To grad students and advance practice nurses

EmeraldNYL, BSN, RN · Jan 3, 2003

Adrienurse, would you get a master's in psych or a PhD? I was also a psych minor and it is my understanding that you can't do a whole lot in psych without a PhD. A family friend has dual degrees in nursing and psychology, and she is a college instructor as well as runs her own private practice. I think the main thing to consider is what is your final career goal? What would you like to do for a job on completion of your grad school? Lastly, what are the job opportunities like in your area for what you want to do? You could probably combine nursing and psych in a way that would be very rewarding. Good luck!

adrienurse, LPN · Jan 3, 2003

Emerald. Thanks for replying so soon. The points you have raised are ones that I need to put some more thought to. I can see having a MA in psychology with a course of study applicable to nursing as well as a BscN + experience as a psychogeriatric nurse + certification in gerontological nursing being a good starting point for private practice or consultancy work. Anybody disagree?

Q. · Jan 3, 2003

Adrie,

Sucks doesn't it?

First of all, I agree with EmeraldNYL; I've heard that in order to truly be succesful in the area of psych you need at least a Master's or higher. Not to discourage you at all, but just so you know if you change fields what you might be up against.

I currently feel as you do and I am in grad school. The only thing that actually keeps me in the nursing field is school itself because I find the classes so interesting and pertinent. It actually stimulates my interest in nursing enough to stay in. In addition, I've already invested thousands of dollars in tuition already and some hard work, so I definitely want to complete it. Although sometimes, I think, "what's the point?" I can't even find a damn job right now.

I can't speak for the CNS role, but I know here it seems very rewarding. It allows you to maintain your hands-on skillset all while improving nursing practice. Truly, it sounds like a dream job in a way. I guess you are closer to politics because usually as a CNS you are probably only 2 layers away from the Nursing VP, but then again, I'm sure there is a way for you to temper how much it effects you.

I'm at a crossroads as well. The only thing I enjoy right now is being a student. And I've also found my interests shift while in school. I enrolled in school with the goal of becoming a nursing instructor, eventually obtaining my Ph.D. But, there's politics with that too and, I can do almost the same thing (teaching/training)but in the hospital setting and make more money.

Is there a general MSN program in your area? Perhaps rather than entering a specific program (like NP school) you could simply enroll in a MSN program and use that time to figure out what your interests are. I find as I attend classes and meet other students who are different roles, I get exposed to more and more of what I can do once I'm done with school. And if nothing less, it gives you something "to do" instead of getting burned out with nursing in general.

Anne Holmes · Jan 3, 2003

Hi Adrian,

I am in London England and have been a nurse for over thirty five years, you seem to have put a lot of thought into what you are doing and all I have to say is go where you feel you can make a difference. My training was conventional in that I trained in an old London hospital, in the roll model, don't do as I do do as I say so to speak.

I am now working towards my nurse practitioners degree and hating every minute of it, the practical stuff I can do standing on my head, it is the academic stuff that is stressing me out the most, in the past I have tended to say things as I find them, now I am having to say the correct words in the right context. I love my job, unfortunately to enable me to continue working in this field I have to do a degree. Nursing in America is all at degree and masters level, we are a long way behind in this country but we are getting there.

On a happier note, I wish you and your family a very Happy New Year, and whatever discision you make I am sure it will be the right one for you

Take care

Anne.

llg, PhD, RN · Jan 3, 2003

I, too, am in the midst of some soul-searching related to my career choices and have appreciated the comments in this thread. One thing I want to add is this:

To be a good CNS, you have to have respect and affection for the nursing staff with whom you are working.

The CNS role (which I have held for 14 years in a variety of hospitals) is, as you have pointed out, very political. The CNS accomplishes many of his/her responsibilities by working with and through others -- and that requires the ability to secure their trust and enthusiasm for your ideas. The CNS role is a leadership role -- and you can't lead unless others are willing to follow you.

So, for those of you considering becoming CNS's, please remember: you probably will not enjoy the role or be very good at it if you don't love both nursing and nurses.

Why am I currently soul searching? Well, I've become a little dissillusioned lately, too.

llg

lalaxton · Jan 3, 2003

ardrie, just a suggestion but why not pursue a Pschychiatric NP?? There is a demand for them and I know of a Psch CNS who went back to get her NP so she could write scripts, she also had her own private practice (this was in SC). Might be something to consider....

Glad2behere · Jan 3, 2003

Oh llg,

Not now! You are one of my heroes! Why the disenchantment?

Are you saying that a CNS role weighs predominantly on the personality as an instrument of its' effectiveness? No inherent or implied authority? Gosh darn, I was thinking of entering graduate school for Health Care Admin because it seemed to be the only reasonable solution to increased salary commensurate to education level, next to anesthesia, which I know I would just be dreaming to think I would ever be accepted there. I have also thought of ACNP because I think hospitals will eventually have to shift to their economic feasibility in ERs. So, given a choice, what would you change about your career path knowing what you now know?

llg, PhD, RN · Jan 3, 2003

Glad2behere: Thanks for caring!

I've been around long enough to know that my current malais (Did I spell that right?) is probably temporary and I will probably muddle through it for a couple of months until something inspires me again. It's happened to me before and surely will again. It's just a little more disappointing this time because thing have gone so well in my job this past year that I had thought I had found the job I would stay in until retirement. Now, I am not so sure.

What set it off this time was my yearly eval in December. I had spent the year being constantly praised by one of my bosses (the DON) about what a great job I was doing and what a joy I was to have around. I created a summer externship program for nusing students that was a huge success and took over our relationships with all the local schools of nursing (and that had not been in the job description I had agreed to). I accomplished all of this while my mother died in the Spring and I broke my right hand and wrist in the summer.

Anyway, my other boss (the Director of Nursing Staff Development) actually wrote most of my eval -- and while the over-all score on the eval was fine, there were some piddly things in there that really ticked me off. They took me completely by surprise and made me really question my loyalty.

The biggest thing was that I got a low score for "treating other people with courtesy and respect" because apparently one of the secretaries in the Education Dept. said that I was essentially, "uppidy." This completely blindsided me as I had spent most of the year trying to suck up to this particular secretary, who handles the school of nursing schedules. I told her repeatedly how happy I was to have her help because I am not very good at clerical tasks and apparently she took that to mean that I consider clerical tasks to be "beneath me" and all my education. She totally misunderstood my intentions. Was I ever given a hint that she had negative feelings toward me? Of course not. Her misinterpretation just appeared in writing on my eval from out of nowhere.

Now, you might think ... "No big deal. No one's going to see those sentences on that eval." However, my hospital has a formal policy that it will not give job references. So, if I ever leave here, the only way I can show I did a good job is to show my perspective employer my evals. How could I ever show anyone an eval that says I don't treat people with courtesy and respect?

The point is ... I thought I had gotten to a point in my career at which this sort of thing would not happen. It's not that I expect people to "kow-tow" because of my PhD and my somewhat lofty position in the hospital's hierarchy. It's just that I am once again reminded that it's often not the quality of the work that you do that matters: it's whether you have sucked up to right people in the right way. I had no idea this secretary (with whom I have minimal interactions) had so much power over me.

Nursing is too much of a popularity contest -- like junior high school. In what other profession do the beginners feel free to "tell off" their bosses? In what other profession do staff people with Associate Degrees make more money than Managers, Educators, and Researchers with Master's Degrees and PhD's?

Yes, I checked. If I had come to this same hospital as a new grad with an ADN and simply stayed here as a staff nurse, I would be making more money than I do now with a PhD in an advanced practice position.

It's all just discouraging. No, I am not planning on leaving nursing -- or even my current job -- any time in the near future. I've accomplished many positive things and I need to let those accomplishments be my reward. I shouldn't need a "pat on the back" come eval time -- but I do. We should be celebrating each other's accomplishments instead of nit-picking every little thing. Of course I know that I am not perfect, but I did a darn good job this past year and I did not deserve that slap in the face.

We currently have a nursing culture that is all about the negative, and that negative culture has worn me down at the moment. I keep looking for the positive, and lately, I have not been finding it.

I've said to much about the specifics of this matter. Please realize that I am taking a risk by being so open about it.

llg

llg, PhD, RN · Jan 3, 2003

To Suzy K:

The CNS job is MOSTLY politics -- unless you can find one in which the direct patient care component predominates. The other apects of the role, such as eduction, consultation, implementing new practice ideas, etc. are predominantly political. Everyone else brings their problems to you and expects you to solve them. The "customer is always right" philosophy means that you always have to please your customers -- which for the CNS are usually the staff nurses and physicians. Taking care of patients starts to seem like the "easy" part of nursing.

llg

Q. · Jan 3, 2003

llg,

I feel for you and your current situation. I too, like Glad2behere, was almost dismayed in a way reading your first post. And I understand what you are saying with regards to the eval. I too came from a place that did not provide references, instead, I gave them my latest eval statement. What bothers me most about those comments is that, especially in this case, the secretary's word is what held. Nothing speaks to your true intent, your mannerisms or language, but rather, her own misguided interpretation. How is it that something so petty can make it to your eval? Is there a place for you to write a narrative about what really transpired?

I also feel the pain about the pay differences. I could make more as a staff nurse than I can as an educator with a graduate degree. Why? Why?

llg, PhD, RN · Jan 3, 2003

Thanks Suzy, for understanding. I'm content with the final, total score on the eval as I scored very highly on some other categories. Also, it would be very dangerous politically to make a fuss about it. So, I have decided to do nothing about it other than to privately confirm with some of my colleagues that indeed, I do NOT treat secretaries, assistants, etc. badly. Everybody I spoke to was shocked that it was written in the eval -- particularly since I was never told about it and given a chance to clear up the misunderstanding with her.

During the eval meeting itself, my bosses made no big deal of it other than to point it out. Since then, they have acted as if everything is "hunky-dorry." That's why I think it would be a mistake to make a big deal of it. However, it puts a very bad taste in my mouth about my ability to trust my bosses in the future.

llg