tiered” networks, in which people pay more to go to health-care providers that aren’t in the top tier.

Tenet said that in exchange for favorable status in these plans, it granted discounts of less than 10% to the three insurers, which it said were Blue Cross & Blue Shield plans covering 15 of its hospitals, or around 30%.

“It makes strategic sense for us,” said Trevor Fetter, Tenet’s CEO, in an interview. “There will be a market here, and it’s important for us, we believe, to participate in that market.” He said that insurers around the country have approached Tenet to discuss similar plan designs.

Analysts said Tenet’s disclosures, which came during an earnings call with analysts, are the most explicit from any hospital chain so far about how the negotiations are shaping up. “It’s the clearest statement they’ve gotten about exchange products, pricing and impact,” said Sheryl Skolnick, an analyst with CRT Capital Group LLC.

Exchange plans will take effect in 2014. In that first year, health plans sold on the exchanges could have 11 million to 13 million enrollees and generate $50 billion to $60 billion in premium revenue, according to an estimate from PwC’s Health Research Institute, an arm of PricewaterhouseCoopers LLP.

Stonegate Advisors LLC, a research firm that works for health insurers, has been testing clients’ plans with consumers in a mock-up version of an exchange, which is an online insurance marketplace. Marc Pierce, the firm’s president, says nearly all the products have included limited provider networks.

The tests have found that premiums are the most important factor in consumers’ choices, he said, with more than half typically opting for a narrow-network product if it cost them at least 10% less than an equivalent with broader choice.

Florida Blue, the Blue Cross & Blue Shield plan in the state, will offer plans with a “tighter, more select group of providers” in its exchange, said Chief Executive Patrick J. Geraghty in an interview. “We believe the exchange is going to be driven by price, and therefore we’re looking for a lower-price option.”

The insurer has already struck deals for narrow-network plans and will use those same terms for the exchange versions, it said. Florida Blue said it has been winning discounts of 5% to 10% off typical commercial rates from hospital systems, but getting breaks as high as 20% in some cases.

Plans with smaller choices of health-care providers are a big focus for insurers, partly because many other aspects of exchange plans, including benefits and out-of-pocket charges that consumers pay, are largely prescribed by the law, giving them few levers to push to reduce premiums.

“The need for a smaller network with lower pricing was critical,” said Juan Davila, an executive vice president at Blue Shield of California, which said it hopes to offer a preferred-provider-organization plan for individuals on the exchange. It would be built around a provider network around 40%-45% of its traditional PPO scope. Mr. Davila said Blue Shield had signed an exchange contract with Tenet but declined to comment on its terms.

So far, insurers and hospitals have sent differing signals on what kinds of discounts the hospitals might grant for the exchange plans, which would vary by market. Publicly traded hospital chains have said they are pressing to get paid approximately what they receive for traditional commercial health insurance.

Some insurers talk about steeper discounts from hospitals. WellPoint Inc. has said it is aiming to pay providers somewhere between Medicaid and Medicare rates, and sees talks trending toward rates close to Medicare. Medicare rates are often substantially lower than commercial prices. An Aetna Inc. official at an investor conference Monday suggested the rates might settle somewhere between Medicare and commercial.

For their part, hospitals have to weigh whether discounts they grant for exchange products pose a risk to the richer pricing they get for traditional commercial health plans, which include those now offered by employers.

Catholic Health Initiatives, a not-for-profit operator of 78 hospitals based in Englewood, Colo., said it is negotiating with insurers about exchange plans in around half of its markets, and insurers are often seeking to craft narrow-network designs.

CHI is taking a “conservative” approach and discussing “very modest discounts in exchange for a narrow-network opportunity,” said Juan Serrano, a senior vice president, in an interview.

Source: Wall Street Journal

The Joint Commission Alert urges leaders at hospitals to take a focused look at this serious patient safety issue. Over a recent four-year period, a U.S. Food and Drug Administration (FDA) database shows that there were more than 560 alarm-related deaths and The Joint Commission’s sentinel event database includes reports of 80 alarm-related deaths and 13 serious alarm-related injuries during a similar period. Patient deaths related to alarms on monitoring devices have also been the focus of national media attention and special reports by the Association for the Advancement of Medical Instrumentation (AAMI) and ECRI Institute. The Joint Commission, AAMI, ECRI Institute and American College of Clinical Engineering also brought together patient safety and health care experts at a 2011 summit to seek solutions to problems with medical device alarms.

Alarms are intended to alert caregivers of potential problems, but can compromise patient safety if they are not properly managed. Many patient care areas have numerous alarms and the barrage of warning noises tend to desensitize caregivers and cause them to ignore alarms or even disable them. Other issues associated with effective alarm management include too many medical devices with alarms or individual alarms that are difficult to hear.  Pre-set or default settings also may cause problems because the device sounds a warning even when no action or decision by a caregiver is required. Rather than calling attention to a patient’s needs, these settings may distract caregivers.

These issues vary greatly among hospitals and even within different units in a single hospital. Although there are many variables, the Alert makes it clear that in order to reduce risks related to alarms on medical devices, a series of actions still needs to occur related to people, processes and technology.

“Alarm fatigue and management of alarms are important safety issues that we must confront,” says Ana McKee, M.D., executive vice president and chief medical officer, The Joint Commission. “The recommendations in this Alert offer hospitals a framework on which to assess their individual circumstances and develop a systematic, coordinated approach to alarms. By making alarm safety a priority, lives can be saved.”

The Joint Commission Alert recommends that health care organizations take the following actions, which correspond with recommendations made by both AAMI and ECRI Institute:

• Ensure that there is a process for safe alarm management and response in areas identified by the organization as high risk.
• Prepare an inventory of alarm-equipped medical devices used in high-risk areas and for high-risk clinical conditions, and identify the default alarm settings and the limits appropriate for each care area.
• Establish guidelines for alarm settings on alarm-equipped medical devices used in high-risk areas and for high-risk clinical conditions; include identification of situations when alarm signals are not clinically necessary.
• Establish guidelines for tailoring alarm settings and limits for individual patients. The guidelines should address situations when limits can be modified to minimize alarm signals and the extent to which alarms can be modified to minimize alarm signals.
• Inspect, check and maintain alarm-equipped medical devices to provide for accurate and appropriate alarm settings, proper operation, and detectability. Base the frequency of these activities on criteria such as manufacturers’ recommendations, risk levels and current experience.

The Joint Commission Alert also recommends training and education for all clinical care team members on safe alarm management and response in high-risk areas. In addition, organizations should consider how to reduce nuisance alarm signals and to determine whether critical alarm signals can actually be heard in patient care areas. Seeking input from patient care providers, health care engineers, risk managers and information technology professionals, organizations should also establish policies and processes for alarm safety that include the regular review of trends and patterns that reveal improvement opportunities. Finally, the Alert urges organizations to share information about alarm-related incidents, prevention strategies and lessons learned with organizations such as AAMI, ECRI, the FDA and The Joint Commission.

Beyond the Alert, The Joint Commission is considering the possible creation of a National Patient Safety Goal to help health care organizations address this issue. A field review of the proposed Goal occurred in February and the public comments are now under review. The Joint Commission already has numerous accreditation standards in place related to alarm safety. The standards address issues such as leadership, the environment of care, provision of care and staff training and education.

The warning about medical device alarms is part of a series of Alerts issued by The Joint Commission. Much of the information and guidance provided in these Alerts is drawn from The Joint Commission’s Sentinel Event Database, one of the nation’s most comprehensive voluntary reporting systems for serious adverse events in health care. The database includes detailed information about both adverse events and their underlying causes.  Previous Alerts have addressed risks associated with the use of opioids, health care worker fatigue, diagnostic imaging risks, violence in health care facilities, maternal deaths, health care technology, anticoagulants, wrong-site surgery, medication mix-ups, health care-associated infections and patient suicides, among others. The complete list and text of past issues of Sentinel Event Alert can be found on The Joint Commission website.

Source: The Joint Commission

Health care workers are sometimes exposed to people who are ill with a vaccine-preventable disease or to contaminated blood and bodily fluids that could result in illnesses. Most health care workers are required to have proof of vaccination or evidence of immunity against several vaccine-preventable diseases to make sure they are protected and to prevent passing these infections to their patients.

An up-to-date vaccination record helps you and your doctors know if you’re protected against vaccine-preventable diseases. Can’t find your records? You’re not alone. The following tips can jumpstart your search!

• Check with your current and previous health care providers, including urgent care and public health clinics, or pharmacies where you may have received vaccinations.
• Investigate old family albums, baby book or family Bibles.
• Contact your college’s medical services department (student health).
• Review your military records.
• See if your state has an immunization registry.
• Check with your health insurance company to see if it has a record of your vaccinations. Often, medical records are passed from health care provider to insurer and then between insurers if you change medical plans.

Source: CDC

We live in the world of life and death. I don’t think anyone will argue with me on that. We can have many levels of definition when we are asked what a ‘bad day’ really is. In the end, we shoulder a lot of responsibility caring for our patients, and we sure don’t want to make ‘that one mistake’.We’ve all made mistakes. I know I have. Some small, some great, some breath-taking, and some are quite comical. At the end of the day we are all human right? Aren’t we entitle to tripping up once in a while?

I think it has a lot to do with HOW we learned of our mistake sometimes that can determine how that mistake impacts us. In nursing school I remember a patient of mine having an IV site issue. The nurse caring for him did some adjustments to his IV site. While addressing the IV, she raised the bed up high enough to be close to waist-height (more than likely to lessen the strain on her back while troubleshooting). That particular day it was my big day to hang my first IV. I got to prime the tubing, lock it into the IV pump and then attach it to the patient (I think we all remember that first time). I was nervous as all get out. I had followed the steps prior to entering the room. I rehearsed them in my head before I approached the IV pump. I check and triple checked the tubing. Reviewed the 7 rights, etc., etc.

I successfully hung the med and had it infusing properly with no alarms and no messes! When I was getting read to leave the patients bedside, my nursing instructor asked if I forgot anything? Silently in my head I panicked and retraced all my steps four more times. Check, check, re-check.

I paused before answering no, that everything was fine.

The nursing instructor asked me a second time. I re-traced my steps, 4 more checks over my work. I replied again with an ‘Aye-oh-OK’ response.

This dialogue happened two more times before the patient finally looked over at me and kindly (and jokingly) said, “She’s obviously trying to tell ya something”.

I still for the life of me couldn’t figure it out??

My instructor kindly replies, “Well, good job on the IV, but if Mr. Smith wants to get out of bed to use the restroom or anything else he’s going to have to jump (and maybe fall).”

I looked at the bed – and it was still at waist-height! I got so involved in my task that I forgot that the nurse had raised his bed for that IV site troubleshoot!

I was mortified. I had missed something so basic, so simple, yet SO very important. To this day I tell that story to any and all that will listen. I have never left my patient’s bed at an unsafe height. Every time I leave my patient’s room I always, always, always lower the bed to its lowest setting. The way I learned that lesson has remained engrained in my brain.

I’ve made many more mistakes since then. Some even more comical, and some down right scary. I once entered in the wrong infusion settings for a narcotic medication for a patient. I transposed concentration and total amount of drug settings on the IV pump. Lets just say, thankfully the patient was intubated and the mistake was found quickly.

So back to my original statement : What is the one mistake every nurse shouldn’t make??

The mistake that they do not learn from.

Learning from your mistakes is the single most important process of growing and maturing as a practitioner. Not learning from a mistake will set you up to make that same mistake again.

Be sure to learn from all your mistakes, no matter how great or small, your patients will thank you for it.

We crunched the numbers with guidance from medical advisors, emphasizing treatment-success rates, research studies, and doctors’ experience. Where there was a close call, we gave the edge to hospitals that provide extra TLC for families of outpatients and inpatients: private NICU rooms, play areas that are open 24/7, and music and art therapists to hang out with kids. Whether a child needs a cast for a broken arm or a bioengineered cancer drug, an asthma inhaler or a double lung transplant, these top hospitals have children covered — and then some.

1. The Children’s Hospital of Philadelphia

2. Boston Children’s Hospital

3. Cincinnati Children’s Hospital Medical Center

4. Children’s Hospital of Wisconsin, Milwaukee

5. Children’s Hospital Colorado, Aurora

6. Children’s Hospital of Pittsburgh of UPMC

7. Texas Children’s Hospital, Houston

8. University of Michigan C.S. Mott Children’s Hospital, Ann Arbor

9. Nationwide Children’s Hospital, Columbus, Ohio

10. Ann & Robert H. Lurie Children’s Hospital of Chicago

Source: Parents.com

Center for Disease Control Director Thomas Frieden said “reductions in some of the deadliest health care-associated infections are encouraging, especially when you consider the costs to both patients and the health care system.”

U.S. hospitals reduced some types of deadly and costly infections in 2011, three years after a government initiative to cut hospital-acquired illnesses.

Infections stemming from catheters placed in a large vein in the neck, chest or groin to give medication or collect blood declined 41 percent from 2008, the Centers for Disease Control and Prevention said today in a report. Infections following surgery decreased 17 percent since 2008, the CDC said.

The Department of Health and Human Services set a goal in 2008 of reducing the catheter or central line-associated bloodstream infections by 50 percent and surgical site infections by 25 percent, the CDC said in a statement. About 1 in 20 patients gets infected each year while receiving medical care, including 41,000 bloodstream infections that strike hospital patients with catheters, the Atlanta-based health agency said.

“Reductions in some of the deadliest health care- associated infections are encouraging, especially when you consider the costs to both patients and the health care system,” CDC Director Thomas Frieden said in the statement.

CDC uses data from its National Healthcare Safety Network, which collects information from more than 11,500 health-care facilities in the 50 states, Washington, D.C. and Puerto Rico.

The data showed hospitals improved their procedures, reducing catheter-associated bloodstream and surgical site infections at a faster rate than in 2010. In 2010, catheter infections decreased 32 percent from 2008 while surgical site infections declined 7 percent.

Hospitals made a 7 percent reduction in catheter-associated urinary tract infections from 2009, the same percentage as reported in 2010, CDC said.

Looking back to when I was in nursing school, and then starting my nursing career, I remember many things that are no longer in use, or things that have transformed over the years. Gone are the days of paper chart, replaced with electronic medical records. Gone are the nursing caps that distinguished the nurse from the rest of the healthcare team.

Here is a partial list of things I remember from days gone by.

Back in the day…..

• Team nursing
• Primary care nursing
• Longer patient stays (Patients were actually able to recuperate in the hospital rather than being sent home too soon. There was no such thing as same-day surgery.)
• Nurses wore uniforms which consisted of white dresses, white hose, white lace up oxford shoes, and, of course……….white nursing caps!
• Only OR staff and physicians wore scrubs.
• The Kardex, a large folded card, was used as an important document of all patient activities, meds, etc. And it was hand-written in pencil so it could be erased and updated as needed. Talk about document tampering!
• Requisitions were composed on a typewriter.
• Patients were called Mr. or Mrs.
• Gloves were used for sterile procedures only. Universal precautions did not exist.
• The only lifting machines we had we male aides…….and of course ourselves.
• Nurses bent and broke off needles from used syringes
• IV pumps were used only in Peds and ICU. Nurses had to calculate the drip rate using the second hand on their watch and a roller clamp to regulate the flow.
• Heavy glass IV bottles were still in use
• The charge nurse made rounds with the doctors……..and carried the heavy metal charts.
• When a doctor arrived at the nurses’ station, it was expected that a nurse would stand up and offer her seat….and the doctor never refused
• Male nurses were very rare
• Cold metal bedpans were offered to patients.
• All patients were offered a daily bath and back rub
• There were no fitted sheets. Remember hospital corners??
• Glass thermometers were still in use.
• Nurses notes and vital signs were recorded using pen with 4 colors of ink as different colors of ink were used on different shifts. Actually only 3 were used since there were 3 shifts.
• Surgery patients were admitted the night before surgery so their preps could be started that evening.
• Nurses smoked in the nurses’ lounge.
• Cancer was most always a death sentence
• Medicine was dispensed by the med nurse carrying a tray with small paper cups of pills and different colored med cards.
• Four-year BSN programs were not as plentiful. Most nurses graduated from hospital-based Diploma or ASN programs.
• State boards were 2 grueling days of exams that were completed with number 2 pencils. No computerized tests in those days.

Feel free to add items that you remember from the past, even if that past does not seem that long ago. Changes are occurring at an even faster pace in the digital and electronic age of today. What do you think of some of the changes???

Source: Allnurses.com

I knew it was too good to last forever.

Today, in a meeting with my company’s regional director of operations and the corporate nurse consultant, my Executive Director and I learned that we will both probably be let go if our building doesn’t pass our re-survey next month. We got our butts handed to us during the exit interview last time, and we’ve had some challenges that have put us behind schedule in getting the new programs up and running in response to the problems found during the inspection. The timing couldn’t possibly be worse; we expect the survey team back at any time after the first week of March, and we simply aren’t finished fixing everything, let alone learning how to use all the new paperwork that Corporate put in place to address the documentation issues.

Neither of us was surprised; we’re both longtime directors, and this is a place we’ve both been before. The proverbial handwriting is on the wall.

Still, the discussion had a surreal quality to it, especially before my boss was summoned to join the RDO, corporate nurse and me in my office. The RDO sat down in the floor supervisor’s chair and gazed straight at me with his head cocked to the side, looking for all the world like a certain physician I see fairly frequently, and asked me the same type of questions Dr. So-and-so always does.

“Are you OK?” he wanted to know, speaking in a tone that was more concerned than condemning. “How are you doing? I mean, how are you really doing.” He was to repeat these queries at several more junctures during the conversation, which made the hair on the back of my neck stand up. I have never felt the need to inform Corporate about my personal health issues, but I got the sense that he knew everything and was just waiting for me to come clean.

Fortunately, this was NOT my first rodeo, and since I don’t use my ‘nonconformity’ as an excuse for being remiss in my duties, I said nothing along that line, only that I’m very stressed out and frustrated at the circumstances under which I’m working at this point.

Which brought to mind something I promised myself back in 2010 when I realized that I’d lucked into the best nursing job ever: that this was it. This was the job I would retire from. Little did I know that this statement would come back to haunt me as I approach late middle age and realize how great are the odds against finding another nursing job. Especially one I can actually handle.

I’m old. I’m tired. I’m cynical. I’m a train wreck, both physically AND mentally. And I’ve decided that if I do end up in the unemployment line, I’m done.

As much as I’ve loved nursing, I know my days are numbered even if I do squeak through this crisis. I’m far too prickly now to just stand back and co-sign people’s BS. I’m easily distracted and tend to lose focus when faced with piles of paperwork. I’m quickly overwhelmed, and easily undone by the stressors inherent in the work. Plus, I’m at an age where it’s time to think about what I want out of my later years. Hmm, let’s see….should I enjoy my home and family, or would I rather go on forever with the 50-hour weeks? And how long will my mind and body hold out if I continue to put myself through this day after day, month after month, year after year?

I don’t know.

What I do know is, I need a Plan B. Of course I’ll continue to work hard at keeping my job, because I really do enjoy it a good portion of the time (and the pay isn’t half bad either). And if I do come through intact, I’m staying where I am until I can’t take even one more snotty patient or irate family member. But I am just not going to put myself through another round of interviews for nursing positions…..if I can even get them, that is. I have an associate’s degree, bad knees, and flat feet that can’t run the floors anymore. A few years ago I could, and did, get away with it because my experience was so varied; now it’s a different story, and with my lack of advanced education I’d be lucky to find a swing-shift job in a nursing home. Which I can’t do. Great.

So, to assist me in redirecting my energies, I’d like to know what you all think would be a good job for me. I mean, besides Wal-Mart greeter (which I don’t think they even have anymore) and carnival barker. What do you think I could do that would make me reasonably happy AND keep my husband and me off the streets? I don’t need a career anymore, but a job paying a living wage is a necessity.

I look forward to your responses. (Friendly reminder: they do need to be in reasonably good taste, of course.) Thanks!

Source: Allnurses.com

Registered nurses fresh out of school are coming across thousands of job postings with an impossible requirement: “no new grads.”

It’s a problem well documented by the nursing industry. About 43% of newly licensed RNs still do not have jobs within 18 months after graduation, according to a survey conducted by the American Society of Registered Nurses.

“The process has become more and more discouraging, especially since hospitals want RNs with experience, yet nobody is willing to give us this experience,” said Ronak Soliemannjad, 26, who has been searching for a nursing job since she graduated in June.

New grads have taken to posting their frustrations on allnurses.com, a social network for nurses.

“It is a tough market for a new grad RN. A ‘year experience required’ or ‘not considering new grads at this time’ is pretty much the norm,” wrote one.

“It’s like new grads have a disease or something,” said another.

How can this be, at a time when health care jobs are booming and a supposed shortage of RNs sent many career seekers running to nursing school?

The recession is to blame, says Peter Buerhaus, a registered nurse and economist who teaches at the Vanderbilt University School of Nursing. In a paper he co-authored in the New England Journal of Medicine last year, he shows an interesting phenomenon happens in the demographics of the nursing workforce when the economy is weak.

About 90% of nurses are women, 60% are married, and roughly a quarter are over 50 years old. It’s typical for many nurses to take time off to raise children in their 30s, and given the long days spent working on their feet, many often retire in their late 50s.

Prior to the recession, about 73,000 nurses left the profession each year due to childbearing, retirement, burning out or death.

But when the recession hit, spouses lost jobs, 401(k)s lost money, and facing financial uncertainty, fewer nurses chose to leave work, Buerhaus said.

“Many of those nurses are still in the workforce, and they’re not leaving because we don’t see a convincing jobs recovery yet,” Buerhaus said. “They’re clogging the market and making it harder for these new RNs to get a job.”

Related: I can’t find a nursing job!

At the same time, enrollment in nursing colleges has exploded in recent years. In the 2010-2011 school year, 169,000 people were enrolled in entry-level baccalaureate nursing programs. That’s more than double the 78,000 students from a decade earlier, according to the American Association of Colleges of Nursing.

There just aren’t enough jobs to go around for all these new grads.

Annah Karam heads recruiting for six hospitals in the Daughters of Charity Health System in Los Angeles. Each hospital has a program in place aimed at hiring at least 10 new grads a year, but the competition is fierce. Karam often receives more than 1,000 applications for each post. For other positions, the hospitals prefer experienced nurses.

“We’re new grad friendly but with the challenges we face in the hospital world, we often need seasoned nurses,” Karam said. “We hire thousands of nurses across the whole system, yet a very small percentage are new grads.”

Eventually, nursing grads should have great job prospects.

Demand for health care services is expected to climb as more baby boomers retire and health care reform makes medical care accessible to more people. As older nurses start retiring, economists predict a massive nursing shortage will reemerge in the United States.

“We’ve been really worried about the future workforce because we’ve got almost 900,000 nurses over the age of 50 who will probably retire this decade, and we’ll have to replace them,” Buerhaus said.

But for recent grads like Soliemannjad, that’s not particularly encouraging.

“It just seems that when the experts talk about the economy getting better, they’re not talking about it improving in two or three months. They’re talking about years,” she said. “You have new grads with student loans to pay off. We simply can’t not work for another year and half.”