To grad students and advance practice nurses

Nurses General Nursing

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I had an epiphany of sorts last night whilst at work.

For the last few months I have been struggling with working full time and trying to get my requirements done so that I can get into nursing grad studies. I was convinced that this is what I wanted to do with my life. I am not content being a general duty nurse. The longer I work on the floor, the worse I'm going to be, I think. Shift work is getting to me. I am becoming too frustrated with everybody else who doesn't share the same drive as I do. This impatience always rears its ugly head when I am dissatisfied with life.

I feel like I'm at a crossroad. The application for grad school is due in February and I need to make a decision about my life.

Sure, I think I'm a good nurse. There are areas of being a nurse that I just love and I don't regret being a nurse. I'm just really dissilusioned right now with nursing. I thought my life would be better if I challenged myself more or if I picked a more independent aspect of nursing such as being a CNS. I'm also afraid that if I choose to study gerontology, it will be too limiting. I have seen that having such a position just gets you that much closer to the politics. I'm wondering if I need to get out of health care altogether. It's just bringing me down and I don't see it getting any better. I'm afraid I'm headed for burnout.

Psychology is another love of mine. I "minored" in it while I was a nursing student in university. I have a lot of classes under my belt already. Would it be crazy to abandon my ambitions to be a CNS and pursue this instead? I think I'm a gifted counsellor already. I could definately apply what I know about working with dementia towards psychology. The thought just opens up a whole new world for me. To study dementia from the cognative psychology point of view would be facinating. Imagine doing so, without having to put up with all the Bull**** of nursing along the way. :)

In a way, I think it would be a relief to focus on something different then nursing for once. Oh what to do, what to do??!!

Can you help me decide?

llg,

How very unprofessional for your superior to state 2nd hand information (and such a flip comment!) in your evaluation. I am seeing a trend in what is going on with you. It sounds very much like what is happening to another CNS friend of mine. It think that it is is situation that is causing me to be disenchanted with what I thought were my plans for the future. Until a few months ago, I was really coveting his job.

You don't meet a more kind, enthousiastic, bright guy then Dan. Unfortunately, he is in the process of being eaten alive by administration at present. :o The one bright point to my day is being driven away to another facility. This sucks. I can see his idealism dying right before my eyes.

Admittedly, he is on the low end of the learning curve (CNS-wise). I happen to think he's brilliant, but my opinion in the matter does not count. He only has one more year of nursing under his belt than I do -- a fact that admin should have taken into account whilst hiring him! Apparently, in his last (very cryptic) performance eval, he was told by the nursing admin that she was "very dissapointed in him". No details, just that his performance was not up to par with her expectations and he needed to improve. No further elaboration, nothing. Imagine starting a new job in a new role (after YOU had been pursued and recruited!), not being given any direction on how you aught to be performing and then being told a year later that your performance was "dissapointing" and that you needed to figure out for yourself what to do to improve it. WTF?

Please tell me not all CNS jobs are like this.

llg,

Sorry it took so long to respond, hope I am forgiven. I think your anguish is something I can identify with, as well as many other nurses. It is sad that an individual of your education level is not compensated fairly. I cannot imagine all the hell you went through to achieve it, and admire you for having done so.

I realize there isn't much that can be said to make you feel better except that you are looked up to, admired, and respected. You'll feel better soon I am sure, and I trust you will continue to tow the line.

I realize there isn't much that can be said to make you feel better except that you are looked up to, admired, and respected.

llg,

I wanted to repeat this, as these are my thoughts too. It's a shame that one persons personal opinion can impact professional positive input from all others that you work with in an eval.

Adrie,

Have you considered looking into a psychiatric CNS grad program?

Linda

Linda,

Well that's the thing. There is no psychiatric stream in the general graduate studies program in my local city. This may be a good excuse to leave this frozen godforsaken town, but I don't know if I'm ready for that. It may be a good choice for me, though because the University of Manitoba is looking more and more pathetic all the time.

adrienurse,

I too had a similar experience to 'Dan' in my last position. I was hired as a CNS, and although I was trained as an NP and was reluctant to take the job because I had no experience as a CNS, I was assured by staff and physicians that I would get lots of help etc. I was also able to name my price so I thought how bad could this be? I basically saw no one for the first 3 months, never got any direction or help and finally found out I was hired because a very influencial surgeon (also on the board of directors) pushed to have a 'body' in the job. (Same guy who expected me to 'magically' appear when he did rounds) Thank God we had to move back to Canada for family reasons, I was going out of my mind!

Specializes in Nursing Professional Development.

Wow! You guys are terrific. I felt a few pangs of regret after posting so many details of my recent job eval. But getting it off my chest helped -- and your responses have made me feel much, much, better.

To Adrienurse: Unfortunately vague job descriptions and expectations, unclear and even conflicting expectations, and intense politics are all commonplace in CNS roles. Unfortunately, everyone in the health care system has expectations of the CNS and sometimes, those expectations don't match. If you please the staff nurses, you make the physicians angry. If you support the head nurse, some of the staff nurses get angry. etc. etc. etc. Making it worse, each of those people believes they have a right to tell you how to do your job -- and they exercise that right repeatedly, saying that THEY could do the job much better than you.

I have come to the conclusion that it (the above stress) is a fundamental part of the CNS job -- and will remain so until the nursing culture changes. Nurses as a rule do not respect a person's previous accomplishments or qualifications and will not accept a person in a leadership position unless that person is continually doing something to please that person. It's a "what have you done for me lately" type of attitude.

If the CNS wishes to be effective in improving practice, he/she must have the support of his/her colleagues -- at the staff level, within nursing administration, physicians, etc. Therefore, all of those people must be continually "pleased" in order to maintain their support. After a while, you feel like your main job is just to suck up to everybody. (And remember, I got nailed on my eval by a secretary, so I DO mean everybody!) Also remember that catching up on the latest literature to teach a class, writing an article, etc. doesn't make your colleagues' jobs any easier, so those types of activities don't please anybody and most consider you to be "not working" when you work on those types of activities. Most only care about what you did that directly made their work easier.

In the end, I don't regret having spent 15 years as a CNS because I enjoy the variety of the things I have been able to do. Also, looking back over the years, there are accomplishments of which I am proud and I know that I have made a positive difference in many people's lives. But it has been very hard work and it has been emotionally challenging.

For those of you who think of the role as an escape from the common stresses of being a nurse, think again. CNS's are expected to be "super-nurses" -- the epitme of nursing -- the embodiment of the nursing ideal -- experts at everything -- the person who can always be counted on to save the day -- the person who pleases everyone. Think about it. Isn't that what most people want of a CNS? Is it reasonable to expect anyone to be that perfect? The challenge for everyone is to come to terms with the fact that CNS's are human, too. We need to be tolerant of the fact that CNS's are not perfect. Until the nursing culture changes to accommodate those imperfections, CNS's will continue to struggle with their inability to walk on water.

llg

Specializes in LDRP; Education.
Originally posted by llg

For those of you who think of the role as an escape from the common stresses of being a nurse, think again. CNS's are expected to be "super-nurses" -- the epitme of nursing -- the embodiment of the nursing ideal -- experts at everything -- the person who can always be counted on to save the day -- the person who pleases everyone. Think about it. Isn't that what most people want of a CNS? Is it reasonable to expect anyone to be that perfect? The challenge for everyone is to come to terms with the fact that CNS's are human, too. We need to be tolerant of the fact that CNS's are not perfect. Until the nursing culture changes to accommodate those imperfections, CNS's will continue to struggle with their inability to walk on water.

llg

EXCELLENT!

llg,

The evaluation obviously bothers you greatly while your supervisors think everything is 'hunky dory'. They may honestly

not perceive that they have done anything 'wrong'

Given how deeply you feel about this, why not bring up the subject with your bosses?

Evaluations usually require the employee's signature as to whether they concur or disagree with the evaluation.

Did you sign off the evaluation?

You loved your job until you were broadsided by this evaluation...what do you have to lose then to readdress this issue with your bosses?

You are always insightful and considered with your responses...

I am sure you would handle reopening the discussion of your evaluation gracefully.

As to accepting a CNS job when you are prepared as a NP....I turned jobs like that down. The CNS role really does require an educational preparation that my NP program did not prepare me for.

As for aspiring CNSs....there are still plenty of jobs ...in fact when I was looking for a job...there were more CNS jobs than NP jobs in the area I wanted to work in.

globalRN,

Believe me I will never make the mistake of taking a CNS job again. I was not prepared for it but I was in an area that had limited opportunities for NP's or CNS's. Next time I would rather work as a staff nurse. Don't get me wrong, I am in awe of CNS's and what they do, just not a job for me. Keep on keeping on llg, your commitment to excellence in patient care will shine through even if a secretary has an attitude problem!

Specializes in Nursing Professional Development.

globalRN: Thank you for your kind and generous, but I think it is really better in this case to simply "let it go." If a good opportunity comes up for me to discuss it with one or both of my bosses, I will bring it up ... but I am not going to force the issue. It's important to pick your battles carefully, and I think I should let this one die a natural death.

I don't expect to leave my job this year, so I should have no reason to need that eval. If something does happen in my personal life that causes me to leave, I am on good enough terms with the Director of Nursing to bring it up at that time. I believe she would sympathize with my position and give me some assistance. If something happens at work that causes me to leave ... well ... that might be another story. But I think that is unlikely and I would probably survive that event by improvising and using other documents to support an application -- such as program evaluations, previous evals, my published book chapter, conference speaker reviews, etc.

I just don't think it is worth it to rock the boat at this time.

Thanks again,

llg

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