Some hard questions about entering nursing

mcknis · Jul 27, 2008

Congratulations on pursuing a nursing career. I am jsut a new grad, but will try to inform you of what i can.

1. What are some of the worse things you have face on the job?

***Tough, but death (or near death), CPR, obesity (huge epidemic in America, no pun intended)

2. Have you ever decide on areas you would not work in?

***long term! it simply is not my cup of tea. I love the elderly, but the treatment in the nursing homes is beyond belief. Love them I do, and respect those who work in them, just not my thang.

3. What are some of your experiences in non hospital settings and how do they differ?

***I can only say what i have seen in school, but outpatient surg centers, infusion clinics, home health and hospice are all interesting and great in their own ways. As far as differences, that is a tough question. Not enough space on here to explain.

4. Are you ever squeamish at the things you see and have to do, and if you did, did that pass in time?

***Being squeamish(sp) for some may exist and not for others. I personally don't get squeamish unless dressing a really nasty wound. The first time I got squeamish was washing someones dentures that had not been removed in 5days!!! I am not joking with this. Nobody checked to see if she had denutresm but after prying them out, this awful odor just creeped out. To get over the smell, many people try Vicks Vaporub under the nose (or in the nose), and it seems to work...

RN1989 · Jul 28, 2008

I applaud you for being honest regarding your desires to be a nurse. I don't think that you will make it as a nurse long term.

Nursing is a lot of crap to deal with and it is only getting worse. The people who leave it the fastest are the ones that only got into it for the money - they find that the amount of responsibility in light of the terrible conditions is too much for them to take.

The majority of patients needing care are elderly and the elderly population is growing. While you could work pediatrics (children) there is no guarantee that you will be able to get a pedi job or will want a pedi job. Otherwise - adult health is what is available and a great majority of patients will always be over the age of 60.

Nurses do not make GREAT salaries. Nursing is actually a blue collar job (despite the need for a college degree in many cases) and the nurses that make the most money are nurses who have no personal life and work so much OT that they are a danger to the public.

Nurses with higher degrees work as nursing professors - low paying jobs, or nurse practitioners which make more than staff nurses but have higher responsibilities and licensure/practice costs. To be a nurse executive who might make the highest salary, you would still have to pay your dues wiping butts and taking care of the general public. You would also have to set aside a lot of ethics to be able to keep a nurse executive position.

I don't think you truly understand the scope of nursing. This is certainly not a field for someone who is only interested in personal gain. I would think it would be very difficult for you to set aside your disdain for the personal (gross, mundane, ordinary) tasks that nurses do and be a nurse that is a good patient advocate. Please rethink you career goals. A career counselor can help advise you on what your are best suited for and help you find a better match for your ambitions.

Anotherguy · Jul 28, 2008

Thank you for the feedback so far, not to sound overly defensive I'd like to inquire about certain points.

"I don't think you truly understand the scope of nursing. This is certainly not a field for someone who is only interested in personal gain. I would think it would be very difficult for you to set aside your disdain for the personal (gross, mundane, ordinary) tasks that nurses do and be a nurse that is a good patient advocate."

I keep reading that there are suppose to be a great deal of options for Nurses, many specialties, many kinds of work. I personally am aiming to be a psychiatric nurse, helping people with addictions and other mental illnesses. Or perhaps a position in public health helping to educate and prevent infectious diseases. I see those as radically different environments than a nursing home or a surgical wing.

I feel I should elaborate though, that I'm not looking for some fantasy where I hand out pills and fluff pillows all day. It's not changing diapers or physical labor that I'm worried about, rather dealing on a day to day basis with people that have severe injuries or facing death isn't something I'm sure I can deal with.

And I guess I'm not really sure how to take the money comment either, I'm sure "great" means a lot of different things to different people, but with my first degree I was able to land jobs that paid around 35k which would be difficult to support a family with much less buy a house etc. While the union rates here are 50k+ for 1st years.

Thank again though for your feedback so far.

RN1989 · Jul 28, 2008

Most psych nursing jobs do not involve the nurses actually treating the person's psych/or addiction issues.

Psych jobs are way less plentiful than other types of nursing jobs. The only reason that an entity that treats patients for addictions or other psychiatric issues has a nurse onstaff is because state/federal regulations require them to have a nurse. Most psych facilities, in or out patient, mostly utilize unlicensed assistive personnel because they are cheaper than a nurse.

The nurse in a psych setting that is not a medical-psych hospital setting, are only there to satisfy requirements for passing medications, performing vital sign assessments, etc. to assess and treat the physical health of the person. These facilities would not pay for a nurse if they weren't forced to.

Without a Masters+ degree, a nurse is not qualified to treat psychiatric illnesses. What a nurse learns in nursing school is more on how to interact in a calm and non-destructive manner with a mentally ill person.

If you are looking to help these types of people, more than just keeping them alive, passing meds, cleaning them up when they need it, you should look more toward a psych degree.

If you still dislike the thought of working with the elderly or chronically/terminally ill, you are still going to find that nearly every adult nursing setting will have more than half of the clients as elderly or very ill. As I said before, the elderly population is growing by leaps and bounds and they make up the majority of patients seeking any kind of healthcare. They are not just limited to inpatient hospital or nursing homes. People are living longer than ever today and you will enounter them on a daily basis in healthcare. Even in a clinic setting you will be helping elderly patients to clean up their incontinent episodes, walk down the hall, and even have confused alzheimer's patients that can't care for themselves but still live alone.

Yes, nurses generally make more than $35K. But the responsibility you take on as a nurse is enormous and the pay is not commensurate with the scope of your duties. The buck stops with the nurse, not the doctor, not the hospital, not the patient. The nurse. And if you screw that up, the board of nursing will terminate your licensure.

There are lots of costs involved in just keeping a job - and rarely will your employer reimburse you. There is the cost of uniforms, stethoscopes/equipment, yearly or every other year licensure fees, continuing education fees, certification fees. It is not cheap. Yes, you may make more than a minimum wage worker, but your taxes increase as well. You may bring home a little more money but it is nothing compared to the increase in responsibilty that you have as a nurse.

As a nurse, whether you care about people or not, you are responsible for keeping them alive. You must perform not only your job, but the doctors job to prevent the doctor from ordering inappropriate treatments and tests. If the doctor orders something wrong or fails to order necessary tests/treatments and you do nothing about it - you can be held responsible.

You will work as janitor, housekeeper, dietary worker, social worker, and psychologist. You are responsible for everything that happens to the client, no matter what setting. When something goes wrong, the doctor comes off scott free while your employer will hang you out to dry, terminating you and sometimes you will have to fight to keep your license.

You said that you don't want to pass pills and fluff pillows. That is what nurses do in any setting. Nurses are the caregivers of the public. If the patient needs their pillow fluffed to be comfortable, that is what you do. Now more than ever, nurses are required to bend over backwards to do ANYTHING the client wants. Some things are not even appropriate but employers are demanding that the nurses do it anyway. Nursing is not about what YOU need, nursing is about what OTHERS need.

Nursing is very personal business no matter what specialty. We deal with people when they are at their most fragile. We take care of the physical, mental, emotional, and spiritual needs of our clients. This is a requirement and it is impossible to separate all these things.

You sound like you would be much happier as a physician where you do not have to become so intimate with the patients.

Nurses get treated like crap. This I think is what you do not understand. If you only make $35K/yr now, then bumping up to $50K as a nurse sounds like a dream. But if you only knew the terrible stress that nurses are under and how badly we are treated, you would realize that the tradeoffs are not worth it. Spending all your time at work on holidays, missing family events is a given. In order to achieve what you say you want, you will still have to spend years of wiping butts, and taking care of people you don't like. You have to start at the bottom like everyone else. Rarely do nurses get into certain jobs (like psych) without having clinical experience.

If there is nothing in you that makes you want to help people in a compassionate manner, you will not last long in the hostile healthcare environment. You will quickly learn that money is not everything. I still think you need to see a career counselor to assess your likes/dislikes/strengths/weaknesses before you jump into this business.

I am sure you think that the nursing shortage will ensure you a job. Do some research. There are few areas of the US that have a true shortage of nurses. The shortage that the news talks about is a shortage of nurses who are willing to work in unsafe and hostile environments. Hundreds of thousands of nurses in the US have RN and LPN licenses but have stopped working in healthcare because they know - money isn't everything.

Anotherguy · Jul 28, 2008

You have given me a lot to think about so far. I think you misunderstood me on the pills and pillow comment, of course I would love a job where all I did was that, but that's not going to happen.

I do appreciate that you are trying to show me the challenges of nursing, I have to ask though if I've struck a nerve in someway.

I've read so many different experiences on this forum, some are dangerously overworked, some are enjoying their conditions. I don't have any illusions about Nursing not being a hard job. But of that terrible stress you are warning me of, how much of it is bad work conditions/ lack of laws, union, than inherently being a nurse?

Cathlabnurse46 · Jul 28, 2008

Ok...I'll jump in.

After 23 years and working in a lot of areas I can tell you that nursing offers a lot to men.

1. Worse things to face. Hmm. Somethine long hours, required holidays, required call. Depends of where you end up working. I worked for years in a diagnostic cath lab and made top pay in the hospital... took no call, no holidays, no weekends for 6 years.. now we are an interventiaonl lab and I work 50-60 hours a week 50+ hours of call and hoilidays! I've seen men in nursing who can't take orders from a woman! Some man can't take blood. I don't like the death of children 9thankfully I haven't had to deal with it in many years. Personally... I love doing anything. I've been burnt out a few times and you need to know when and how to recognize that... and deal with it.

2. I Would not work a burn unit. Most likely not OB (not that they would hire me). Not Dr. office. Maybe a cruise ship. I would love to land a job on a ocean reseach vessel. No to floor nursing (once was enough.

3. I onced owned a Home Health CO. I once owned 2 Assisted living facilities. Both very different kind of nursing. Home health is also nice and slow paced, with less supervission.

4. No i'm not squeemish... at anything at the time. Usually after a major event is over and after the epi high is gone, somethings the tremors begin and I second guess myself. This is normal. Good training prepares you to act (just like in the military) but when it's over and you can think about the event the reality of what happened sinks in. I've done hundreds of codes...maybe close to thousands and still on occassion one sits with me now.

RN1989 · Jul 28, 2008

But of that terrible stress you are warning me of, how much of it is bad work conditions/ lack of laws, union, than inherently being a nurse?

It is all intertwined. Every employer has crap. The grass is not greener, it is just which manure you can stand to smell and shovel.

Hit a nerve? Honestly, I am tired of people coming into this profession because they are looking for money and have very little desire to work in what is essentially a helping, public service profession.

I have yet to see many people who come into this profession for money actually stay in the profession. I am tired of the revolving door. It is not worth my time to teach a newbie the ropes when I know that they are going to leave soon because they figure out that they made a big mistake. Not too mention that they are wasting a slot in a nursing class that could go to someone who was willing to stay in the profession for better or worse.

People who want to be nurses mostly for the sake of being a nurse, are much more apt to stay in the profession no matter what. They may or may not actively participate in activities to make the profession better, but they remain and don't contribute to the "shortage".

So many people have the wrong idea of what nursing is, so when someone comes in who states that their main motivation is money......I think they need to do more research and get a personal assessment completed before they waste the time and resources required to train them to be a nurse.

As a manager, I have declined to hire several nurses that let me know that money was a deciding factor in the reason to be a nurse. When people find out the reality of nursing, their salary is no longer a motivating factor to get them to do good work. Their salary is way too small to get them to want to do their job. And if they cannot be motivated to do an exceptional job because it is the right thing to do, they become a drain on my unit's morale as well as my unit's resources.

These types of people feel locked into the job because of the money they spent from school. This often makes them resentful and sullen. They become careless, lackadaisical, and sometimes outright insubordinate. They are part of the problem but the refuse to take part in any solution to fix the problems on their unit or nursing in this country.

When they find out that it requires education beyond an associate's and bachelor's degree, along with specialty certifications, to climb the career ladder, they feel cheated, like someone told them a lie about nursing.

After a couple decades of watching people come and go, it gets easy to spot people looking for a quick buck who didn't get all the info.

djc1981 · Jul 28, 2008

To the OP, maybe shadowing a few nurses will give you a better idea. No offense, but RN1989 sounds very bitter and burnt out and may not be the most reliable source. There are TONS of nurses who LOVE the job and couldn't dream of doing anything else. I think nursing is far beyond some "blue collar job". We are highly educated professionals, and this type of inside cannibalism of the profession just gives fodder for outsiders to tear nurses down even more. EVERY job has its downsides. Teachers, accountants, other allied health personnel will all have their grievances. My aunt works in the ER...she has her BSN, no graduate degree, and just made 96K last year working minimal OT. Yes, you can support your family and live a nice lifestyle in this area. Having the mindframe that money is bad and shouldn't be considered only continues this Nightingale stereotype that nurses should view money as a dirty word. Nurses should want and strive to make the most possible - goodness knows nurses work for it!Nursing also allows alot of advancement and flexibility/hrs and so much upward mobility if you choose to get more education. There are so many positives. Don't let some who are naysayers talk you out of it if you think you can would like it. Again, talk to many nurses and shadow to get a more balanced view. :twocents:

Music in My Heart · Jul 29, 2008

I personally am aiming to be a psychiatric nurse, helping people with addictions and other mental illnesses.

At least in these parts (SF-Sac region of Cali), psych jobs are tough to come by, especially for new grads. Our program director just told us that they had a graduate last class who was outstanding and was still unable to land a position as a psych nurse.

In our psych rotation through several different organizations I did not see anybody who didn't have at least 15 years of nursing experience.

I wouldn't hold my breath for a psych job.

Spatialized · Jul 29, 2008

I'll throw my :twocents: in too..

1. What are some of the worse things you have face on the job?

poop, vomit, blood, mucus, screaming family members, screaming docs, screaming patients, inadequate/incompetent ancillary staff and on...but really none of these things bother me. The hardest things to deal with is the inflated expectations brought on by our fix-at-all costs mentality. Some folks you are just not going to fix and until they (and family) realize this it can be a very big challenge.

2. Have you ever decide on areas you would not work in?

Peds, OB - no kiddos or mommies for me. I did long-term care and won't go back, not my cup of tea.

3. What are some of your experiences in non hospital settings and how do they differ?

Like I said above, I worked in LTC for awhile and did not enjoy it. Felt like my license was on the line every single day. But the people (the residents) were wonderful people who I felt I actually connected with which made it palatable. As I student I rotated through out-patient surgery (high turnaround), correctional (in the local jail) which was very unique, home health (didn't care for it) and public health which was intellectually intriguing, but didn't have as much hands-on as I wanted. Many times outside the hospital you don't have the rigid structure, except for corrections, and you have to be more self-motivating and able to work without direct close supervision. At least in my small experience.

4. Are you ever squeamish at the things you see and have to do, and if you did, did that pass in time?

Every now and then I may get a moment of stomach-churning from a particularly horrid wound, but nothing really hits me. It is said that all nurses have their "yuck" factor (renal/liver failure urine, y'know when it looks like motor oil...gives me the heeby-jeebys), some can hold it together better than others. The first couple of times I felt ribs crack and/or move during CPR freaked me out a bit as well.

You have to be very realistic about why you want to become a nurse though. If you're in it only for the prestige (..snort..) or the money you will fail. Financial gain wears thin by the third full bed change on a demented CDiff patient in the first 2 hours of a shift. There should be some altruistic side to it, without that, why help people? I work with nurses who are only doing it for the money (anymore) and they are bitter, burned out, and as uncaring as you might see. It isn't pretty.

Yes, there are many jobs for nurses out there that are not full-on bedside nursing. But to get to them usually requires a little commitment on your part by spending time at the bedside. If you're in this for the money, but don't want to be a (bedside) nurse, there are things you can do in the medical field: CT/MRI/Radiology tech, Ultrasound, vascular lab techs, PT, OT, Speech and on and on.

Bottom line though, I love my job. Dealing with the poop, vomit and blood, the codes the death and all of the assorted detritus of modern medicine is part of that. It is intellectually, emotionally and physically challenging, more than any other job I've done. It works for me. Not everyone though is cut out for it. Don't push yourself into something you fell isn't for you - it won't work, trust me.

Best of luck,

Tom

nursemike, ASN, RN · Jul 30, 2008

I don't entirely disagree with any of RN1989's points. Nursing can be a tough way to make a living, and I think if all you cared about was the money, there must be easier ways. I've spent much of my life doing hard, physical labor, but in the past few years I've left shifts tired in ways I didn't know you could be tired. Being self-employed, I knew a bit about stress, too, but as a nurse I've known near-panic anxiety, along with all the usual stress.

That said, it's possible to love this job, and you don't have to be a selfless martyr to do so. It is necessary to care about people, but what kind of sick soul doesn't care about people? I try hard to keep my patients safe and comfortable. I genuinely like most of them, and I get downright attached to some of them. One of my patients once asked whether I was deliberately bringing his meds last because he liked to gab, and appreciated it when I admitted I was. More than one of my patients has asked that I make sure to stop by at the end of my shift for a hug before I went home. I assure you that I am not even remotely saintly, but any reasonably nice person who doesn't mind working hard can enjoy little victories like these. Probably the most I've ever done to actively save someone's life might be washing my hands so they don't get a lethal infection, but every once in awhile I can notice something and call it to a doctor's attention before it becomes a more serious problem. It's a pretty decent ego boost when a doc tells you, "Nice catch."

Bedside nursing is tough, but it isn't thankless, and it can be downright fulfilling. There are individuals, units, and entire facilities that can be crappy, but I work alongside some of the best people I know--smart, strong, compassionate, and ready to do pretty much whatever needs to be done. If I were to win a big lottery jackpot, I'd miss my job. (But I'm pretty sure I could cope.)