Questions

[Q.]

Ok everyone.

I was just talking to my cousin who's been a nurse for about 10 years or so. She's your hard core med/surg ICU nurse. I was talking to her about how I hate my current job that I'm in (research) and am in school now for my MSN in Nursing Education and would love to work as a CNS at this particular hospital that I applied for.

This particular hospital is an inner-city, high risk population. The CNS job is in OB. I have 5 years OB experience with moderate to high risk, but not inner city. I was telling her how I don't mind high risk but don't necessarily "like" the high risk patients; I don't know if I am explaining this right. But basically she told me I'd be doing a disservice to the patients if I were the CNS because I don't really prefer that population. Now I feel guilty. Is that true?

I mean, I love OB and love labor patients - I love labor and delivery and love the high risk preterm stuff. In fact pre term labor is my forte. But every job has it's aspects that is crappy and L&D's is drug addicted moms. Would I be a bad CNS in that hospital?

[WashYaHands]

Suzy,

I don't think you'd be a bad CNS in that hospital, however, one of the roles of a CNS is that of patient advocate. It might be difficult to be an advocate for a population if you reserve personal judgment regarding their lifestyles. This is not to say that you agree with moms using drugs, but can you genuinely advocate for and support these moms (including using tough love)? I suppose it depends on how you feel about drug addicted moms who are more than likely low income (possibly welfare), and will those feelings interfere with your ability to adequately do the job?

One other thing you may want to check on is if there is title protection for the Clinical Nurse Specialist in your state. If there is, it would be illegal for you to practice as a CNS without registration or legal acknowledgement by your State Board of Nursing, much like a student nurse using the title RN before graduation. The reason I bring this up is because if you do not get this job, it doesn't reflect on your ability, only the technicality of the law.

Wish you luck with it,

Linda

[Q.]

I don't think in Wisconsin you have to be certified; we were actually just talking about that in school. Here, it's a title and that's that.

I see what you mean about being a patient advocate, and I've done that numerous of times for patients that my cousin might think I don't "like" (as in welfare moms, drug use, etc) and I guess I just feel like I can be an excellent nurse for them, advocate for them, teach staff nurses to do their best, all while wishing that there never were high risk deliveries or situations like that to begin with.

Am I making sense?

[WashYaHands]

In Colorado you don't have to be certified either. But, you cannot use the title unless you are listed on the advance practice registry with the state Board of Nursing. the title, CNS, is legally protected by statute, as is the title RN. Might be different where you're from.

Perhaps what your cousin was trying to say was to really examine your philosophies, beliefs and value systems before you get into a job that you may not agree with, and then be miserable in. As long as you believe that you'd be a great nurse in the job and the position interests you, go for it. :)

Linda

[live4today, RN]

Linda, you've already said everything pertinent to Susy's questions regarding working as a CNS in an inner-city hospital that I would have said myself. You said it so well, too, because it is a very important aspect of care to be considered by any nurse or other health professional who may consider taking a job in an area that may cause "indifference" or a possibility of "judging" one's patient population based on their "lifestlyle choices".

I had the opportunity to interview (years ago) for a health department job working with OB patients in an inner-city low income area, but did not take the job for the very reasons mentioned here. The first thing the Nursing Director of that Health Division said to me was she didn't think I had the "background or the lifestyle" to master dealing with that particular population because I had grown up in a middle class suburban environment that was predominantly white, plus I've also lived that lifestyle while raising my own children.

Once I heard her version of what I woud be up against, etc., I had to agree with her on everything. Even though my heart was in the right place, I would not have been doing those moms in the inner-city low income environment any good whatsover, so I respectfully bowed out of the opportunity to work with that population.

That was a first experience for me as I had never come up against anything like that before, so I must state that it certainly opened up a train of thought for me that had not presented itself before.

Looking back in hindsight, could I take a job like that today?

I don't think so. I was right to decline taking a job like that because the job was not about me simply being able to be a nurse with a good heart and good intentions. The job was about being able to give those moms something they could relate to and feel "at home" with. I may have intimidated them with my "upper middle class" status. I could NOT relate to their lifestyle since I never had to live the life they did.

So, for what my sharing of my own personal experience with this was, I hope it broadens the train of thought for those considering undertaking a job like this, or in working with innercity clientele in any area. Unless you can relate........decline for their sake....IMHPO.

[whipping girl in 07, RN]

Renee, while I agree that you need to be able to relate to your patients to be able to be a good advocate, I do not think that you need to have lived it. The inner cities have tended to be a vicious cycle of young single mothers who raise children with no education and therefore no jobs. Then the kids grow up and start the cycle all over again. If we rely on the few who've "been there, done that" and managed to get out to fulfill all the needs of this high risk population, they will continue to be underserved.

Now, if you look within yourself and know that you could not do it, then you're right, you are doing them a disservice if you try. But if you believe you can truly be a patient advocate without having been there, then by all means go for it. I take care of patients every day that are severely ill, that may be dying, that have bizarre family dynamics, all without having ever been there myself. I console family members who've lost a close family member without having lost anyone closer than a grandparent. Suzy worked in L&D but does not have any kids herself. I'm sure you've worked in areas in which you have no personal experience, but you've managed to take excellent care of your patients. I know this because I've seen the compassion you've shown to people on this board.

Just my humble opinion.

And I'm glad this forum was started, as I'm really at a crossroads when it comes to career choices.

[Q.]

Great responses you guys.

Actually, over a big bowl of chili and tall glass of beer last night, I went over this with my husband. Interestingly enough, if you were to look at my CV, most of my "bigger" accomplishments have been around underserved populations.

What my husband stated, and I agree with, is that you can separate out the condition from the patient, meaning, you can care for and provide the best nursing care to a drug addicted mom, all in hopes of saving HER life and the babies, but at the same time not personally like the PATIENT. And I agree with him.

I've taken care of a no-name grand multip who didn't even know where her other 10 kids were, and didn't give a rip either. She was positive cocaine, in labor, thick mec and IUGR. I still provided THE best care for her in that moment. Do I agree with her life choices? No. Do I think we should continue to give her entitlements? No. But despite that I took care of her immediate labor needs. I think there is a difference.

[WashYaHands]

Do I think we should continue to give her entitlements? No. But despite that I took care of her immediate labor needs. I think there is a difference.

This is the statement that your cousin was most likely referring to. Direct patient care is only one aspect of CNS practice. There are 4 other roles that the CNS functions in. One of these roles is that of collaborator, which would require you to collaborate with the entitlement agencies to allow your patient to access that resource. So, if in your heart of hearts you believe that your patients should not receive entitlements, how will you effectively be able to collaborate in such a way that they can access them? And, will you be able to advocate for the patient to receive them? No doubt that you are an excellent clinician, but in the CNS role as a whole, you'll have to consider the bigger picture, think outside of the box, and ask yourself the hard questions as well as be honest with yourself about the answers. I'll quote one of my mentors who has been blatantly honest with me through my CNS education, "It's not about the money, it's not about you, it's about the patient."

I hope this all makes some sense. I don't want you to feel like my posts are trying to deter you from this job. I want you to be happy with your career choices and love what you do.

Linda

[Q.]

No Linda, I like your posts.

I see what you're saying with this, but I guess, even though I disagree with welfare abuse, etc, I still have enrolled my patients in WIC, referred them to social services, etc and helped them get established with T-19 if they qualified. Does this make me a hypocrite? I'm not sure.....I don't think so.

I mean, as long as these entitlement programs are out there I'm going to refer my patients to them in interest of her infant, ultimately. But do I vote for politicians who want to create MORE? No. Does this make sense?

[WashYaHands]

Yes, it makes sense. I don't think it makes you a hypocrite, unless you yourself were to utilize the services and then condemn those that use them also, which is not the case here. If it doesnt effect patient care and it doesn't bother you, it's doable.

Linda

[live4today, RN]

Hi Konni, :)

I see what you are saying. Thanks for your input on this.

The Director of Nursing at that health clinic did NOT want nurses who "did not fit in" per se to her female clientele because we would be doing field service...visitations in their homes. She felt this was much different than our caring for patients within the hospital setting. The way she explained to me what I posted in my post above made me rethink taking the job. I have a "low tolerance level" with moms who smoke, especially seeing them smoke right in their babies faces, so if something like this bothers me, I know it would eat me up inside to visit homes where I would want to strangle the mom, and remove the kids from that environment. I hate to see a child abused in any way shape or form, therefore, could not have done that job the way it should have been done.

Even when I did home health, I woud have Emphysema, Lung Cancer, and COPD patients who chained smoked regardless of how much they choked on their own air, I had a hard time keeping my mouth shut in regards to their continuous abuse of their bodies. Some nursing areas are better than others for me, so I steer clear of the ones I know I can't be "fair" in.

[whipping girl in 07, RN]

Renee, I do see your point. I remember in nursing school the few home health visits we had to do just killed me. And some of my classmates saw even worse things than I did, no more visits than we had to make. So I can understand where you are coming from.

But if someone could truly be nonjudgemental, I think they could do the job just fine without having been there themselves.