No idea what to do after my nursing degree! Is sonography a better option?

[ellensb]

Hi everyone,

I am looking for some advice on future career paths. I am really torn between nursing and sonography. I'm not even sure if I have a future in nursing.

I finished studying nursing last year in South Africa. I am in the process of registering here in the States at the moment, and I am debating if I should get an associates degree in sonography instead of, or in addition to, becoming a Registered Nurse here.

During my nursing degree overseas I worked over two thousand hours in clinics and hospitals. Throughout this experience, I started to realize some of the aspects of nursing that I hadn't known about and that I didn't particularly enjoy. I know that every job will have its downfalls, but I just don't know if I can handle a job in the nursing field.

I really didn't enjoy all the politics in nursing. I felt like I would always be at the bottom of the food chain (under doctors, nursing unit managers, other nurses, etc.). It also seems really difficult to gain confidence when you are always just being told exactly what to do. I am not sure how much of this will diminish as I work more if I become a RN. However, I am petrified that my confidence and experience will only increase as I practice on humans. I hate the idea of missing veins when drawing blood or, heaven forbid, risking someone's life while I am learning. The leap from Student Nurse to RN seems so extreme and it STRESSES ME OUT!

I also feel like, in the nursing field, there is almost too much to know and I will never be 100% competent....there are so many types of medicines, so many procedures, so many methods, and so many body systems. The only time I felt really confident was during my midwifery training. We had to deliver 35 babies in our last year of the nursing degree. I felt like this was something I was good at. Unlike the rest of the nursing that I did, I felt as if it was something natural and I was not there to prevent nature from occurring, so to speak. I was there to aid it. Where as in the other aspects of nursing, I felt like we had to work hard to prevent nature from occurring (Although, I know the baby may be naturally in a malposition or presentation, and you have to intervene to fix this, but on a whole child birth is a much more natural aspect of nursing). I'm grateful for all the work of science and medicine that nurses and doctors do in this world, but it seems really stressful that those professionals can be sued or lose their licensure if they miss something and nature ends up taking its course. Also, midwifery USUALLY has a specific set of procedures to follow, unless you are an advanced midwife and have to care for the premature infant or other high risk tasks. Obviously general nursing conditions, such as HPT and diabetes, are ESSENTIAL to midwifery, but I felt there was a much more specific body of knowledge for midwifery. (I think I'm failing at explaining what I mean, but I hope you all understand what I'm trying to say).

So I came away with my nursing degree realizing that I only felt confident delivering babies. Then it occurred to me that in the States a RN is not allowed to deliver babies in a hospital. Can you only deliver babies if you are a midwife working apart from doctors? I loved working in the hospital and delivering the baby, but having a doctor on call in case an emergency arose. Is that not possible in this country? I could just be a L&D nurse, but isn't that like cutting it short right before the peak of the action? Just monitoring and helping labor, but not being able to actually deliver the baby?

These are ALL some of the things that led me to look into Sonography. Similar (in my mind) to midwifery, I feel as if Sonography focuses on more specific aspects of health care and there seems to be more specific sets of procedures. I think that I would gain more confidence working in sonography, since I could work more independently and away from the politics of nursing. It appears that there is almost a more manageable body of knowledge that I would need in this field, which would also help me to be a more confident practitioner.

I also imagine that I would feel much more confident not risking someone's life as I learn. Although I know they're lives are still in your hand since you have to diagnose them and a misdiagnosis can lead to someone's life being put at risk, but there is a big difference in my mind between analyzing the diagnostic images and acting to resuscitate patients, for example. Does that make sense?

I also like the idea that sonography doesn't deal with the constant ringing of patients' bells and the typical ungratefulness from patients. I felt that in nursing I was more of a caretaker than someone "saving lives" like I had romanticized. Sonography seems to just deal with one patient at a time, and actually having time to converse and have a pleasant experience with your patients, rather than running between demanding patients all the time.

Does anybody have any advice or input? Does nursing get better overtime? Am I looking at this with the total wrong outlook? Is Sonography worth it? I have read some that people struggle to find employment in the sonography field.

[HouTx, BSN, MSN, EdD]

In the US, nursing education is designed to produce generalists - specialization only occurs at the graduate level. Nurse Midwives are Nurse Practitioners. Midwifery is alive and well in the US, but it's complicated because scope of practice & licensure is dictated by each state. (Part of the "states rights" established by our Constitution).

In my state for instance, Midwife licensure is shifting from the Department of State Health Services to the Texas Department of Licensing and Regulation ... both 'certified professional midwives' and Nurse Midwives are eligible for licensure. Nurse midwives are all NPs... so they have to deal with both the TDLR and our state Boad of Nursing - who govern nursing licensure. Crazy, right?

In the US, you will find that many of our healthcare practices have evolved as a result of our illness-based payor-based system. Historically, there has been very little payment for preventative or wellness care.... so everything gets turned into a 'disease' that must be treated by a physician. This includes childbirth. Delivering babies is outside the scope of nursing licensure unless you're a Certified Nurse Midwife.

Some of us have always spoken out about the 'medicalization' of childbirth (my own kids delivered by NM's eons ago) but it's certainly not an overwhelming majority. The other strong healthcare influence is legal liability... medical malpractice represents an enormous chunk of legal practice. In the US, the statute of birth-related injuries is 21 years!!! Lots of bazillion dollar lawsuits in that arena, so 'defensive medicine' with all the bells and whistles is the norm.

Welcome to our crazy. I can understand your anxiety. I wish you very good luck in determining your career path.

[ellensb]

Wow, thank you for reading my very wordy post and taking the time to respond. I'm in Texas too, so that means those same crazy laws would apply to me. I knew there was a major difference between South Africa and US nursing, but I guess I hadn't fully imagined just how different it would be. It is such a pity about all the lawsuits and everything. It really puts me off of thinking about midwifery in the US. It seems like most everything turns into a lawsuit and that is another terrifying side of things. The more and more I learn and think about it, the more I lean towards Sonography. Thank you so much for your time and input!