Nursing Career Adventures

Nursing continues to evolve and change. We all remember to some extent the way it was “when I graduated from nursing school.” Change occurs at different rates and for different reasons. Allnurses.com staff were recently able to interview several nurses in various stages of their careers. Nurses Announcements Archive

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Specializes in Nephrology, Cardiology, ER, ICU.

This article is featured in the Winter 2019 issue of our allnurses Magazine.

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Karen K. Wiley, MSN, RN, CEN is the immediate past president of the Emergency Nurses Association (ENA). We recently spoke with her about the changes that have occurred in nursing over the years. Ms Wiley introduced herself: “I have been in nursing for 40 years. My first job was on a 55-bed orthopedic floor where I worked for 8 years. I then worked in various positions including the Intensive Care, Coronary Care Unit and Post Intensive Care. In 1993 I transferred to the emergency department where I worked until December of 2017. I consider myself semi-retired. Currently, I am the 2018 Immediate Past President for the Emergency Nurses Association. My master's degree in nursing was in Nursing Administration.”

There are many reasons for choosing nursing as a career. “I chose nursing for a career because it is what I always wanted to do. However, I did not go into nursing until after I was married and had 3 children. When I graduated from high school I did not want to go back to school, at least not right away. I worked in an office.”

We have all faced hurdles in nursing too. “My biggest hurdle during my nursing career was working in the emergency department and keeping everyone safe. Patients as well as nurses. Often you work short staffed and you are caring for psychiatric patients and medical patient who remain in the emergency room because there are no beds in the hospital or no staffing on the psychiatric floor.”

Nursing continues to change and evolve as our patients become more complex. “The biggest changes that I have seen in the nursing scope of practice include standardized nursing protocols for stroke, chest pain, and sepsis, In addition, we now have Nurse Practitioners, and Physician Assistants.” She went on to discuss that team nursing was the approach to care when she first started in 1978. This consisted of her responsibility of 21 patients along with 2 nursing assistants and 1 RN who cared for the more acute post-operative patient. While working in the emergency department, acuity needed to be considered as the usual workload was 4 patients While that number seems desirable, 4 very ill patients (think diabetic ketoacidosis) are quite labor intensive versus 4 relatively stable patients (think sore throat, well baby checks).

Ms Wiley has experienced many changes over the past 40 years. “The changes I have seen in my career that have impacted the profession include computers, (order entry, nurse and physician documentation, medication, any surgical and x-ray reports) The benefit is that nurses and physicians can work in the patient chart at the same time. The negative aspect is when entering the information live, patients do not feel you are talking or listening to them, but the computer. Legal issues have occurred when important information is not documented or the supporting documentation is not there. Another change is 12-hour shifts. Patient satisfaction surveys, and violence in the work setting are others.”

Media portrayal of nursing has changed over the years too. It was common to see “physicians defibrillating the patient or doing CPR but now we do defibrillation hands-free. The media also portrays nurse and physicians in a steamy love affair. Our international nurses watch American TV programs and they do not have a very honest view of how we truly practice. The physician and nurse practice as partners in providing care for patients.” She experienced nursing care overseas via an exchange program sponsored by ENA. Ms Wiley visited Norway and Poland and made the following observations:

In Poland, EMS has more control of care. It is very unusual for patients to come by themselves to seek care in the ED. This only occurs when a physician has called ahead to inform the ED that the patient is coming. EMS is the usual mode of arrival even though the patients are triaged upon arrival and may still sit in a waiting room.

In Norway, she noted that care was very physician-driven and nurses lacked autonomy. However, they are starting nurse practitioners and are working to integrate this into practice.

We ended our discussion about how to feel valued at your job. Her words echo many of us; “I feel valued in my job when patients tell me thank you. Also when I walk out the door, I know that I did my best.”

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