Constant Change in Nursing: A Self Reflection

JoAnnaSkewlRN, BSN, RN

Growing Up

The story of my life summed up in one word would be "change." I changed schools often when I was young but all were close to my home in Louisa, Virginia. In high school, I changed jobs frequently to include: 2 farms, 4 shoe stores, 4 pools, 2 call centers, and a fast food chain. My senior year I changed from student to student, wife, and mother. Then the marriage ended; leaving me as a single mom. I tried the military (which was not a good fit) and married another man. This time the marriage has lasted and we will be celebrating 15 years this month. We have had 3 more children, 7 homes in 2 States, and I have gone back to school 3 more times. Through all of the changes in my life, becoming a nurse was one of the most challenging and satisfying.

At 16 years old, I became certified as a lifeguard. The training included CPR and First-Aid; my first real exposure to working in a healthcare field. I cared for injuries to patrons in and around the pools where I worked. I was responsible for thinking quickly in an emergency as well as part of a team. The management encouraged me to become an Instructor for the American Red Cross. This allowed me more exposure to the practice of nursing as an educator.

Deciding that I wanted to perform some act of "warm fuzzy" service and loving the adrenalin rush of a medical emergency; I joined a local rescue squad and became certified as an Emergency Medical Technician-Basic (EMT-B). Working with some of the most knowledgeable, pre-hospital providers in the field; I watched and learned how they took care of people. I was in awe of their calm confidence no matter the situation. Thinking that would be a great full-time occupation; I obtained a position with a transport service that paid for advanced pre-hospital training. The only problem was I didn't feel like I was "helping" them: I was monitoring the patient during transport. Looking back I am more aware how valuable that type of monitoring is to the patient but at the time I wanted more: I changed jobs.

I worked for a blood collection facility which improved my venipuncture skills but not my job satisfaction. I applied for a position at a local trauma hospital--a ground floor opportunity as a patient assistant. The panel interview went very well but at the end of the interview I was told I was overqualified for an assistant position. Determined to find a better job in the healthcare field; I applied for a position as a telephone triage secretary at a local pediatric office. I thought I had found the right job until the day came that I couldn't perform at my level of training.

A Turning Point

I was in the office before the doctors and nurses that morning and I heard a knock on the still-locked front entrance. My manager took over the phones and I went to the door. A woman stood holding a barely-breathing child in her arms. According to this mother, he started having difficulty breathing about 20 minutes earlier and she had no medicine. The patient--a preschooler with a known history of asthma--was starting to turn gray around his mouth. I quickly brought them inside, knowing it would be at least another half hour or more before any nurses or doctors came in. I called for my manager and advised her to call 9-1-1.

If I had been on the ambulance, the treatment protocol would have been to start administering a nebulizer treatment and transport to the closest, stabilizing facility. I asked my manager if I could begin treatment while waiting for the transport team. She told me I could not treat the child as I was only to offer telephonic triage and advice in my position: We would have to wait for emergency services personnel to arrive. As the minutes passed, we watched the child completely lose consciousness. Knowing there was only an EMT-B volunteering at the local rescue squad station that day and he or she would only be able to provide oxygen--and not the needed treatment--I pleaded with my manager to allow me to go off the clock and treat/transport the child. She hesitantly approved my request. A few minutes later I was treating the patient. With the assistance of the hospital medical team--via radio--we stabilized the child and a potentially deadly situation was avoided.

A few hours later I returned to my usual duties: answering calls, giving advice and making appointments. My seemingly perfect job had changed to one of mundane task. During my lunch break, I sat at my desk alone and crying. One of the doctors came by and asked me why I was upset after having just saved a life. I explained that earlier that week I had looked into going back to school to become a Licensed Practical Nurse (LPN) but had decided not to because I was happy with my job and didn't know if I could afford it. She encouraged me by telling me how impressed she was with my work and--though she would hate to see me go--my knowledge, decision-making skills, and comfort talking to patients in a way that "met them where they were", was more like a nurse than many she had worked with in the past. That evening, I applied to the local technical school's LPN program.

It was not easy to be in school for 2 years. I still worked-- part-time as a manager at my father's restaurant--while my husband worked full-time, and we raised 2 small children. I wanted the most out of my school experience so I joined the health occupation club and competed in public speaking events as well as serving as an officer at the local and state level. I graduated in May of 2000 and took the NCLEX-PN the next month. Now it was time for yet another change.

A New Nurse

I worked through an agency in long-term care facilities, specialty offices, and a community hospital, it was a great experience, I felt useful, and part of a team. A year later, I decided I wanted to be a registered nurse and researched different training programs. My husband and I traveled to my top 3 choices and finally decided on University of Colorado. I lined up a job and a house and we moved with the goal of establishing residency prior to my starting school.

Things were working out well: I continued to work as an agency nurse in Colorado, my husband had been offered a job, the kids were in school, and we had a great social support system. Then we were thrown a major curve ball. I was 16 weeks pregnant with twins and had a miscarriage. A week later-while returning home from an OB specialist appointment--my husband and I were in a car accident. My husband had not yet signed his work contract: He had no income or insurance. I found a part-time position as a school nurse a few miles from my house. After months of medical management we were financially exhausted. My husband had an unsuccessful back surgery and was approved for Social Security disability but we decided to move back to Virginia; thinking we would have family support and I could hopefully return to school.

The hospital I had previously worked for was extremely happy to have me back (at a lower, non-agency wage). I applied to the community college near my work. My LPN program had closed and this school offered a transfer agreement for students who had completed their certificate in the prior 3 years. My timing was perfect: I was accepted into the program in the final months of that agreement. I worked at night at the hospital, took an overload of classes, substituted at the pool for extra money in the summer, coordinated medical treatment for my husband and myself, and cared for my 2 children. I graduated in 2004, passed the state exam, and became a Registered Nurse.

Now pregnant with my 3rd child, we traveled back to Colorado to find a new lawyer to represent us in our lawsuits from the car accident. I worked at a hospital that preached how an Associate's degree in nursing was substandard training. I was placed on medical leave before the delivery of my baby. During my medical leave we made several unplanned trips back to Virginia for family emergencies. I was forced back to work 4 weeks after my cesarean section delivery and was frustrated by the lack of bonding time with my new baby. Crammed in a bathroom stall to pump breast milk on my 20 minute lunch break; I struggled to feel needed in raising my infant son. I cried every night before going to work. I had not been this unhappy with my job since I made the decision to become a nurse. I looked around and found a position as an overnight observation nurse with an outpatient surgical center only a few minutes from my house. This job paid very well, was relatively low-stress, and had great benefits. Still, something nagged at me and I was not satisfied: We decided to go back to Virginia.

Still Searching

I evaluated my prior employment. As an agency nurse, I enjoyed a higher rate of pay and less politics but the instability of PRN work. In a lower-paying doctor's office I developed long-term relationships with patients, educated them, and usually had more time for my family. Hospitals, offered good benefits, pay and the ability to research to influence changes in healthcare but in night-shift position. My goals were to be able to improve the care I provided patients through research and education, spend quality time with my family, financially support our family of 5, and eventually return to school to obtain a Bachelor's degree in Nursing (BSN). A position as a night charge nurse on a pediatric unit of community hospital became available; I interviewed and was hired.

In my new position I was the lead investigator of a research project, obtained a Clinician IV status. I also began legal consulting on the side, participated in several continuing education offerings, and was taking a class to become a certified pediatric nurse but I missed my family. Night shift was becoming an issue in our home so my husband and I decided I would begin looking for another job. Loving pediatrics and providing health education; I decided to try school nursing; a job where I could continue to learn and teach, while still allowing me to spend more time at home. After months of searching; I saw a posting for an itinerant nurse at Henrico County Schools. I updated my resume, printed off an application and faxed it the next morning. That afternoon I received a call to set up an interview.

Guess What?

Enjoying the job and just settling in at the school system; I found out that we were going to have our 4th baby. I continued to work but near the end of the school year I was put on bed rest. I returned to the schools 8 weeks after delivery. Shortly after my return I identified a need for diabetes management in the schools and I received training to meet that requirement. I went to a legislative event sponsored by the Hemophilia Foundation of Virginia. I loved talking to the representatives and explaining care that was needed by people with chronic health conditions. I also volunteered for some local Diabetes awareness groups. Little did I know that this new knowledge and experience would be put to use in my personal life.

In 2009, my second child began having seizures. I used my knowledge of the public education system and ability to research to learn all I could to help my daughter. Looking for support locally, I met the Executive Director of the Epilepsy Foundation of Virginia. She provided training for me and we began to work together to improve outcomes and advocate for student education in the least restrictive environment.

That year my supervisor came to me and told me that she could tell being a school nurse was not only a job to me, but also a passion. The School Health Specialist at the Virginia Department of Education wanted her to recommend someone to help the specialist and my supervisor present to new nurses at a summer conference and asked if I was interested. She also encouraged me to join our professional organization, the Virginia Association of School Nurses (VASN). I became active in the organization and was appointed a Regional Director to the VASN executive board and liaison of that board to the Legislative Coalition of Virginia Nurses (LCVN).

It's Calm, I Think

During my most recent performance evaluation, I was asked about my career goals. It was suggested to have job security and to remain effective in my professional role as a school nurse I should consider going back to school. I contemplated this and shared my concerns of needing to have face-to-face time with professors and the financial ramifications of going back to school. Taking her advice, I sent my transcripts to JMU's RN-BSN program and then my application. The Superintendent of Schools granted me an educational leave of absence. My husband and I tightened up the budget and I applied for financial aid. With an acceptance letter and a leap of faith, I enrolled at JMU.

Summary

Currently a full-time student, I have been assigned the task of performing a self-evaluation of my nursing practice in order to discover my personal nursing philosophy. In review of the last 21 years, I found that I value education and utilizing research methods to increase my knowledge. Patient satisfaction and preventative care are important to me as well as advocating for affordable, appropriate, and accessible health care and management. In my opinion, nurses should be up-to-date and knowledgeable about their particular nursing practice specialty and be willing to educate and be educated about changes in patient care in order to best perform their job. To get a job in nursing, a person needs to have technical training. To be accepted as a professional, a person must attend college. To have a career as a professional nurse, a person has to have a desire to make a difference and not be afraid to educate and be educated.