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  1. Meet Theresa Puckett If you do a Google search for "nurse fired for being sick" you will be inundated with articles about Theresa Puckett, PhD, RN, CRCP, CNE, a nurse from Northeast Ohio who found herself terminated after a legitimate bout of the Flu during one of the worst Flu seasons our country has seen. According to an article in Becker's Hospital Review, Theresa worked as a PRN Nurse at University Hospitals, based in Cleveland. She called in sick one day at the end of December 2017 with flu symptoms. Theresa visited a physician and tested positive for the flu virus. She was treated with Tamiflu and ended up missing two days of work. Her physician provided a note excusing her from work for these days. She returned to work a few days later and was instructed by a supervisor to leave early due to continued illness. The next day, she saw a Nurse Practitioner who diagnosed her with a sinus infection and provided her with another note stating she should not return to work for a few more days. However, returning to work was never an option for Nurse Puckett because she was terminated. You may be thinking - How does that happen? According to the University Hospitals statement to Becker's Hospital Review, they allow six unscheduled absences for full and part-time staff within a 12 month period, and nine absences may result in termination. For "as needed" or PRN staff, two occurrences of unscheduled absences within a 60-day period may result in termination. Because Theresa returned to work for one shift in between her two absences, this counted as two occurrences and qualified her for termination. Presentism versus Absenteeism If you have ever gone to work sick, raise your hand. As hands of nurses around the world are raised high, let's discuss the reasons we've all done it. To really understand both sides of the issue, you need to understand the difference between absenteeism and presenteeism. Absenteeism is the practice of staying home from work or school when you are ill. Of course, there are other reasons people call off, but for this article, we are only exploring this issue concerning illness. So, what's the opposite of absenteeism? Presenteeism - the act of going to work when you are ill. Nurses have high standards for themselves and the care they provide to patients, even when they are ill. A 2000 study by Aronsson, et al. reported that rates of presenteeism were highest among nurses and teachers. But, we know that presenteeism may result in adverse patient outcomes, poor nurse health, and cost consequences. So, why is it so difficult to take a sick day? Let's consider a few of the most important factors when deciding which side of the issue you support. The Team Needs You Your throat is on fire, your head feels like a giant elephant is jumping on it and crawling back into bed sounds like the best possible plan - but, you know your teammates need you. You don't want to let others down. Staffing on many units is kept to a minimum so even one call off could cause your co-workers to take on larger assignments, be in unsafe situations, or be upset with you for calling off. A February 2018 article by News 5 Cleveland quoted one nurse as saying "Nurses are often commended for coming into work sick, so they don't put their comrades at a disservice for being understaffed." It seems the issues of teamwork, loyalty, and service is a double-edged sword on nursing units. Patients Need You Nurses spend more time with patients than any other healthcare professional. You recognize minor changes in assessments and notify physicians. Yes, the doctors diagnose and order new treatments, but it's the nurses who carry out these orders that are often life-saving treatments. A 2015 study published in JAMA Pediatrics explored the reasons physicians and advanced practice nurses work while ill. While 95% of the respondents believed working while sick put patients at risk, 83% reported working at least one time in the prior year while sick, and 9% reported working while ill at least 5 times. Symptoms reported in this study included fever, diarrhea and acute onset of respiratory symptoms. 92.5% of these clinicians cited not wanting to let patients down as one of the reasons they headed to work with these signs of illness. So, as you lie in bed contemplating calling in - that's what runs through your mind, right? Without you - who will care for your patients? And, what if you are not the only one with this dreaded illness? So, off to work you go. Sick Time Policies Are sick time policies created to protect or punish you? This is a hard question to answer. And, it often leaves nurses faced with difficult decisions that end in absenteeism or presenteeism. Let's explore a few sick time policy practices. Forfeiting Pay Some call-off policies will withhold pay from nurses if you call off at specific times. This might mean that calling off the day before a holiday will result in forfeiture of holiday pay. Or, if you call off on your last scheduled day before a planned vacation or on your first scheduled day after a planned vacation - you forfeit vacation pay. In a world where many people live paycheck to paycheck, this policy might result in nurses putting themselves and their patients at risk to keep pay that many would argue is rightfully yours. You can't plan illness, so if you are sick around these specific time points, what are you to do? Unexcused Absences Most policies give a number of 'unexcused" absences allowed over a period of time, such as 12 months. Typically after missing this number of days, you will be reprimanded. You may also be given a specific amount of time, such as the remainder of the year or 90 days, in which you must not miss any more work. Of course, if you end up legitimately ill during this time, you are probably going to go to work or risk disciplinary action. No Sick Pay Nurses who work a limited number of hours per week or prn often have no sick time. This leaves you making financial decisions in the face of illness. Or, your policy may require you to use vacation time before using sick pay. This may seem counterintuitive given the fact that nurse burnout and fatigue runs rampant on many nursing units and days off are necessary. Physician Notes Some sick policies require a physician's note for any unplanned absences. Others might state that no MD note is necessary because all unscheduled absences are unapproved. Or, you may also find policies that require a doctor's note after a certain number of days, which may be due to the Family Medical Leave Act. No matter what your policy reads in regards to doctors notes, you need to understand it before you need to use it. Be sure to get notes when they are required to remain compliant with your facilities policies. Termination Almost all sick policies will lead to termination as an end result. And, when such procedures are executed the same across the board, most nurses find these policies to be acceptable. However, when these policies are not carried out consistently, you may feel that they are being used against you or other staff on your unit to force your hand at finding a new job. Some of the allnurses team met Theresa at the NursesTakeDC rally earlier this year. Nurse Beth was able to interview Theresa and learn more about her ordeal. Thank you for sharing with us, Theresa. What are Your Thoughts? So, where does all of this leave you? Do you stay home when ill or head to work in an attempt to avoid discipline, even when you know it is not best for you or your patients? Now it's time for you to decide. Tell us your thoughts and experiences with nurse absenteeism, presenteeism, and termination.
  2. RSouth

    Just a Nurse | Life of a Nurse

    As I am approached by an angry family member of a patient that has been getting increasingly worse, they shout at me to which I reply... "I am just the nurse." After my shift, as I make my way home, I reflected on my response and what I meant in that statement "I am just the nurse...." What exactly did that mean? As a looked back on the major accomplishment of my life, I realized that the response I gave, although only a few words, was worth more than anything I could explain. "Just the nurse" meant that I had mastered the art of assessment and deliberation. Mastered prioritization and communication skills. I had spent more of my recent life with strangers who ended up closer than a family than I had spent with my actual family. I have spent countless hours filling my brain with information that I could only pray to remember the next day once the test began. I had tried on dozens of scrub uniforms until I finally found the perfect brand. And let's not forget about the walking, I have put more miles on my work shoes that most cars are able to reach. I have held more hands and offered more comfort than one person could possibly be capable of. I have dealt with more unexpected outcomes than any individual should be able to adapt to. I have answered more medical questions for my family members and friends than I care to discuss. Yet, here I am. Head held high knowing the power that I possessed to change the trajectory of a life by "just being a nurse." As a nurse, we have the power to hold hands and comfort souls while we wipe the tears away. We have the power to offer protection and be the defenders for our patients and families. We help comfort in the midst of pain and spread courage in the face of fear. We are able to be an advocate for those who are unable to advocate for themselves. We give hope when all hope is lost. We offer a shoulder to cry on and a listening ear in the middle of the night. We pour our soul out to others for long shifts, yet wake up and give more the next day. We are healers of not just the physical but the spiritual. Being "just a nurse" is more than a job choice. It extends beyond a profession. Being a nurse consumes your soul and radiates from within. It is our calling, our destiny. As a nurse, we are proud of the person whom we have grown to become, shaped by what our eyes have seen. We are every-changing in our outlook on life as each day is a precious gift that we see taken far too soon and far too often. It is an understanding that each day will be different and that every day is a chance to touch a life, a life that may have been lost if it were not for you. Once you are a nurse, you soon understand your path of life that is destined for you. You become a visionary not only for yourself, but for those lives that are touched and inspired by you. You become someone's cheerleader in the worst moments of their life, and their biggest fan when success has been achieved. As a nurse, you understand that you are more powerful than most superheroes on the television on any given day. Because being "Just a Nurse" is simply understanding that not all superheroes wear capes, some wear scrubs and stethoscopes......
  3. Meagan

    A Letter to my Hospice Patient

    To the Patient I’ll Never Forget When we first met, it was my third year of nursing. I was young and excited to start my new job in the clinic. You were in your 80's, and had been through a lot - Heart Disease, Chronic Kidney Disease, Dialysis, and now CHF. By the time we met, you had been coming to the clinic for several years. I heard nothing but wonderful sentiments about your kindness and resilience from my coworkers. I had only known you for 6 months before you surprised me – you wanted to transition to hospice. I remember that day very clearly. We had been working very hard to keep your CHF under control, but we knew it wasn’t enough. You were more short of breath with minimal activity, had more swelling to your legs, and developed reoccurring ascites for which you required numerous abdominal paracentesis. You went to see the renal specialist and cardiologist – and hadn’t received good news – there was nothing else they could do. You see, at that time, I had been a nurse for about three years and my experience came from a busy Telemetry unit. I had taken care of and helped to transition many hospice patients, but they hadn’t walked out of the hospital to go home. They were usually very ill, and after lengthy conversations with family and physicians, they were transitioned down to the inpatient hospice unit. As a nurse, my experience was actually caring for the hospice patient. What I didn’t have experience doing was initiating the hospice transition. You were my first. And, after you passed away, I realized I had learned some of the most valuable lessons in my nursing career. I learned to slow down. When you work in the hospital, you’re always in “save” mode. You’re on high alert for the slightest change, because if you don’t catch it, it could spell disaster or even death for your patient. You’re ready at the slightest change to race down the hall and put to work those ACLS skills you worked so hard to learn. You’re ready to be the best patient advocate you can be to save their life. But I didn’t work on the unit any more. I worked in a clinic with a patient population consisting of the chronically ill. It dawned on me when you chose hospice that it was okay to slow down. I learned it was okay to use my clinical judgement as a nurse to initiate those difficult conversations with my patients and take a more holistic approach. I learned that hospice does not mean “giving up.” When we talked about hospice and your thoughts on starting the process, you told me with such conviction that you were ready. You had been through “save” mode many times. You had been stuck countless times for IV’s or labs, had numerous abdominal paracentesis’, and had already been through dialysis. By this time, you didn’t want any more doctors office visits, trips to the hospital or any invasive procedures. I remember you telling me that you felt so blessed to have made it this far, and that resonated with me. I learned what dignity truly means. By definition dignity is, “the state or quality of being worthy of honor or respect.” After you passed away, it was hard for me to see that empty chair every week. But, what I realized was that you had given yourself and your family a gift. There are times in our nursing careers when we see patients who can’t make these decisions for themselves. Sometimes they don’t have advanced directives in place, or they have family members that just can’t agree. I respected your family’s commitment to your wishes, as this is something I don’t think we get to experience often enough. Although many years have passed, I will never forget the conversations we had, and the lessons I learned as a new nurse. I think about that day often and I thank you for helping to shape my nursing career. Fellow Nurses, have you had similar experiences that changed your nursing practice? What was your greatest take-away?
  4. Maureen Bonatch MSN

    What Advice Would You Give to Future Nurses?

    The news is often overflowing with articles about nurse burnout, bullying, staff shortages, and questionable compensation. You may have experienced some, or all, of these issues yourself during your nursing career. Maybe enough to make you wonder why you went into nursing in the first place. This may make it difficult to come up with a positive response when someone asks you, “Do you think I should go into nursing?” The issues of inadequate staffing and the significant number of nurses reaching retirement age are a common concern of the nurses today. A continuing influx of nurses into the profession is required to help reduce these staffing issues. Although with a significant number of nurses leaving the profession, it can be helpful to provide advice that is more practical, rather than personal, for someone considering a career in nursing. Don’t Be a Dream Crusher Complaining comes as a natural response to most people, some so much that it’s become a habit. We might not think twice about unburdening all the unsavory things about being a nurse on a willing listener to feel validated. Even if your complaints are justified, this can paint a negative image of the nursing profession. It may potentially deter future nurses before they determine if nursing is a good career choice. Even if it feels like the bad aspects of the job are outweighing the good, consider that the positive benefits of nursing are probably what led you to the profession, and made you stay. Provide Practical Advice The profession of nursing continues to be an attractive, growing, career option. One that’s held in high regard and respect by many who consider it the most honest and ethical profession. With an awareness of the challenges that can accompany a nursing career, explain what you feel might be a few key characteristics of a good nurse. That way they can determine if a nursing career would work well for them based on their career goals, personal strengths, weaknesses and their personal life. What Are Some Characteristics of a Good Nurse? Flexibility: Nurses work holidays, weekends and with varying schedules. Sometimes there may be several different shifts in one week or extended hours during one day. Empathy: Nurses must draw upon empathy when caring for patients at their most vulnerable times, or dealing with the challenges of patients that have different views, beliefs or are just difficult to care for. Compassion- Providing compassionate care is at the heart of nursing, no matter what the specialty. Physical endurance- Long shifts spent on your feet providing physical care for patients can take a physical toll, so recommend that they consider their personal tolerance and physical limitations. Attention to detail- Accurate documentation and having a discerning eye to notice changes in patient conditions is essential to provide quality patient care. Excellent Communicator- Nurses work with an increasing variety of disciplines, cultures, and in diverse environments. This requires strong verbal and nonverbal communication skills. Lifelong learner- Healthcare is continuously changing through the use of technology. This increases demands on nurses to continue learning to keep their skills relevant. Emotional stability- The demands of nursing can be stressful, so positive coping mechanisms, prioritizing self-care, and the ability to recognize and address signs of burnout are important. Organized- Stellar organization skills are helpful to juggle the varied demands of a nurse’s usual day and provide quality patient care. See for Themselves These key characteristics are shared by many nurses, although each specialty, and different nursing environments, can come with their own positive and negative attributes. It may be challenging to adequately describe a day in the life of a nurse to ensure a future nurse is entering the profession without blinders. A deeper look into the reality of nursing could be achieved for someone who is uncertain if nursing is the right career choice. What are Some Ways We Can Encourage a Future Nurse? Take an online course Shadow a nurse to observe a usual day Become a certified nursing assistant (CNA) to experience providing direct patient care Obtain work in an entry-level job in a healthcare environment Share Your Wisdom The nursing profession isn’t for everyone, and ultimately the decision is an individual one, but you can help a potential nurse to make the best decision about their career. Instead of chipping away at the fresh face full of idealistic hopes and dreams, allow their enthusiasm. It just might help you remember why you chose nursing in the first place. What Advice Would You Give to a Future Nurse?
  5. Since nurses are expected to be self-regulated professionals, we are legally and ethically obligated to identify and make a valid attempt to resolve all practice issues as they arise as a means to minimize potential negative impacts they may have on patients, our fellow colleagues, and daily operations. In part three of this three-part series, we will focus on how to document and evaluate to improve practice issues within our work settings. Let’s take a look at two strategies we can implement to gain a better understanding of what’s going on, so we can find the best way to resolve practice issues: Document It is important to keep personal records of all steps taken to resolve a practice issue. This ensures there is an accurate account of events and that you can use to demonstrate that you’ve met your professional obligations. It is recommended that all communication with managers and other leaders of your organization be noted in your personal communication log. Additionally, it may prove to be helpful to have any discussions or meetings followed up with a summary email. This provides all parties involved with a detailed record of what was discussed and allows for you to highlight specific details, seek further clarification after you’ve thought about it for a while, and to hold other individuals accountable for their contributions to the discussion and/or meeting. Each board of nursing offers detailed information about the legal and ethical responsibilities relating to reporting and documenting challenging situations within practice. The boards of nursing help to clarify the nurse’s legal and ethical obligation to report incompetent, unethical or impaired practice of a nurse or unethical conduct by any health professional to management, administration and/or the appropriate regulatory body. When documenting any of the above mentioned, be sure to include the following: The practice issue witnessed When the practice issue occurred (specific date and time) Exactly what happened - be sure to remain objective and factual. Describe how the issue has impacted your ability to meet Standards of Practice, Code of Ethics or organizational policies Any other relevant information A request for leadership to follow-up It is essential to note that the client chart is NOT the place to document discussions regarding a practice issue unless the practice issue had a direct impact on the client. You may also be required to document the practice issue in an incident reporting system. Be sure to know your organization’s policies regarding documentation and/or refer to your state’s board of nursing for more information regarding principles of documentation related to practice issues. Evaluate The final step of the nursing process evaluation - and now you must evaluate if the practice issue has been resolved and to determine how your actions may have impacted on the issue itself. If the practice issue was addressed with the support of others, it is important to include them in the evaluation process. Remember that you are never alone in nursing practice - it is always a team effort! Evaluation helps to ensure that the issue has been addressed and serves as a way to examine what you would do or change in the event of another practice issue. Depending on the severity of the issue, it may not be possible to resolve it immediately and this should be considered during the evaluation process. If your organization’s leadership decides that it is best for them to manage the practice issue without your involvement, it is appropriate to ask that you be informed when it has been addressed or resolved. Be aware that because of confidentiality, the leadership may not be able to provide you with detailed information about how they have resolved the issue. They may only be able to inform you that the issue has been addressed. If you see the practice issue reoccur in the future, it is important to let leadership know and follow the same process as before. You’ll find that as you move through your career, and from one facility to another, things fall between the cracks as individuals leave organizations. It is very likely that an issue that you help to resolve one year, may resurface within the next year or so. If you’ve determined that the practice issues have not been resolved, take a step back and consider why. Review the process you used by asking yourself the following: Did you clearly identify the issue? Could you define how and when client care or service was affected? Were the right people involved in the discussions and attempts to resolve the issue? Is there evidence that your leadership team took steps to address the practice issue? What could have been done differently? Once you have reviewed all of the possibilities, you’ll choose your next steps. If the practice issue persists you need to continue to take action until it is addressed. Further action could include: Request a meeting if you have not yet had a meeting with your leadership team. Meet with your direct supervisor again to determine when resolution is likely if you have already met with them and the issue persists. Consider discussing the practice issue with the next level of leadership in your organization if your direct supervisor does not provide the support needed for resolution. Continue to notify the appropriate people until the issue has been resolved. In this three-part series, we’ve discussed the six steps in resolving practice issues within nursing practice. The six steps include: Identifying Practice Issues Fully Exploring the Anticipated Effect and Outcomes of the Practice Issue(s) Identifying Resources Taking Action Documenting Evaluating Does the above list of steps sound familiar? If you guessed - The Nursing Process, you’d be correct! The Nursing Process is always the most important tool that nurses can use to resolve highly complex situations - even major practice issues. To read the first 2 parts of this series, go to: Strategies for Nursing Success: Part 1 of 3 - Identifying Practice Issues Strategies for Nursing Success: Part 2 of 3 - Identifying Resources and Taking Action to Improve Practice Issues If you have any other tips or suggestions you’d like to share regarding resolving practice issues, please feel free to leave your thoughts in the comments section below! Best, Damion
  6. Shawna RN

    I'm Just The Nurse | Life of a Nurse

    I’m just the nurse. That was my response when questioned regarding my role. One day, that response felt wrong. I am the nurse that will provide care, advocate, educate, and inform. This thinking “just a nurse” is exactly what is wrong with the world view of nursing. The truth about nursing is unknown by most people. Maybe, that is due in part to the many roles a nurse can have. A nurse can provide direct patient care inpatient or outpatient, research, administration, legal, and the list continue. I am not just a nurse. I am educated and knowledgeable. I am caring and compassionate. I work in private practice and my role changes from minute to minute and day to day. I provide phone triage. I obtain information and give advice to patients over the phone. I may be talking to the parent of a sick child, a prenatal who is in labor, or a patient with chest pain. I must be able to think quickly and provide appropriate advice. If a patient needs to go to the hospital, then I need to be able to tell them that right away. I can’t wait for the physician in the event of an emergency. Take a stroke patient for example, every second is critical, and care cannot be delayed. I room patients, obtain vital signs, and get them ready to see the physician. Depending on the patient and visit type, different information may be needed. I may need to obtain a urine specimen, obtain blood for laboratory testing, administer oxygen, administer medications orally, through injection or IV. They may require a procedure in which case I would set up for the specific procedure they are going to have. In addition to regular office visits, my office does casting for simple fractures, sutures for lacerations, excisions, circumcisions, cryotherapy and IV antibiotics. Our patients range in age from newborn to geriatrics including OB/GYN. I also manage. I do staff scheduling and order supplies. I put out fires and sometimes I’m the fall guy. I manage our state vaccine program. Order imaging for patients and obtain approval from their insurance companies. When the pharmacy tells you that your insurance doesn’t want to cover your medication, and it requires prior authorization, yes, I do that too. I also work with insurance companies to ensure that patients are getting regular preventative care as a care coordinator. I attend meetings and gather information. I am given our office report card so to say and make changes where needed. I’m calling patients to tell them they are past due for their physicals, diabetic eye exams, colonoscopies, and mammograms. I talk to patients about medications, treatments, questions, and concerns. I talk to every drug rep that comes through the door. I hold the hand of a new widow and listen. I sit with a patient that has just been told they have a terminal illness. I continue to work after finding out that a favorite patient has passed away. I hold back my own emotion to maintain a professional image, to continue to meet the needs of other patients, to provide information, and guidance as needed. My car is my safe haven and my ride home is when I can allow my emotions to show. Conversations are not always pleasant because I didn’t do these things fast enough for some. You may not know that I work through lunch most days to ensure every request is done. I forgot to drink enough fluids today, and I didn’t use the bathroom yet. I have worked an hour over and now I must leave to race to my child who awaits me. A forgiving child who is often the last child at aftercare because I could not leave a patient. I am a caregiver. I am an educator. I am a nurse. I am human. I am a mother, and a wife who sometimes comes home empty. Shawna Whitford, RN
  7. My career has been marked by one main constant - change! Can change really be constant? Read my story and decide for yourself. I started my career as a home health nurse. I was really happy with it for a while because I got to spend one-on-one time with my patient and I made (what I considered at the time) good money. But after about a year, I was looking for something else. Home health nursing was wearing me and my car out. I was putting about 600 miles on my car every week and I was working about 80 hours a day. My poor husband told me, "I feel like I live alone because you are either at work or working at home." And he was right! I had a huge territory, and I saw 7-10 patients a day. I was constantly being asked to pick up extra work because there were not enough RNs. This got old, and besides, I became a nurse to work in a hospital. This led me to my second job: working on a cardiac step-down unit. I loved this too! My job was 10 minutes from home, I didn't have to bring home any paperwork or documentation, and (what a privilege!) I was given health insurance and paid time off. I thought I was in heaven (again). So what happened? I was working with some really snooty nurses who didn't like new people at all, it seemed. This made me feel sort of lonely for 36 hours a week, and my pay actually went down. My husband and I had always wanted to do travel nursing, so I got signed up with an agency and off we went! That was a really fun time in life, filled with so many adventures, good pay and more choices. Travel nursing is full of change: a new hospital every 13 weeks. This was good for me. I guess I'm sort of gypsy at heart. I loved moving around all the time. I loved the change. Every new place was a new start and by the time I started being temperamental about the hospital, it was time to go and start over again. What could possibly go wrong, you ask? Well, living in an RV or a hotel most of the time started feeling cramped. I missed my (grown) kids because I was away from home so much of the time, and about this time I was also feeling really burned out in hospitals. To give myself a new change, I decided to go back to home health. Here is my current problem. Working in home health requires being available 5 days a week to make enough money. I thought it would be a good trade-off for the reduced stress compared to the stress level I was feeling hospitals. But it has been less than 6 months and already I am tired of working 12 hour days 5 days a week. I am tired of having to call doctor's offices on my days off. I am tired of working all day in the field only to come home and have to document, answer emails, call patients to set up my next day, and I'm tired of being tired. I miss having 4 days off every week. Yes, I have applied and been offered another hospital job. Will this make me happy this time? I sure do hope so. Before the comments start - I have considered other types of nursing. I have looked at and applied to many non-hospital and home health jobs. Unfortunately, I have not been able to get an interview for a single one. Additionally, I really do love 3-12s, and I have only seen that in hospitals. I realize that I am going to have to accept the fact that no job is going to be perfect. I think I've done that. I hope I've done that. If I am to be 100% honest here, I know that working for myself is the only answer that is going to make me feel satisfied in the long run... and I am working on it
  8. jeastridge

    Is Nursing Kind?

    Kindness never goes out of style. One of the first lessons we learn in life that relates to how we treat others is often what we call The Golden Rule, “Do unto others as you would have them do unto you.” While this life-theme fits in beautifully in our spiritual lives, how does it apply to being a nurse? Does it? Can it? Is nursing getting harder? We are practicing in a hard time. Nursing is always hard, but for some reason, the last two decades seem to have progressed in ways that make nursing harder. There is a lot of focus on excellence, but not exactly the kind of excellence that leads to kindness. There is a lot of push for efficiency and flexibility, but sometimes we feel our personal lives sacrificed on the altar of corporate interests who often appear to completely disregard the meaning of the word kindness. The cost-cutting measures, pressures to document and concerns about staffing levels often bear down hard on the persons who work closest to the patients—the nursing staff. Whenever an organization goes through a re-alignment or sells out to another entity, it appears that one of the first measures submitted for scrutiny and possible “chopping” are nursing ratios and pay levels. Sometimes, our more service-oriented profession puts us at the bottom of the power structure and we find ourselves in the uncomfortable position of defensiveness, sometimes without adequate representation or voice on the boards that control outcomes. Additionally, years of medical malpractice lawsuits have yielded some unwanted results. While the ability to sue is still sacrosanct, the huge payouts over time have resulted in fearful institutions that carefully guard their territory and work hard to become impervious to lawsuits (an impossible feat, it appears…). The practitioners that find themselves in the crosshairs of this controversy are sometimes the nurses who document and document, using electronic medical records that are built as defense mechanisms instead of patient care tools. How do we keep being kind? Where does all this leave us in our pursuit to be kind to our patients and to truly care? How can we be persons and employees who set a good example that leads others to follow? 1. Stay centered. While our professional life may keep coming at us full force, it is up to us to practice good physical, mental and emotional self-care, practices that enable us to overcome obstacles and push forward with kindness in the face of the opposite. By investing time in daily meditation, exercise, prayer, journaling—whatever feeds your spirit—you maintain the integrity of self that promotes kindness even in oppositional environments. 2. Allow for the benefit of the doubt. People have bad days. They mess up. They are “hangry” (hungry + angry = trouble). They are grieving. They are going through life crisis. Their pet died. We just don’t know what kind of uncomfortable shoes our neighbors are walking in. Yes, they may just be “high and mighty” and mean folks but then again, what good does it do us to go with that assumption? The training on “Trauma-Informed Healing” encourages us to ask not, “What is wrong with you?” But instead ask, “What happened to you?” We can experience a refill of the blessed gift of kindness when we change our questions and look at others with eyes that allow for grace. 3. Be kind even when it is unreasonable. Most of us know that when we are offended, mistreated and stepped on, we want to retaliate. That is human nature. Nurses are human, for sure. We get tired of being at the bottom of the totem pole of consideration. We get tired of being asked to pick up the slack again and again. We get tired of adding thankless jobs to our list, simply because someone higher on the pay grade thinks it is a good idea. We have a choice to make every day: reply with anger or defensiveness or even with the simple truth (which can be harsh sometimes…), or find ways to continue in kindness—all the while seeking true justice. Being consciously kind! Social media is awash with quotes about kindness, some of them helpful and others, not so much. But the one that really sticks with me is by Brian Tracy: In life you can never be too kind or too fair; everyone you meet is carrying a heavy load. When you go through your day expressing kindness and courtesy to all you meet, you leave behind a feeling of warmth and good cheer, and you help alleviate the burdens everyone is struggling with. As nurses, we have a daily choice to make. We can succumb to the pull of unkindness and rail against the unfairness of our professional life or we can continue to pursue excellence all the while seeking true justice and improving conditions for ourselves as professionals and for our patients who depend on us. How do you work to stay kind?
  9. My family had humble beginnings. As a child, we were working class. My father had only graduated from high school and my mother, who was an immigrant had only completed elementary school. However, they worked hard and by the time I was in high school we were solidly middle class. In high school, I was a stereotypical nerd who got straight A's. However, I had a terrible secret. I was being horribly physically abused. One night, I remember being struck 700 times with a board about 1/2" thick and 3" wide. Actually multiple boards, because they kept breaking and then being replaced. I lost count at 700, so it was way more than that. And that was typical for me. I learned that after repeated blows, I would go numb physically and I also learned to transport myself mentally to a different place. I kept going by telling myself I would get into an Ivy League college and get away from my home and never go back. Well, I did! I got into Yale. As a college freshman at Yale, everything was wonderful! I couldn't believe I had made it and I got decent grades. My parents were happy they could brag to all their friends that I was at Yale. After I made it clear that I would no longer accept any beatings, they cut me off financially. I was only 17. Yale was supportive, but explained that because I had entered school as a dependent, I would have to leave school, be self-sufficient for 2 years, and then Yale could give me a full ride so I could finish school. Well, I was so young and completely heartbroken that I fell into a deep depression and failed 2 classes my last semester. (The first of several episodes of major depression). I had nowhere to go, so returned home. Because I refused to be beaten, my mother threw me out of the house with nothing but the clothes on my back. She also stole my savings. So I was now 18 and homeless. Fortunately, some kind friends took me in for the summer and I worked 2 jobs to save as much money as possible. Then I was able to get a secretarial job that paid well. I ended up getting married at the age of 21 and becoming a stepmother to 2 wonderful children. However, the only job I could get as an Ivy League dropout was secretarial work and many employers humiliated me by saying "My secretary went to Yale" and laughing at me. I remember burning with shame and anger and vowed to finish my BA. After a couple of years of working and saving, my husband and I were in a position to allow me to finish college at a state university. My GPA was bad at 2.9 because I would get A's in the classes I enjoyed and bad grades in the classes I didn't like. I was young and my study habits were poor. However, I did graduate. But I had earned a liberal arts BA, and in the 1980s, for most women that meant starting out as a secretary. I ended up working for a very nice Chief Technology Officer who noticed I was good with computers, so he suggested I get a BS in a computer related field and the company would pay for it. So, I would drive an hour or more each way 2 nights per weeks to school and earned my BS in Computer and Information Systems Management. However, my GPA was again mediocre because I was working full-time and still did not have good study habits. Then I was able to start a career in high technology, ultimately working my way up to Director and Vice President level positions, making about $175 K per year. I traveled all over the world and lived all over the US - Washington DC, Silicon Valley, and Los Angeles. But I felt unfulfilled and increasingly miserable in my job. (BTW - it was common in my field to work 60 to 80 hour weeks, 6 to 7 days a week and traveling on top of that - so no personal life! I could go for several months being out of town M-F and only coming home on weekends) Fast forward to 2008, when the Great Recession hit. Like many people, I was laid off. At the same time, I was helping to take care of my mother, who was by then an invalid. I began thinking of my future - I had always regretted not becoming a doctor. I did some research and realized healthcare was a great field and I could apply my business and technology skills. So I used my savings to attend a two year executive education program at UCLA in Healthcare Management and Leadership and I got straight A's. Along the way, I realized I wanted to provide hands-on patient care, and based on my new knowledge, nursing seemed like the best fit. I took a Red Cross CNA course to make sure I could handle the patient care. It was soooo hard, but every day after clinicals, I would arrive home exhausted, but feeling fulfilled and happy that I had helped people that day. So I decided to pursue becoming a Nurse Practitioner. Unfortunately, my mediocre undergraduate grades were now an issue. In addition, in California, the colleges were impacted, which meant you had to take nursing prereq's wherever you could win a "lottery" and get into one of those classes. I took my prereq's all over - various community colleges and also through UCLA Extension. I did well, getting all A's except for Chemistry (got a B). However, I did have to withdraw from Anatomy and retake that because I just was not prepared for all the memorization. So, I applied to nursing schools. My father was skeptical, due to my advanced age, but I figured I had some valuable experience as a manager and leader, and I also understood technology (software like EMRs/EHRs), plus had general life experience. I was accepted by the UCLA Direct Entry MSN program and also by Johns Hopkins' ABSN program. I decided to attend Hopkins and started the ABSN at age 53. Nursing school was the hardest thing I had ever done! Many times I cried by myself, wondering if I could survive. While I was strong academically, I struggled with skills such as setting up IVs, etc. I was always one of the slowest students in learning skills. A couple of instructors told me I wasn't cut out to be a nurse. I also struggled with depression and anxiety. (Interestingly my best support during this period was from MDs I knew, who said I had what it took to be an NP and were annoyed I hadn't gone to medical school). After graduating, I immediately started the MSN program and found myself comfortable and confident in my physical exam skills! (I'm not sure what happened there). However, the summer we had off from school, I had a major issue with my father which threw me into the most severe depression of my life and I had to be hospitalized for 5 days. When I started school again, I got C's on a couple of exams, which shocked my professors. I asked for help. Fortunately, they were very supportive and made sure I got the support and care I needed so I could regain my academic footing. I also had to repeat one clinical and will be forever grateful for the professor who went to bat for me so that I could graduate with the rest of my cohort. I graduated at age 56 with my MSN and was hired in 2 months for my dream NP job, starting at $95K and increasing to $140K within 18 months, based on performance. I also won a HRSA scholarship, which paid for the last 18 months of my MSN, along with a small stipend, in return for 2 years of public service. If I could have stayed in Baltimore, my preceptor on my last rotation would have hired me. My advice: hang in there and work hard! And ask for help as soon as you run into trouble - my only mistake at Hopkins was not asking for help soon enough due to panic and embarassment. Apply to the best schools and don't be afraid of the price tag - many of the expensive schools have a lot of scholarships and good financial aid, so they are actually cheaper than some state schools. That is why I chose Hopkins over UCLA - it was actually cheaper with the financial aid I received and I am a California resident! Apply for every scholarship you can and ask all your professors and the financial aid people what is available - sometimes the professors know about scholarships that financial aid does not, or vice versa. If I were younger, I would have joined the military to get loan repayment. In addition, at Hopkins we had students who had been corps men in the military who were going to Hopkins full time and the military was paying for everything. With regard to looking for a job, be flexible on location. I live in California and everyone wants to live in San Francisco, LA, or San Diego. Yet, there are many jobs in other parts of the state that are begging for candidates! I got a job in a stunningly beautiful area with a population of about 100,000 and a very low cost of living. For example, to rent a one bedroom apartment in San Diego area is now at least $2,000 a month (and much more in SF or LA). Where my job is, you can get a nice 1 BR place for $600 to $700 (on the water!) a month. The downside is I will have to live there for 2 years and can only drive to my home (I own a home) on the weekends. So, research where nurses and NPs are needed and be willing to go there. Hope this helps some folks. Best wishes to all.
  10. Deb_Aston

    The Importance of Best and Worst Days

    Close your eyes and think about the worst shift that you ever survived; I use the word "survive", because after such a shift, one can feel like they have been through hell and back in what seems like a never-ending 12.5 hours... who am I kidding, we are nurses, it's more like 13-14 hours! My worst shifts weren't the "busy" ones that happened because we were short-staffed, didn't get a break, or got swamped with admissions; those happen all the time and we (just) "get through" them. No, the worst shifts stay with you; you remember how they made you feel... sadness or regret, self-doubt, anger, helplessness, or frustration... or all of those things piled into one really crappy day. We remember the painful things; it's not by choice. As nurses, we often bear witness to horrific things that occur every day, in every city or town. We see car accidents, victims of violence, drownings, child abuse/neglect, etc. We try to help in any way that we can; when we can't, our heart breaks because of our limitations. My worst days still live within my mind; I remember the bruised, emaciated body of a little boy who was kept in a cage in his adoptive parent's basement as we tirelessly worked to resuscitate him; we did everything that we could, but it was too late. I remember caring for a teenage girl who attempted suicide by hanging, who was brought back to a life of complete debilitation. I remember providing end-of-life care to a young girl who fought a courageous, but impossible, battle with cancer, and once she peacefully passed from this life, with her parents and siblings at her side, her mother's heart (literally) stopped beating, and we had to immediately (and unbelievably) go into life-saving mode, call a "code blue" and start CPR on mom, right outside of her deceased daughter's room. We brought her broken heart back, whether it wanted to continue to beat or not. I still think about that family many years later. I will never forget that worst day and the lesson it taught me that one can truly die from a broken heart. Now...take a breath, close your eyes, and think about your best day at work...did it inspire you to be a better nurse, or a better colleague...or a better person? The best shifts are not the ones that are uneventful, or dare I say, "quiet". No... the best shifts are often unexpectedly extraordinary. A best shift is created when you are working with a great team and all the stars are aligned in your favor for a positive outcome. I remember one of my best days; I was an active responder during a Rapid Response that turned quickly into a full code. We did everything in our power to re-start a life, but we soon became acutely aware of the high probability that we may lose our patient. During the final pulse check, we all looked up at the monitor in complete silence...a rhythm suddenly appeared, and pulses returned. We were all in utter disbelief, but we gratefully accepted the gift from above that will sustain us for an entire career. The best shift becomes that "crazy, unbelievable" story that you share with one another, forever bonded as witnesses of a true miracle. The worst and best days are important because they make us who we are; they define our actions, attitudes, and our experiences. We learn from them; they make us (more) human, and better nurses. They also create stronger and more united teams because best and worst days connect us in a way that most other professions simply cannot. I wish you all best and worst days that will give you the strength and empathy that you need to be compassionate, grateful, and kind to one another.
  11. Ashley Hay, BSN, RN

    A Nurse's Sacrifice

    Nurses are usually first to diminish their own contributions and quickly dismiss any outside accolades from those not in the business of healthcare. "Isn't it hard? Nurses are angels. My father had wonderful nurses when he died. I can't imagine how you do it every day." Comments like this bring the focus to us as individuals, making us inherently aware and uncomfortable with reality of the heavy weight our daily role carries. It is usually met with a brisk hand flail and quickened breath - attempting to get onto any other topic. "Oh, thanks. I love my job, it can be hard some days but it's just something you do". This doesn't even come close to representing the struggles nurses endure every single shift. Our humble nature prevents us from accepting any adoration for our professional work and honestly, it's probably because that would cause us to reflect inward on what our work really costs us on a personal level. I have been a registered nurse in oncology, both pediatric & adult, for over 10 years. Yes, I really love what I do. Really. It was only recently, after taking a class on incivility, I realized the true magnitude of personal sacrifices I had made for my beloved profession. Let's start with night shift, shall we? We all know working night shift in any profession can have damaging physical effects; turning your internal clock upside down, shaking it loose for parts and dumping out all of your circadian rhythms along with it. What most nurses don't talk about is things like not being able to have dinner with their families, not being able to sleep next to their spouse, having little patience and nothing left over to give when we finally do come home. Like many, I was told I had to "pay my dues" and work the night shift. So I did - for three years. I remember crying in the staff bathroom at around 12:10 am on New Year's Eve. All of the voicemails from friends and family who were out celebrating made my heart heavy. I needed to collect myself quickly - the call bell rang for me. I saw my elderly patient, alone - a widower, with colorectal cancer, post bowel resection. I focused on the task at hand and shoved my own feelings down as deep as they would go. Moments like these are exactly what we need to start looking at - why do we not allow ourselves to feel badly about missing out on important life events? Most of us couldn't even begin to count all of the weekends, nights, and holidays worked. Most of us don't even really think of it. But, you probably remember the last important thing you had to miss - a child's practice, a friend's birthday, a spouse's corporate event - and it does weigh on us. I even let my schedule dictate where my career would bring me. Going back to school? Need a day shift. Want more time to travel? Need 12 hours. Want get to know your family again? Outpatient clinic, work less holidays. I've seen nurses adjust their own insulin pumps because they don't have time to eat properly while working. I've known nurses who have gotten kidney stones because they don't have time to hydrate, never mind urinate. I have been unable to take my own medication on time during busy shifts. I've gone full shifts without a break. We have all felt utterly exhausted, seriously hypoglycemic and totally emotionally drained - sometimes multiple times per week. This profession is incredibly rewarding but do we know when to draw the line? Would we ever know when to tap out? I'm not so sure. Nurses are bred tough, maybe too tough for our own good. With all this in mind, let us take a moment to fully acknowledge the sacrifices we have made and continue to make every day. Remember to be kind to your fellow nurse. We absolutely must take care of each other. Please, take a mental health day when needed. Your family and your patients will all be happier! Be proud of all you do. It's certainly not an easy job - some days may be totally thankless and bring on tears of frustration or self doubt. But, receiving that tearful 'thank you' from a deeply grateful patient, parent, or spouse can make it all worthwhile. I guess I'm still a sucker for this gig after all.
  12. This article is featured in the July 2018 edition of our allnurses Magazine... Download allnurses Magazine History of the shortage In March 2000, the National Sample Survey of Registered Nurses conducted by the Division of Nursing of the U.S. Department of Health and Human Services Bureau of Health Professionals revealed several interesting facts about the future of nursing: The average age of a registered nurse increased from 42.3 to 43.3 years between 1996 and 2000 (Spratley, Johnson, Sochalski, Fritz, & Spencer, 2000). The number of licensed nurses in 2000 was nearly 2.7 million, which was a 5.4 percent increase since the last study. However, this was the lowest reported annual increase by the department since 1977 (Spratley et al., 2000) The RN population under the age of 30 dropped from 25.1 percent in 1980 to only 9.1 percent in 2000 (Spratley et al., 2000). By 2014, The U.S. Health Resources and Services Administration released "The Future of the Nursing Workforce: National and State-Level Projections, 2012-2025." In this report, 34 states were projected to have a shortage of nurses by 2025 (U.S. Department of Health and Human Services, 2014). This would create a total deficit of 808,000 nurses across the United States for the same period (U.S. Department of Health and Human Services, 2014). While portions of the data were correct from these original studies, there have been significant changes that could not have been predicted. Let's discuss the factors at play with the current state and future outlook of the nursing profession. Factors for Consideration It's not enough to merely accept we that are in a nursing shortage. We must strive to understand the positive and negative factors that have affected us as a profession. Age According to our 2018 Salary Survey results, with more than 16,800 participants, nurses between the ages of 50-59 made up the largest group of working nurses (25.12%), up from the 2017 results (21%). The next two largest groups included nurses between the ages of 30-39 years (23.7%) and ages 40-49 years (22.6%). The 2017 results for both of the last two age groups are down from the 2017 results (27%). Our results indicate that the majority of our nursing population is in the middle-age of life and getting older. As we look to the future, we must consider how our aging nursing workforce will keep up with the demands of the healthcare industry. While the baby boomers have continued to work longer than expected, we saw a new group take an interest in nursing as a career that no one saw coming - the millennials. As we look to the future, Generation Z is starting to choose careers and enter college. How does this impact our future? Boomers, Millennials and Gen Z Some of the predicted nursing shortage data had baby boomers and millennials pegged incorrectly. Nurses under the age of 30 accounted for 12.72% of the nurses polled in our 2018 survey, down from 16% in the 2017 survey. The over 60 group accounted for 16% of the nurses polled. This is an increase of 7% in this age group compared to our 2017 survey results. Could the millennials fill the void the baby-boomers will leave? According to an article published by Health Affairs, millennials are becoming nurses at nearly double the rate of baby boomers (Auerbach, Buerhaus, & Staiger, 2017). However, the pending retirement of the baby-boomers is upon us, with a projected decrease of 1.3 percent loss per year between 2015-2030 (Auerbach et al., 2017). While the millennials have helped fill the positions of the baby boomers, don't hold your breath just yet. The rate of RN's taking the licensure exam plateaued between the years of 2013-2016 (Gooch, 2017). So, what's next? Should we look to the next generation - Generation Z? Yes, the nursing workforce is still in need. According to the New York Times, Gen Z outnumbers the millennials by one million (Williams, 2015). This generation is currently finishing up their high school careers and choosing college majors. This generation may be what the future of nursing needs. Male Nurses Men still hold a significantly small portion of the nursing jobs in the United States. According to the U.S. Census Bureau in 2013 the number of male registered nurses more than tripled between 1970 (2.7%) and 2011 (9.6%). The number of male licensed practical and licensed vocational nurses more than doubled from 3.9 percent to 8.1 percent for the same period. While they hold a small portion of the total number of nurses, the trend of men entering the field of nursing has helped with the nursing shortage. They also create diversity within our profession that past generations have not seen. The Affordable Care Act The nursing shortage was in effect long before the Affordable Care Act (ACA) was passed in March 2010. Before the ACA, 48.6 million or 15.7% of Americans were uninsured (Bradley University, 2016). After the ACA, this number fell to 9.2%, which is the lowest uninsured rate in 50 years in the United States (Bradley University, 2016). This is good, right? More people are insured, which should equate to a healthier American population. Unfortunately, the future of healthcare is still uncertain. Medicare enrollment is projected to increase by 50% over the next 15 years due to our aging population (Bradley University, 2016). More people than ever before will continue to be insured in the U.S. Forty-seven percent of healthcare workers have reported that emergency room use has increased due to more people having coverage for these services under the ACA (Bradley University, 2016). The increase in patients with insurance was not factored into the original prediction for nursing shortages. The ACA continues to impact the future of nursing by creating the following: More jobs - As more people are insured, more nurses will be needed to care for patients. Previously uninsured people with long-term health conditions need education on disease processes, medications, self-management, and proper diet (Thompson, 2017). Nurse-Patient Ratio Changes - The increase of insured people in the United States could mean a higher number of admissions, creating a higher nurse-patient ratio (Thompson, 2017). An increase of patients could add strain on hospitals, clinics, and other healthcare facilities (Thompson, 2017). Higher Demand and Pay - Average pay projections for registered nurses have increased steadily since the passage of the ACA (Thompson, 2017). This is the law of supply and demand in action. As the need for nurses increases, we will have the ability to demand higher pay. Nurse Practitioners - Nursing is not the only healthcare profession experiencing a shortage. There is a projected shortage of physicians as well. One way to combat the lack of physicians is the use of Nurse Practitioners (Bradley University, 2016). Many practices employ at least one Nurse Practitioner and will likely hire more in the future. Nurses Leaving the Profession As if the issues of nursing supply and demand were not enough, nursing has another problem - many nurses have plans to leave the workforce soon. According to the results of our salary survey, 35.39% of the nurses polled have plans to leave the nursing workforce within the next 15 years. But, why? The top two reasons, which accounted for nearly 70% of respondents, included age and retirement. This correlates well with the aging nursing workforce. However, the next three results in our survey are concerning. Job dissatisfaction was given as the reason for plans to leave the nursing profession by 7.66% of respondents. Another 4.65% reported that nurse-patient ratios were a factor influencing their decision to leave nurse. Finally, another 3.76% cited plans for career change as the reason for leaving. These three results account for 16% of those leaving the profession. What does this mean? A 2015 article on nurse.org explained that lack of ability to move to areas of need, disillusionment with the profession, a fast work pace and workplace bullying are factors that many new nurses don't think about until they are working and find themselves dissatisfied with the profession (Dent, 2015). One study evaluated nurses intention to leave the nursing workforce related to "horizontal violence," better known as workplace bullying (Armmer, 2017). This study found that newer nurses were more likely to leave the profession while more tenured nurses felt they could just find a new job in light of workplace bullying (Armmer, 2017). Nurse-patient ratio conversations have been an important topic in legislation lately. Many nurses understand the harmful effects of high nurse-patient ratios on burnout, increased risk of nursing errors and lower quality of care. One study evaluated the impact of wage, work environment, and staffing on nurse outcomes (McHugh, M. & Ma, C., 2014). McHugh and Ma (2014) found that while wage was important, interventions that improve the work environment and maintain staffing levels are more critical to attracting and retaining nurses in the workforce. For a more in-depth look at the importance of nurse-patient ratios, take a look at the spring issue of the AllNurses magazine. As more nurses leave the workforce due to dissatisfaction, we must each do a personal inventory of our feelings, actions, and biases against other nurses. Nursing Faculty Shortage and Enrollment According to the American Association of Colleges of Nursing (AACN), nursing schools across the country are struggling to expand nursing student capacity to meet the rising demand of healthcare following reform (American Association of Colleges of Nursing, 2017). The AACN (2017) projected a 3.6 percent increase in enrollment in entry-level baccalaureate programs in 2016. However, this increase will not keep up with the anticipated demand for nursing services. This touches on the need for nurses, but what about those people who educate nurses? You guessed it, another shortage. An article in Becker's Hospital Review (2018) reports that nursing schools rejected over 56,000 qualified applicants from undergraduate nursing programs in 2017. Many of these applicants were top of their high school graduating classes (Knowles, 2018). The article goes on to report that nursing schools are struggling to provide the clinical space and class size accommodations needed to keep up with the number of applicants and the nursing workforce needs (Knowles, 2018). Concerns over an inadequate number of nursing faculty further complicate this issue. According to the 2018 AllNurses Salary Survey, the average salary for an educator is $80,164. While higher clinical nursing salaries are good, it may be keeping some nurses from considering a career as a nursing instructor. The current annual national faculty vacancy rate in nursing programs is over 7 percent today (Knowles, 2018). This equates to about two teachers per nursing school, or a shortage of 1,565 teachers across the United States (Knowles, 2018). Nursing school and faculty issues pose more concerns for the future. Even if future generations chose nursing as a profession, will nursing schools be able to keep up with the demand? How can we educate new nurses without qualified instructors? The future of our profession feels shaky. Shortage by State When you consider the nursing shortage, you may only look at the big picture or total number of nurses needed. Another interesting factor that must be considered is the location of the shortages. Not all states are projected to have a nurse shortage. According to Nursing@Georgetown, sixteen states will experience a nursing shortage by 2025. The most substantial nursing shortage will be seen in Arizona, followed by North Carolina and California (Nursing@Gtown). Meanwhile, states like Ohio, Pennsylvania, and New York will experience a surplus of nurses (Nursing@Gtown). While it seems like there is a logical solution to the problem, many nurses are not able to relocate to fill vacancies in other cities or states. We are left with a surplus in some areas of the country and massive shortages in others. Do hospitals and healthcare systems have a solution? Healthcare systems across the country are attempting to find ways to attract more nurses to their vacancies. According to a recent article on CNN Money (2018) hospital systems like UCHealth that operates nine acute-care hospitals in Colorado, Wyoming, and Nebraska has over 330 openings for Registered Nurses. To entice nurses to move to their locations, they have offered sign-on bonuses up to $10,000. And, that's not all, they add on stipends for continuing education too. Other hospitals have provided sign-on bonuses, relocations bonuses, and hefty tuition reimbursement packages for employees and their children (Kavilanz, 2018). The University of West Virginia even offers free housing to nurses as part of their commuter program (Kavilanz, 2018). Bonuses and education stipends only last so long. Would higher nursing salaries make the profession more appealing? Can our current economy support wage increases across all states? Maybe a more important question- can the healthcare industry and patients afford to not have nurses at the bedside? The Verdict: Myth versus Truth It seems there is enough evidence to conclude that we are still in the midst of a nursing shortage. But, you must come to your own conclusion. Many factors have both positively and negatively affected the flux of the shortage. But, the fact remains this is a complicated topic with many moving pieces. As nurses, we must continue to stay abreast of the latest data on the nursing shortage and decide how we can impact the future of nursing. References: Spratley, E., Johnson, A., Sochalski, J., Fritz, M., Spencer, W. (2000). The Registered Nurse Population. U.S. Department of Health and Human Services. Retrieved from: https://datawarehouse.hrsa.gov/DataDownload/NSSRN/GeneralPUF00/rnsurvey2000.pdf U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis. The Future of the Nursing Workforce: National- and State-Level Projections, 2012-2025. Rockville, Maryland, 2014. Retrieved from https://bhw.hrsa.gov/sites/default/files/bhw/nchwa/projections/nursingprojections.pdf Auerbach, D., Buerhaus, P., Staiger, D., (2017). Millennials Almost Twice as Likely to be Registered Nurses ss Baby Boomers Were [Abstract]. Health Affairs, 36. Retrieved from https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0386?journalCode=hlthaff Gooch, K. (2017). Millennials Represent Boon to Nurse Workforce, Join Ranks at Twice the Rate of Baby Boomers. Becker's Hospital Review. Retrieved from Millennials represent boon to nurse workforce, join ranks at twice the rate of baby boomers Thompson, M. (2017). How the ACA Affects Nurses. National Health Care Provider Solutions. Retrieved from How the ACA Affects Nurses - NHCPS.com Dent, S. (2017). 4 Reasons Nurses Quit (And What You Can Do Instead). Nurse.org. Retrieved from 4 Reasons Nurses Leave The Profession | Nurse.org Nurse.org (2017). Nursing Demand by State: 2018 Projections. Retrieved from States With Highest Demand For Nurses | Nurse.org Nursing@Georgetown. (2017). How Will the Nurse Shortage Affect your State? Georgetown University. Retrieved from How Will the Nurse Shortage Affect Your State? - Blog Williams, Alex. (2015). Move Over, Millennials, Here Comes Generation Z. The New York Times. Retrieved from Move Over, Millennials, Here Comes Generation Z - The New York Times American Association of Colleges of Nursing (2017). Fact Sheet: Nursing Shortage. Retrieved from: http://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-Shortage-Factsheet-2017.pdf Armmer. F. (2017). An Inductive Discussion of the Interrelationships between Nursing Shortage, Horizontal Violence, Generational Diversity, and Healthy Work Environments. Administrative Sciences 2017, 7 (4), 34; doi: http://dx.doi.org/10.3390/admsci7040034 Bradley University. (2016). How the Affordable Care Act Affected Nursing. Retrieved from https://onlinedegrees.bradley.edu/resources/infographics/how-the-affordable-care-act-affected-nursing/ Knowles, M. (2018). Nursing School Reject Thousands of Applicants Amid Shortage. Becker's Hospital Review. Retrieved from https://www.beckershospitalreview.com/workforce/nursing-schools-reject-thousands-of-applicants-amid-shortage.html McHugh, M, Ma, C., (2014). Wage, Work Environment, and Staffing: Effects of Nurse Outcomes. Policy, Politics, and Nursing Practice, 15 (0): 72-80. Doi: https://dx.doi.org/10.1177%2F1527154414546868 Kavilanz, P. (2018). Hospitals Offer Big Bonuses, Free Housing, and Tuition to Recruit Nurses. CNN Money. 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  13. During my last week of RN school, I noticed there was this unspoken expectation for all RN graduates to become hospital nurses, apparently, I did not get the memo! At my pinning ceremony, I watched many of my fellow classmates holding up signs for the school Flicker account that said, "#PICU RN; # ICU RN; #MedSurg RN" and so on. I listened to how excited they were that they would be starting new grad internship programs at the local hospitals surrounding our areas-I shared in their excitement! We had finally done it; all the hard work, long nights of studying and writing papers were over-we were now RNs (well, until we passed the NCLEX, but that's for a different story). My classmates would rush over to where I was and ask, "Hey girl, what hospital are you going to be working at?" I would reply, "Oh I'm not going to a hospital-right now anyway. I'm just going to stay where I'm at. I'm the nurse (I was a working LPN during RN school) at a day training facility for adults with varying levels of developmental disabilities." My classmates would scrunch their faces up, then raise their eyebrows and force a smile, and reply with "Oh, that's awesome." Then just as quickly, they would scurry away. It made me think, what the heck was that?? I slowly started to feel like my classmates thought I was less of a nurse than they were but surely that wasn't correct; unfortunately, I had this nagging sensation in the back of my mind. I saw no reason to leave my current job; even though my current job was more in the way of case management, fixing minor injuries, and paperwork-I had never felt like I was less of a nurse, than right at that very moment. RN pinning came and went. The ATI NCLEX review week and NCLEX Predictor came and went, yet I continued to have this nagging sensation. I went and got my hair done and one of the ladies in the salon asked, after I told my 'life story' as many of us do to pass the time while getting our hair done, "So what hospital do you work? I will definitely go where you work!" As flattered as I was, a mental rolling of the eyes occurred. So, as many times before and many times to come, I smiled and thanked the woman for the compliment, then proceeded to explain my line of nursing. The obligatory slow nodding of the head, the forced smile, raising of eyebrows, and the "Oh, I see..." comment. So, what is it? I was truly questioning myself at this point. It wasn't just because of a few fellow classmates, or an older lady at the salon-it was everyone I encountered really. It became very frustrating to see people's disposition change so drastically once they found out I was not a "real nurse." You could almost hear the thoughts going through their minds, "Oh yeah, she's a RN. Well thank goodness, I know her; or, well thank goodness someone at this very moment is qualified to save my life." But, the second you mention that you work in a little clinic, take care of cuts and bruises-your automatically not a real nurse anymore?? I couldn't understand it. I could talk the talk. My friend from school would get onto me all the time. I would use words like, ecchymosis and erythema all the time. I would recognize meds-no I'm not a pharmacist/pharmacist student, but I recognized them, knew what they were used for and at times knew some of the regular doses and usual times for administration. I recognized abbreviations used by nurses in the hospital charts, e.g. ABT; VRSA; CTA; bil; the old way to write number 1 ( i ). I was getting good at interpreting, at a super basic level, certain labs or at least guessing which labs a physician would be more than likely to order for certain suspected disorders/diseases. When nurses would talk about having to handwrite in charts on Med-A patients, I too would scrunch my face and make that-UHH! face, because I knew how much information goes into that type of charting. So, I couldn't understand why, when people-even some nurses, would give me that, oh-she's not really a nurse look. I have met so many different types of nurses. I have met your "basic" (I use this very loosely) hospital nurse, case managers-who are RNs, LPNs and RNs that are MDS Care Plan Coordinators, mental health APRNs who have specialized in mental health/psychiatric clinical nursing, DONs in LTC facilities, schools, and IDD facilities. I have met RNs that work for the Department of Public Health, RNs that are nursing instructors, RNs that are CNA instructors. I have met nurses that work with patients that have intellectual developmental disabilities (IDD); nurses who specialize in wound care, I have even met a nurse that is a Parish Nurse-which I found awesome because it was a type of nursing path we had learned about approximately two weeks before I graduated and thought to myself-yeah, I will never meet a nurse in that field. The list of different specialty positions, settings, et, goes on and on, yet there was never one time did I look at these nurses and think: they aren't real nurses. So, how does a nurse answer this question; the answer is: you don't. The nursing profession has grown far greater than Florence Nightingale could probably ever have dreamt it could. There are nurses that perform triage over the phone, nursing informatics nurses-I mean honestly, how many nursing students (current) or practicing nurses actually knew what a nursing informatics nurse was before learning about it in school?!? So, how should you react when persons look at you and give you that, "Oh, they really aren't a nurse." Just smile, and do what nurses do best-educate. Nursing is by far the coolest career a person could ever decide for themselves! The different specialty areas to choose from, and sub-specialty areas in those areas, it is awesome just how far a nurse could go. I like to think to myself, is the APRN more of a nurse than the RN? Is the RN more of a nurse than the LPN? Is the CRNA more of a nurse than the GNP? The answer to these questions is no. All of these nurses are nurses in their own rights-they all struggled through nursing school some way or another. We should teach people that nursing is just a big umbrella with many different areas and sub-areas, et. We should remind ourselves, as nurses, that just because we are different does not mean one nurse is less of a nurse than the other. We should be proud of the nurses we have become, and the type of nurses we are. No matter what type of nurse you are: mental health nurse, LTC nurse, hospital nurse, female/male nurse, whatever the background you came from that made you the nurse you are-own it! Teach the community that we are many, and we are always evolving! So, to end, I will introduce myself proudly. "Hello, my name is Grace. I am a LPN, (waiting on my RN license to be sent to me) who proudly runs her own clinic at a facility that cares for and promotes those with IDD to be as independent as possible. It is nice to meet you; what type of nurse are you?"
  14. Maureen Bonatch MSN

    The Challenges of Being a Nurse

    At the beginning of our nursing career, we might’ve thought the biggest challenge to overcome was passing the NCLEX. We may have envisioned passing this test as if it were the biggest, and last, obstacle standing between us and caring for our patients the way we want to. When in reality, it was just the beginning. Much of the time the issues that challenge nursing career plans are out of our control, and the NCLEX is just the first of many tests nurses face most days. Even if challenges are out of our control, building an awareness of the source of frustration, and focusing on ways to address it, are the first steps to feeling more in control to overcome career challenges. Time Isn’t On Our Side Nurses generally go into the profession because they want to care for people, but often much of their time is spent doing paperwork. Patients may not always understand that these additional tasks are a necessity, and it can result in frustration for them, and also for nurses. This, and ongoing staffing shortages can limit the hands-on time nurses get to spend with their patients. The struggles for nurses to accomplish all that they’d like in a workday that might include frequent overtime can lead to a work-life imbalance, stress, and potentially burnout. When time challenges your best intentions for managing all your tasks so that you still have adequate time for your patients, try to organize and prioritize time commitments as well as you’re able to. Understand that some things may be out of your control. Explain to patients that the paperwork is part of your job, and inform them of when you plan to return when you’re leaving their room. Sometimes a little transparency, and helping patients understand what to expect when they’re feeling vulnerable or at a loss of control, may help reduce their frustration. If you continue to feel overwhelmed, and like you’re running yourself thin with no reprieve, be sure to look for, and address, any signs of burnout. Unexpected Injuries and Health Issues Despite the best intentions for a long career on the floor, nurses often suffer from back or other physical injuries. This can result from long hours standing, lifting and transferring patients, and the overall physical nature of providing nursing care. This may be combined with working with staff shortages, which can result in inadequate assistance that may result in an injury. Nurses may also be exposed to violence in the workplace due to working with angry patients, or if illness contributes to violent behaviors. Always keep safety in the forefront of your mind when caring for patients. If your body is starting to protest about long hours working on the floor, consider continuing your education to increase career options, or look into other opportunities to utilize your nursing degree without as much physical strain. Don’t forget to practice self-care. Taking the time to care for yourself and get adequate rest is not an indulgence, but a necessity. You can’t care for others if you don’t take care of yourself. Continuous Changes in Healthcare Striving to never stop learning is especially important for a career in healthcare. With rapid, ongoing changes, working in healthcare is continuously presenting us with new technology. This can affect the way care is provided, improve documentation methods, and offer varied options for scheduling. Some of these changes are beneficial and can make the job easier, but often the trial and error of learning new technology can be difficult or frustrating. The Affordable Care Act (ACA) brought changes to healthcare delivery, including offering more patients access to healthcare than before, an increased focus on preventative care and chronic conditions, and the need to improve cultural awareness. Even if a change is for the better, it can still be stressful when you’re trying to keep up with the new while continuing to provide the personalized patient care that is at the heart of nursing. Nursing usually isn’t a career that allows you to bask in keeping things the same way that we’ve always done for very long. Try to stay relevant by reading healthcare journals, reviewing online educational material, network with peers, and explore other methods to keep your mind sharp. Rise to the Challenge Most of this information isn’t new to us, and there are probably many more nursing challenges that you can identify. We may have been dealing with some of these issues, or have been aware of them for some time, but nurses are known for their resiliency and resourcefulness. The test is determining how we will rise to face these challenges to make the most of our nursing career. Have You Overcome Any Challenges in Your Nursing Career?
  15. Maureen Bonatch MSN

    Don't Burn That Bridge When You Change Jobs

    The high-demand for nurses has resulted in plenty of opportunities if you're ready to pack up your stethoscope and favorite pen for a new nursing job. Maybe you've been looking for a while, or perhaps the perfect opportunity opened and you just can't wait to start. Don't be so hasty in your exit that you leave a bad impression. You might forget what you said, or did, as you skipped out the door, but most likely, everyone else didn't. Manners Still Matter You might be feeling unappreciated, or perhaps you didn't receive the encouraging farewell you hoped for, that doesn't mean you should drop your professionalism with your name tag. If you end your employment gracefully, it will serve you better than the brief satisfaction of letting them know what you really think. Exit with grace- You have many things you'd like to say, but an exit interview isn't the time to unburden all your frustrations. However, it can be if you can structure your comments in a professional manner. Believe it, or not, many managers do want to know how to improve the organization or identify relevant issues during the exit interview. However, presenting a list of vague, or unfounded, complaints only makes you look spiteful. They will notice- Unless it's unavoidable due to illness or extenuating circumstances, if you don't provide the required notice, they'll notice. Notice doesn't mean calling off during your final countdown. Even if the job is one you're dissatisfied with, calling off generally impacts your coworkers, or your patients when they're left understaffed. It's a small world after all- Thanks to the Internet, it's easier than ever to connect. Your new manager might be the friend, professional acquaintance, or former classmate of the manager you just abandoned. You won't start your new job off on the right foot if they hear how unprofessionally you exited your last one. You come with a special set of skills- That doesn't mean you have to leave your replacement in a lurch by not offering to help make your departure a smooth transition by instructing them on key duties. Aren't you hoping for the same courtesy at your new job? Your reputation might proceed you- You can have stellar skills, but if you leave a bad impression during your exit, that's what most people will remember. It also makes it uncomfortable to explain why you left without notice if you're interviewing for a new job. They're wondering if you'll do the same to them. Don't go viral with your venting- If you talk poorly about your organization, manager or coworkers on social media, it often gets back to them and it never makes you look good. The Grass Isn't Always Greener There are bad managers, bad jobs, or ones that might be a poor fit for you at your current stage of life. Things may change in your life that make that old job the perfect fit now, or that manager or coworker that drove you crazy may no longer work there. When you start a new job, everything is new and everyone is usually on their best behavior. Your new coworkers and boss want to impress you, and you want to impress them. When that wears off and the daily challenges and personalities are revealed, you might realize that your old job might not have been that bad, or perhaps you might start looking for another job. Consider the Three R's I'm not talking about reading, writing, and arithmetic. Even if you're happy with your new job, there are times when you might need to call upon your old manager for a letter of recommendation, a reference, or a referral. Perhaps you're going back to school or applying for a scholarship. Even if they don't have the memory of an elephant, most companies track resignations. This might remind them of how you bolted without a second thought, so they might wonder why they should give you one now. When You're the Boss This isn't the time to drag out all the reasons why you might be happy to see this employee move on. Even if you've vowed to never rehire this nurse, you're still representing your company and want to wrap up the exit interview on a positive note. Build, Don't Burn, Your Bridges You may have many jobs over your nursing career. You're not only building your skills at each one, you're creating your professional network. Nurture those relationships, so you can continue to grow personally and professionally.
  16. So, here I am...13 years as a Pediatric Nurse (Intensive Care Unit), and my back finally crapped out on me I've got a herniated disk in my neck, leading to right arm weakness and numbness - surgery will help, but I've been unable to get it as of now due to an untimely case of necrotizing fascititis (it's been a rough year!!!). In addition to those fun times, I also have inflammation of L4/L5 - L/5-S/1 which so far has required 2 sets of injections (next step, nerve ablation) in order to walk without excruciating pain. So, I thought I'd share my story with others on here....so that you can learn from my mistakes and successes! Things To Be Aware Of 1. Pay for disability insurance. If your place of employment provides it, enroll right away! You may think it's another worthless deduction on your paycheck, but you never know what the future might hold. If I hadn't paid for this, I'd be in a whole lot of money pain right now. As it is, I'm working closely with the disability insurance company, getting 60% of my salary, and they have a Vocational Rehabilitation Assistant - she helped me clean up my resume, gave me tips on interviewing, and is generally a great cheerleader (she even gave me advice on what outfit to wear, because, yikes! Scrubs are not professional enough for a job interview). Protect Yourself Now! 2. Your back is your job!!!! Moving a patient by yourself might seem like a quick and easy way to do things - especially when the hallways are empty, and there's not another coworker to be found. Take the time to TRACK SOMEONE DOWN. Follow all those "annoying" skills they taught us in nursing school for proper body mechanics. I'm saying this even though the herniation was caused by falling out of bed, not at work - but realistically, the strain of 13 years on my feet and running about was what started me on the path to spine issues - the fall was likely just the straw that broke the camel's back (pun intended). 3. Mourn for the loss of what you were, but embrace and look forward to what you can become. It was a great blow when my Spine Doc straight out said I should no longer work at the bedside. It's what I know, it's what I love...I felt like a part of me was just gone, along with my identity as a nurse. Don't ignore these feelings, talk to someone about it - it's a loss like any other, and you have every right to mourn it. HOWEVER, after accepting that the bedside part of my career is over, I embraced the fact that the nursing world is my oyster. There are so many opportunities, and new ones appearing everyday as the world of nursing, and the face of medicine is constantly changing and growing. 4. Keep your options open. Waaay back at the beginning, when this all started, I had it so set in my mind that I was going to get an operation, my back would be fixed, and I could go right back to were I left off. I was told there was no such thing as "light duty" for a bedside clinician, and my supervisor suggested talking to HR about a non-clinical position. I ignored this advice, because I was so fixated on my plan. When it blew up in my face, I was suddenly reading a letter stating that the hospital that I poured all my heart and soul in, devoted countless hours of overtime, and went above and beyond to help maintain the unit, could no longer maintain my position, and that effective immediately I was no longer an employee. Since hindsight is a terrible beast, let me give you this tip: talk to the HR department. I lost the opportunity to do so (due to new hiring laws, I can't go back and work at this hospital until I'm 90 days nicotine free). if I hadn't been so fixated on my plan - I could have had a part time job doing something within the hospital, and not lost my seniority by moving to a different company. Remember life is fluid, and our dear friend Murphy loves throwing curve-balls. 5. Learn your employers policies regarding FMLA, short term leave, and long term leave. If I had the chance, I would have printed each of those documents out, so that I could refer to them. Instead, I have no access to the system (as I am no longer employed), and can't refer to the policies to understand my options. 6. Out of sight, out of mind. This one is important. Keep in touch with your supervisor. You don't have to call them everyday, but send them an email now and again, seeing how they are doing, updating them on your condition, etc. I have been doing this, and my supervisor is happily writing me letters of recommendations. I don't know if she would have been happy to do so if I had just popped up a year later, saying, "Hey, remember me? I worked my butt off for you guys...I know you haven't heard from me in a year, but can you write a recommendation for me?" 7. The internet is literally an amazing tool. USE IT. At a total loss for what to do now? GOOGLE is your FRIEND! Literally searching, "non-clinical nurse positions" will result in a massive amount of articles, lists, resources, job descriptions, and explanations on how to go into a new/different field of nursing. If possible, see if you can find an online program to advance your career even as you convalesce. Back pain and arm numbness doesn't hinder my ability to complete assignments, so I continue to work towards my Masters in Nursing Education. 8. No limits. In today's world, you DO have the ability to re-invent yourself as something completely different. There is no age limit at schools...if you have the resources (since you certainly have the time now that you can't work, and if you have disability insurance, you still have a decent paycheck coming in) and the desire, what have you always wanted to do? Love nursing, but always wanted to be a vet tech? Interested in retail and pharmaceuticals? As your body takes its sweet time healing, there is no reason why you can't exercise your mind. Most of all, DON'T PANIC. The old adage, "When one door closes, another one opens" might seem like pointless drivel while you watch your carefully planned life circle down the drain - but, it's the truth. Don't fear the big bad of your future, embrace the opportunity to grow, both as a person and as a nurse. So what have I learned? Well, first off, Nec Fasc is no fun. Ever. Being a patient, and having home care nurses coming out to change your wound vac dressing, juggling pain meds with the constant fear of becoming addicted, dealing with depression and anxiety over the future, and sometimes being in so much pain I can't even walk....it's hard to see the bright side. But, you know what? I'm alive...I'm a darn good nurse...and I have a passion for caring for others. My future in nursing is still a little hazy, as I wait patiently for the wound to heal, so I can get the back surgery I need - my mind is free to explore all the wonderful opportunities that are out there, just waiting for the right person to slip into a brand new role. I'd like to think that somewhere out there, there is position waiting just for me. I wish you all luck and wellness in your career, and remember! Change is something to be embraced, not something to fear.
  17. karenvalk

    Public Health~A Critical Specialty

    Recently while completing an online survey, I was asked to identify my area of nursing specialization. There were many options to choose from-medical-surgical, anesthesia, emergency, geriatrics and the list goes on...but NOT listed was my chosen field of practice, public health. Sadly this is not a new experience, as public health nursing is often not the first image of nursing that comes to mind. My love affair with public health began early while in nursing school in Memphis. Still a teenager myself, my nursing school partner and I were assigned to follow a young pregnant woman throughout her pregnancy and delivery. We made our way to the housing projects of south Memphis where we were greeted by Annie, who was close to our own age and pregnant with her second child. Our instructions were to try to impart some of the newly-learned book knowledge we had to hopefully improve the outcome of Annie's pregnancy both for her and her baby. Despite our different circumstances, Annie welcomed us warmly on our weekly visits into her sparsely furnished apartment she shared with her mother and two year old daughter. I have never forgotten the call we received at 3 a.m. to meet her a few blocks from our dorm at the City of Memphis Hospital to witness the birth of her second daughter. She trusted us and relied on very young and green nursing students for advice and support (maybe not a good idea)! Forever impressed on my youthful mind was the realization that a person's environment, family support system and "social determinants of health" have a very significant, potentially lifelong impact on their health outcomes. Annie became one of the first of many patients whose stories are permanently etched indelibly on my heart. After spending the majority of my career working in public health, I can say without a doubt it is uniquely challenging and rewarding though not in the same way as hospital nursing. My long-held idealized world that includes equal health care for all is exemplified by the mission of the American Public Health Association to "Improve the health of the public and achieve equity in health status." I am blessed to know generations of patients-entire families and extended families that come to us for the multitude of services that we offer. Public health is multidisciplinary-nurses work collaboratively with physicians, nutritionists, environmentalists, social workers, health educators, dental practitioners, psychologists, emergency planners-forming a team of public health professionals whose common goal is to improve the well-being of the communities they serve. Public health nursing encompasses an increasingly wide range of responsibilities. It is impossible to be a great public health nurse and not also be a staunch advocate for the benefits of immunization. Public health nurses obtain many hours of continuing education on the latest immunization updates and then must pass an immunization exam yearly. Standards for vaccine storage, handling and administration are rigorous and require strict adherence. If you choose to receive vaccines at the health department, you can rest assured that the nurse administering them is experienced as well an expert! Sadly we now must cope with the vast amount of misinformation and deceptive commentary on the internet and social media regarding vaccines. Left to distant memory are the times when measles, mumps, and chickenpox were part of nearly every child's life; causing great suffering and sometimes even death. Recent outbreaks of these once-common childhood diseases illustrate some of the problems brought about by the anti-vaccine movement. Children of present generations have been spared the scars of smallpox vaccination present in persons of my generation thanks to public health efforts of vaccination and the extinction of smallpox disease. Yearly campaigns to promote and administer influenza vaccine as well as dispel the many myths that exist surrounding it are vital to the mission of promoting public health-we all belong to the "herd." Public health nurses are extremely well-versed in communicable disease management, including tuberculosis, hepatitis, HIV, and sexually transmitted infections to name a few. Conducting visits to tuberculosis patients' homes to ensure they take their medications correctly and rounding up contacts to infectious diseases are tasks with which public health nurses are quite familiar. Rampant Chlamydia rates especially among teenagers, syphilis making a surprising comeback, and gonorrhea becoming increasingly resistant to antibiotics make proper management of these infections even more critical. Family planning and supporting women and men to ensure that all babies are wanted and planned for is another important component of public health. Contraceptive methods are continually improving in both effectiveness and acceptability, especially with the increasing availability of long-acting, reversible methods. Public health nurses are essential in the provision of accurate education regarding contraception and helping patients determine their best method and timing of pregnancies. By no means is this a full account of public health nursing and the responsibilities it entails. I would like to encourage any nurse, whether new to nursing or seasoned and experienced, to consider public health nursing as a career. If your ambitions include making full utilization of your nursing school education, creating lifelong relationships with your patients and their families, and working collaboratively as a full member of the public health team in an effort to make your community a better place to live, then public health nursing is for you! Karen Valk, FNP
  18. Dr Georgianna Donadio

    Options for Nurses in Today's Medicine

    The Way Things Were As a hospital trained nurse, it has been my privilege to experience nursing for over five decades. It was quite different 50 years ago when we wore all white – stockings, uniforms, shoes and caps. Back then, we stood up if seated when a doctor entered the room. At that time, all the doctors were men and all the nurses were women. The culture of medicine at that time had almost a religious aura about it, with the doctor as the deity and the nurses as guardian angels who watched over the patients, comforting them and following doctors’ orders. To illustrate just "how things were", you can listen to a conversation I had with two very senior nurses interviewed for a nurse radio program. It may provide historical context and some fascinating medical lore. Nurses Eileen Keenan and Lynette Juliet were best friends and colleagues from 1935 until their retirement in 2003. Sixty-eight years of nursing service that covers almost 7 decades of change and transformation in nursing. An Change in the Environment While there are still remnants of that culture, to some extent today in various medical facilities or hospitals across the country, the medical environment is quite different now due to technology, higher education and the media. Today’s nursing is perceived as a career, where it was once viewed as a calling or vocation. Going back to the 1980s when caps were still parts of the nursing mystique, the profession was perceived as being in service to patients and required dedication to the welfare and care of others. It has been said that nursing attracts individuals of a highly compassionate nature. With educational requirements as they are today for entering the profession, there is a great emphasis on academic and clinical skills and less emphasis on patient engagement and relationship development skills that there was just a few decades ago. There are more individuals who are entrepreneurial minded entering the field of medicine and nursing, so there are many directions a trained nurse can go in with her/his credentials. Although the need for well trained, caring nurses is constant, today many nurses wish to strike out on their own and offer private practice services rather than work in acute care or in-patient environments. The medical infrastructure depends on nurses as the hands and heart of healing and nursing is today still the fastest growing medical profession in the country. Another attraction to nursing is that it appears to be recession-proof, which was demonstrated during the latest difficult recession which began in 2008. Changes in Nurses and Nursing The average age of nurses today is over 50 years old and many individuals are entering the professional later in life than in years before. The number of males has also significantly increased and continues to grow as salaries for nurses are competitive with other professions and skill sets. The introduction of holistic nursing, Whole Health nursing and nurse coaching has also opened up other areas of work for nurses as well. There are telephonic nurse coaches, insurance company coaches, and HR coaches in various corporations and hospital. For the nurse who wishes to have their own private practice in any of these holistic fields, clarification around the legal and billings regulations for nurses is critical. All nurses can work privately in their state, according to the practice guidelines of that state. The state regulations can vary significantly and each nurse should contact their licensing board to identify what is permitted in their location. There are, however, hard and fast rules that apply to all nurses across all states. No nurse can direct bill for medical services, with the exception of designated APRNs. Below are the chapter and verse references from Medicare regarding nurse billing. Nurse services can be billed under a physician’s license but she/he cannot use their nurse NPI number, which is intended for the physician or institution to use for billing for the service they may provide. There are only four (4) Advanced Practice Nurse credentials that allow for direct billing of insurance: Nurse Practitioners, Nurse Mid-Wives, APR Clinical Nurse Specialist and Nurse Anesthetist. Non-advanced specialty trained nurses cannot direct bill Medicare for any services, and most commercial payers closely follow Medicare. According to Medicare nurses are not a recognized billing provider class. They can only bill "incident to" a physician's service using 99211 for a patient visit if they meet the requirements to do so and only under the physician's NPI number, not their own. There is absolutely no debate about this. Please see below from the Medicare Claims Processing Manual, chapter and verse cited. Medicare Claims Processing Manual Chapter 12 - Physicians/Non-physician Practitioners 30.6.4 - Evaluation and Management (E/M) Services Furnished Incident to Physician’s Service by Non-physician Practitioners (Rev. 1, 10-01-03) When evaluation and management services are furnished incident to a physician’s service by a non-physician practitioner, the physician may bill the CPT code that describes the evaluation and management service furnished. When evaluation and management services are furnished incident to a physician’s service by a non-physician employee of the physician, not as part of a physician service, the physician bills code 99211 for the service. A physician is not precluded from billing under the “incident to” provision for services provided by employees whose services cannot be paid for directly under the Medicare program. Employees of the physician may provide services incident to the physician’s service, but the physician alone is permitted to bill. Services provided by employees as “incident to” are covered when they meet all the requirements for "incident to" and are medically necessary for the individual needs of the patient. More About Private Practice In upcoming articles, we will explore various specialties that nurses can be trained for which will allow them an additional scope of practice, and credentials to be able to bill for services in private practice.
  19. Download allnurses Magazine Nursing As a Profession: Changes Through the Years Reflections from Rosalee Sites, RN, BSN, MA Memories of Early Days Cleaning our own bedpans in the soiled utility room...steaming needles and syringes after checking the needles for burrs...no IV meds...1 nurse and 3 aids on a 52-bed unit...no critical care units...no recovery room after daytime hours...smoking on the wards...doctors smoking!... Growing up in Elkins, West Virginia in the 1940s, Sites remembers wanting to be a doctor. Interested in all things medical, she knew from an early age that medicine was her destiny; but because of financial considerations in her family and some of the limitations of the time, she instead applied for, and received, a nursing scholarship to the Davis Memorial Hospital Program. After 3 years of rigorous studies in the classroom and on the job training which involved staffing the floor, she was awarded the coveted black stripe on her nursing cap along with her pin and headed to work in 1965. Graduating from a degree program during that time, meant that she had to work hard, repeating a good deal of her initial training, to finally get her BSN 8 years later from East Tennessee State University. "Nursing has been a wonderful profession for me, and I would do it all over again if I could." Working the night shifts on the wards meant that she was responsible for as many as 52 patients a night. She remembers making her rounds early in the shift and taking special note of those that might need something right away. One particular night stands out in her mind because it highlighted the importance of her role as a nurse and how the patient perceived her as being someone they could count on. While rounding, she came into one lady's room and the patient said, "You are here. I've been waiting for you." She asked, "Is something wrong?" The woman went on to say that in the daytime she had family around and there were lots of employees working but at night "It is you and me. That is the reason I wanted to meet you." Her statement stamped itself in Sites' mind, helping her clearly understand how important she was to her patients-they trusted her and counted on her honesty and care; she felt a sense of responsibility for their successful treatment and recovery and her role in it. "Nursing assessment skills are the most important tools we have even now. But back in the early days, they were some of the only tools we could employ: skin color, temperature, respiratory rate, nail bed color, clamminess, pupillary response-all of this nursing observation had to take the place of non-existent monitors." Sites says she can remember rolling a patient's bed into the nursing station with her, so that she could watch them while she charted. "There was just so much less that we could do for people during those times. Medications were limited as were tests. We had to do the best with could with limited resources." "Me, God, and the Telephone" Early on, Sites recognized her special skills in administration and after a few years of general nursing began to specialize in administration as house supervisor with coverage of the emergency room, a small 4 bed unit at the time. As house super she had to do bed placement, deliver antibiotics to the floors on her rounds, and cover the ER. "It was me, God, and the telephone," she remembers. Making necessary calls to physicians at home and running the ER which would be considered primitive by our standards today, was all in a days work. "As a nurse, I have been privileged to share very special moments in patients' and families' lives: being with them as their loved one takes their last breath, bringing a smile to a critically ill child, listening to an elderly lady talk about her family, helping a family member get their father who had dementia on his knees as was his nightly custom for prayer..." After getting her Master's in Organizational Management, Sites continued to make important pioneering differences at Holston Valley Hospital in Kingsport, Tennessee where she continues to practice today. She started the first state-of-the-art Emergency Department, beginning with 23 beds. To really understand what was needed and what was available in terms of design and functional capability, she and a team of other employees visited EDs around the country to borrow the best ideas from the all, eventually making the ED at HVH one of the premiers in East Tennessee. She also headed up a group needed to obtain a Trauma Level 1 designation and worked hard to make that hallmark of advanced technology and ultimate care in trauma part of her local hospital. "The Changes Kept Coming" As the years rolled by, intravenous antibiotics became commonplace; roller clamps and marked bottles morphed into bags of fluid which gave way to machines that counted the drops and delivered the necessary medications in the right quantities to patients. Scans, CTs, MRIs, EKGs, ultrasounds, robotic surgery, all become part of the daily routine for a changing profession. "Even though the changes kept coming, I always realized that the role of the nurse remained central in all of the care we provided. Our patients continued to count on us." Sites went on to clarify, "Your patients will remember you giving them medication for pain, for starting their IV, for inserting their NG tube but more importantly, they will remember you for listening to them; we used to have a physician on staff who said, 'If you listen to your patients they will tell you what is wrong with them.'" The advent of CPR and Life Support provided new ways to intervene at the end of life. "The first person I did CPR on was my own dad in 1965. Because he didn't survive, I worried that I had done something wrong, but later I realized that he had a long cardiac history and there was nothing that I could have done." With CPR came ventilation, ICU care and increasingly interventional medical care. "Continued Education is Critical" A lifelong learner, Sites revels in tackling new topics and continues to be a focused student. As a nursing leader at her institution, she took to heart the major importance of encouraging her staff and others to continue learning. She pushed LPNs to get their RNs, made ACLS mandatory for ED nurses (to loud outcries of protest!), prodded along the process of obtaining certifications in ED nursing. Along with all of this, she was visionary in understanding the critical importance of working with and training the EMS staff so that the pre-hospital care maximized the patient's chance of survival. "As professionals, we owe it to our patients to learn all we can and to push ourselves to reach out for more." She objects to ever hearing the phrase, "I'm just a nurse," and emphasizes the unique and special role that we enjoy as nurses who often are the ones seeing the bigger picture, the ones who are able to bring different disciplines together, the ones who translate what is in the EMR to both the physicians and the family. Our role has always been important but never more than now. Nurses as Leaders "Being a nurse has responsibilities and requires leadership." Throughout her career, Sites has taken seriously the role of mentor to other nurses, and finds it deeply disturbing to hear nurses complain about the profession she loves. "Maybe you have not thought o yourself as a leader but that is exactly what you are. You are a professional nurse and you will be a leader in whatever area you may find yourself." As her career progressed, Sites sought out ways to not only improve conditions within her hospital but also in her area. Helping to start a local medical clinic for the working uninsured and serving on a number of boards and committees, Rosalee continues to see part of her role in nursing as someone who takes on community issues as well. She has been known to quote Sir Winston Churchill, "We make a living by what we get, but we make a life by what we give." Evolving Uniforms and Lack of Uniformity In the early days of nursing, compliance with uniform standards was strict and adhered to stringently. Sites remembers, "We polished our shoes, ironed pleats in our aprons and looked forward to the day when we could earn the right to wear the black stripe on our caps." She laughs to think that they were also required to wear girdles so that there would not be any distracting "jiggles!" Sites states, "What we wear can help inspire confidence in our patients, because if we dress well for our role, it can help us and it can help them. Appearances do matter." Nurses in most areas were not allowed to wear pantsuit uniforms until the mid-'70s. Scrubs came out in the mid-'80s and a general loosening of uniform standards continued until recent times when many hospitals have adopted new, more consistent uniforms, including the requirements that all RNs (and other professionals) wear a certain color scrubs so that patients and families can have an easier time distinguishing between providers. Career Changes and New Challenges Most nurses would readily agree that being able to change positions within the nursing profession is one of the great benefits of our training. Sites is no exception. After spending many years in the ED, Sites wrote a grant to the Robert Wood Johnson Foundation and was approved to start a Parish Nurse (also known as Faith Community Nurse) Program in her community. Now, 20+ years later, she continues on as the director of the program, faithfully administering the growth from a start of a handful of nurses and churches to two different programs with almost 50 nurses total. "Our hospital system wanted to find a way to engage with older adults and I saw Parish Nursing as a great way to do this." After receiving the grant and getting the program started, Sites pursued innovations, continuing education for the group, and diligently encouraged all the FCNs under her leadership to meet and exceed expectations. "One of the primary roles of Parish Nurses is advocacy. They need to be informed, knowledgeable and caring. Sometimes, the nurse if the only person who really cares; is there anything more important than that?" she asks. Looking Ahead "We have come from a time when we could do very little for our patients to a technology-heavy environment that threatens to distance us from those we care for." Sites goes on to say that the very technology that improves patient care can also cause us to lose perspective in our personal lives, over-focus us on screen time and diminish the necessary personal interaction. "You must work on being healthy in mind, body and spirit, modeling a healthy lifestyle for others, refueling and renewing your strength so that you can continue to give." When asked about the future of nursing and the ways that we may need to improve, Sites goes back to the basics: education. There she sees systems that are producing new nurses with good textbook knowledge but less practical training; nurses who are equipped to pass the NCLEX but who are less equipped to do basic bedside procedures. "What happens, when we have graduate nurses that are not fully prepared is that they end up leaving the profession. They feel dissatisfied with their jobs and they change jobs, experiencing less support from their peers. "As mentors and nursing educators, we must pursue avenues to do a better job with training so that when nurses hit the floor they are at least able to have some level of proficiency so that they are assets and feel reasonably comfortable in their roles." Parting Words of Wisdom Through a long career in nursing, Sites has seen a lot: evolving from when we could do very little to extend or improve life to an almost hyper-interventional care time, she sees the need for balance, gratitude and grace. She continues to see nursing as one of the most relevant professions in existence, but one that cries out for its nurses to get back to their roots of truly caring for one another, both our patients and our fellow employees.
  20. TheCommuter

    Do Nurses Earn Big Money? You Decide.

    "You're rolling in the big bucks!" Am I the only one who becomes at least mildly irritated whenever a random individual finds out that someone is a nurse and proceeds to say, "You're rolling in the big bucks!" To keep things honest, I'll recall a few observations about the people who generally do (and don't) broadcast their feelings about nursing pay. In my personal experience, no doctor has ever told me to my face that I'm earning 'big money.' No engineers, attorneys, pharmacists, speech language pathologists, or other highly educated professionals have hooted and hollered about the supposedly 'good money' that nurses make once they discover that I am one. On the other hand, bank tellers, call center workers, clerks, and others who work at entry-level types of jobs have loudly made their feelings known about the incomes that nurses earn. I was employed at two different fast food chains while in high school, and during my late teens, I worked a string of dead end jobs in the retail sector. From ages 20 to 23, I maintained employment at a paper products plant in high cost-of-living southern California as a factory worker and earned an income of about $40,000 yearly with some overtime. Of course I thought that nurses earned handsome salaries during my years in the entry-level workforce. After all, the average RN income of $70,000 annually far exceeded my yearly pay back in those days. Keep in mind that I paid virtually no taxes as a fast food worker because my income was so low. Also, I paid relatively little in the way of taxes as a retail store clerk. Awash With Cash Many of the certified nursing assistants (CNAs) with whom I've worked over the years have fallen into the trap of believing that the nurses are awash with cash. However, the ones that pursue higher education and become nurses themselves eventually come to the realization that the money is not all that it is cracked up to be. For example, Carla* is a single mother to three children under the age of 10 and earns $11 hourly as a CNA at a nursing home. Due to her lower income and family size, she qualifies for Section 8 housing, a monthly food stamp allotment, WIC vouchers, Medicaid, and childcare assistance. Moreover, Carla receives a tax refund of $4,000 every year due to the earned income tax credit (EITC), a federal program that provides lower income workers with added revenue through tax refunds. Much of Carla's CNA income is disposable. Carla returned to school part-time, earned her RN license, and now earns $25 hourly at a home health company in a Midwestern state with a moderate cost of living. She nets approximately $3,000 per month after taxes and family health insurance are deducted as she no longer qualifies for Medicaid. She pays the full rent of $900 monthly for a small, modest 3-bedroom cottage because she no longer qualifies for Section 8. She pays $500 monthly to feed a family of four because she no longer qualifies for food stamps or WIC vouchers. She spends $175 weekly ($700 monthly) on after school childcare for three school-age children because she no longer qualifies for childcare assistance. Carla's other expenses include $200 monthly to keep the gas tank of her used car full, $300 a month for the electric/natural gas bill, a $50 monthly cell phone bill, and $50 per month for car insurance. Her bills add up to $2,700 per month, which leaves her with a whopping $300 left for savings, recreational pursuits and discretionary purposes. By the way, she did not see the nice tax refund of $4,000 this year since she no longer qualifies for EITC. During Carla's days as a CNA most of her income was disposable, but now that she's an RN she lives a paycheck to paycheck existence. I'm sure she wouldn't be too pleased with some schmuck proclaiming that she's earning 'big money.' The people who are convinced that nurses earn plenty of money are like shrubs on the outside looking in because they do not know how much sweat and tears we shed for our educations. They remain blissfully unaware of the daily struggles of getting through our workdays. All they see are the dollar signs. I'm here to declare that I worked hard to get to where I am today and I deserve to be paid a decent wage for all of the services that I render. Instead of begrudging us, join us. Further information to help readers decide... Do-Nurses-Earn-Big-Money-You-Decide.pdf
  21. From holiday over-eating to New Year reckonings about weight? From worrying about money to wondering what else you could do to increase your income? From working in a job that frustrates you or you've outgrown to wondering what else you could be doing? From leaving the workforce to enter the world of retirement and not knowing how to adjust? Transitions are everywhere at any time and can be perceived as negative or positive. I prefer the latter and have some thoughts to consider. T - Trust your instincts Rather than be caught off guard when things change, take the high road and note what your gut is telling you about what is going on. Keep in mind the change you are experiencing might be just what you have been secretly wanting! R - Reset your eating and exercise program Have you been stuck and know you want to get healthier but not sure how to make the first move? I'm sure you have dealt with this before, so reflect on what helped you be successful in the past and recreate those steps. A - Adjust your thinking from I CAN'T to I CAN See yourself healthy, happy and whole. Send time every day imagining yourself being your best and being grateful for all that you are and have. Hang up pictures to visually represent what your goals look like so you can start living in that body even before you get there. N - Notice what you need right now Go outside right now for a walk. Yes - right now! By yourself! Take a notepad and pen along because great ideas are sure to surface while you are walking and you may want to write them down before you lose them. Focus as you walk on what you really need right now to move forward thru this transition. This will be your starting point. S - Set goals in alignment with your values to create the life you love Have you ever taken the time to really ask yourself what you want? Yes, you know what your parents want for you, what your kids want, what your partner wants, and what you "should" want. But what do you really want? Write down 3 dreams you have for a more complete life and post it where you can ponder it. I - Integrate all your skills into a single focus By now you have probably acquired a lot of great life and work skills that make you the fantastic talented person you are. During this transition, you might find that it is time to put them all to good use and see what emerges. Write down a list of everything you are great at - write until you can't think of anything else - at least 30 things. T - Train yourself for new skills After I had acquired all the skills I thought I needed in life, I opened up myself to what might be next for me - the key - being open to possibilities. What showed up for me was "wellness coaching", or some people call it "life coaching". When I was searching for "what's next for me", a friend coached me and after just 2 sessions, I had a new direction, a plan, and I was on my way again. I loved the experience so much, I was trained to be a coach as well as a coach trainer. I - Invite new opportunities When I was transitioning out of the workforce and into my own independent wellness business, I needed to figure out how to earn money while still doing the work I am passionate about. Because I remained open to new ideas, I was presented with a way to help people get healthy as well as make the income I needed. The key was to stay open to new ideas and give them a chance to see if they could work for you. O - Own up to what is best for you Not sure what direction to take as you transition? Your guide should be how you "feel" about what you decide to do. As they say, if it feels right - do it! N - Now is the time to reinvent yourself Call it a New Year Resolution or just call it a gift to yourself. But the new year brings with it new energy, new motivation and an excellent time for a new start. Enjoy the process of your transition. Remember, it's about the journey not the destination. And above all make it fun! Feel free to share what you are committing to this year.
  22. My Story in a Nutshell When I became a nurse in 1996, I was coming from a challenging entrepreneurial path as a massage therapist and yoga instructor. Being just over 30 and struggling to make ends meet with only a high school diploma, a small child at home, and a wife in college herself, nursing was an excellent career choice, especially since I'd already cut my teeth as a personal care attendant and private duty home health aide. I also had several nurses in my extended family, an added impetus to give nursing a try. Since I've always been a rebel, those who knew me well weren't at all surprised when I chose to not pursue a med/surg or acute care position after graduation. Even though I was told this unfortunate choice was "career suicide", I forged ahead and created a nursing career wholly focused on ambulatory care. These past two decades saw me working in federally qualified inner-city community health centers, home health, hospice, public health, and intensive case management. Prior to becoming fully self-employed, my last clinical position was serving as Chief Nursing Officer/Director of Nursing of a small home health agency in Albuquerque, New Mexico. This article is featured in the Fall 2018 issue of our allnurses Magazine... Download allnurses Magazine The Entrepreneurial Journey Based on my previous failures as an entrepreneur, it may have seemed illogical to pursue self-employment on the heels of 22 successful years as a nurse, but the desire to be my own boss never left me. After navigating the politics and challenges of mainstream healthcare, that desire only grew stronger. In essence, I wanted to be self-employed, set my own hours, work from home, and have more control over my life. I knew that self-employment would be difficult, but I also knew that increased personal freedom was something I was willing to work very hard to achieve. Being financially risk averse, I took the safest possible route towards entrepreneurship, which meant incrementally starting a nursing blog, beginning a practice as a career coach for nurses, working as a freelance writer, and later launching a podcast and an arm of my business as a motivational/keynote speaker and consultant. My personal "runway" from being a nurse with a few money-making side hustles to quitting my job and being 100 percent self-employed was approximately seven years. This slow burn allowed me to build my business without the weight of total uncertainty. It was only when things were humming along that I chose to resign my last position and put a stake in the ground as a fully self-employed nurse entrepreneur. Lessons Learned Entrepreneurship is filled with difficult lessons. We can start the journey bursting with enthusiasm and idealism, only to have it squashed by harsh realities. Launching a business takes a lot more than putting together a website and a social media feed. People actually need to find you, and that's where hard work is necessary. Search engine optimization, content marketing, networking, social media strategy, business formation documents and incorporation, business bank accounts and credit cards - it's all part and parcel of this path. One hard lesson I learned is that one person just can't do everything. It's great to learn new skills, but sometimes the learning of a complex skill (like building a Wordpress website) isn't necessarily a good use of your time when you need to focus on producing income. I had to learn that hiring others is smart business - it allows me to do the things I'm good at and let others do the rest. Once I had some cash flow, I began to use expert freelancers to push me along. These experts included someone to produce my podcast, a social media manager, business coaches, graphic artists, and web designers. Along the way, I've picked up some skills, but I continue to rely on others who know more than I do. A successful business can be difficult to build, but it's very satisfying to do it well. Rome wasn't built in a day - patience, creativity, and persistence are indeed my best companions. The greatest lesson I've learned is to have multiple streams of income so that one "arm" of my business can be slow while another picks up steam -- this allows for the natural ebb and flow without causing undue worry about money. It's a delicate balance. And Now for Something Completely Different For nurses feeling tired of the same old grind, the potential for a new lifestyle and workstyle is possible. For some, a simple side hustle earning a little extra money is enough: blogging, consulting, or coaching can be done during your off hours from traditional nursing. For some, working from home or starting up a business can be a full-time gig. And for others, a combination of side gigs and part-time or per diem nursing is just right. The caveat here is that we all have varying needs for lifestyle stability and cash flow. One person's entrepreneurial dream can be another's nightmare, thus marching to your own drum in this regard is essential. If you explore the entrepreneurial path and realize it's not for you, there are plenty of other out-of-the-box paths to choose from. Talking with those ahead of you on the journey is essential - do your due diligence, weigh your options, network like crazy, assess the potential for success, and connect with the people who can support you in realizing your dream.
  23. When you graduated nursing school, you may have envisioned working at the bedside for thirty or forty years before hanging up your nursing shoes. But, lately, you're not sure you want to finish 2018 at the bedside, let alone a few more decades. If you're feeling this way, it's important you know that you're not alone. The RN Work Project, a national study of new nurses, reports that 17.9% of new nurses left the profession within 1 year of starting their first job and 60% left within 8 years of starting their first position. Nurses with more tenure leave because of staffing issues, schedules, and overall job dissatisfaction. So, how do you know if it's really time to leave or if you're just in a career slump? Recognizing it's Time If you're wondering if bedside nursing is where you should be, you're probably going through a lot of emotions. You may feel like your stuck or even regret entering the nursing profession all-together. Don't beat yourself up. A degree in nursing is more flexible today than ever before. So, before you worry that you've made the mistake of a lifetime, let's explore a few signs it's time for you think outside the box of a traditional nursing career. You Get Little or No Joy out of Caregiving Caring for others is hard. Whether it's the long shifts, schedule, or stress levels that come with a lifelong nursing career - it can make the job a bit more demanding than what you want. So, if you find yourself dreading going into work and this feeling lasts for weeks, or even months, it's probably a good indicator that you need to start considering something new. Your Passions and Gifts Aren't Being Used at the Bedside Many nurses start realizing that being at the bedside doesn't give you much ability to use other skills, such as writing, marketing, or organization. Yes, you certainly do write, market, and organize as a nurse, but if you find yourself dreaming about utilizing these skills or others on a daily basis, it may be time to look for new opportunities. Using your passions doesn't always mean you need to walk about from your license. It just means you need to consider a niche of nursing that lets you use both your nursing knowledge and our passion. You're ready to throw in the towel on nursing all together Many nurses find themselves in this situation. But, don't act hastily. A degree in nursing doesn't mean you have to work at the bedside. You have options - especially in a healthcare market that is continually looking for new and creative ways to deliver care cost-effectively. You can look into non-traditional nursing positions that let you use your knowledge, without being at the bedside, such as case manager, health coach, or utilization review - just to name a few. What's Next for You Before you take any other steps, you need a plan. Follow these tips to move in the right direction: Write It Out Make a list of your strengths and weaknesses. Another way to think about this is to jot down all the things you like about nursing and those tasks you despise. This will help provide some clarity for your next role. Next, make a list of your passions and start analyzing the two lists side by side. Do a little research on non-traditional roles that incorporate the tasks you like and your passions. Stay Positive It can be easy to slip into a pattern of beating yourself up over this change. But, what will that accomplish? You're right - nothing! So, don't worry about the past. Many people make career changes after a few years - or a few decades. Try Changing Your Mindset If the thought of jumping ship worries you or comes with financial consequences you can't face, try changing your mindset. You might also want to look for a new employer to see if your issues are more with the unit than with your bedside career. Take Your Time As my grandma used to say, "Don't jump out of the frying pan and into the skillet!" Give yourself plenty of time to make sure you're making the change for the right reason. The last thing you want to do is enter another role that isn't right for you. Have you recently left the bedside? Are you happier now or do you miss it? Let us know why you left the bedside and how your new role is working out for you.
  24. I remember what it was like to be a new nurse, being unsure of what or how to do whatever my patient needed. I jumped in and asked a lot of questions and for the most part, my more seasoned coworkers helped me out by guiding me to the appropriate solution. I learned by listening to and watching those nurses. There were a few nurses who were difficult, who didn't want to help a newbie out; I rapidly determined who those nurses were and didn't go to them with my questions or for guidance. Eventually, I became a seasoned nurse and enjoyed helping the next generation, and then the one after that. I was a good nurse, conscientious and loved my job and loved learning. Somewhere down the line, I became an old nurse in a new position; I retired after 30 years in one hospital system and decided to try something new, totally new, in a totally new state 1200 miles away from home. It took a lot of nerve, but I knew inside me it was something I needed to do if only to prove to myself that I could. I was recruited for my new job and was well qualified for my the position, I had been a co-investigator on a research project, had published an abstract for a national conference, had experience and was certified. My new job was in New England and I loved the scenery, the ocean and life there; but I found I had lots of things to learn--the local hospitals and clinics, the likes and dislikes of my "new" chronic patients, which pharmacy would compound meds and which ones always lost the script we sent, the nearby resources that my patients needed, the preferences of each of the three doctors I now worked with. I worked as the only nurse in my clinic three out of my four work days. I struggled with not having my fellow nurses to talk to, consult with, commiserate with. I struggled not being known for my abilities and my knowledge and skill. Everything that makes me a good nurse I had to prove again. I received very little orientation to this new job and although I did my best, eventually I decided it wasn't working out; the job wasn't a good fit for me and I wasn't a good fit for the job. Move ahead two years and I am back in the Midwest, my part of the country; working at a big city hospital. I was really excited to be back with my original love, the NICU. This 100+ bed inner-city unit was much larger than my previous NICU. I could work an entire shift and never see a fourth of the nurses working that night. I honestly felt lost there, I knew no one, no one knew me. Again I wasn't known for my skills or abilities. To them I was just a new nurse, I was treated with less than respect by many. I toughened up to that treatment. Even after two years I just don't fit in...I had surgery and was off 4 months, one person came to see me and when I came back to work very few noticed that I had been gone; I got married and no bridal shower, only one coworker came to my reception. Many notices/invitations for bridal showers and baby showers for other nurses cover the bulletin boards in the lounge and the Facebook page was full of them as well. I float into a different part of the NICU and I get the easy assignments, the ones a non-NICU float could handle. I missed having sick babies, I offer to start PIVs and am declined as "this kid is a hard stick". In my former jobs I have placed many an IV in many a patient, many times when no one else could get one; however my skill is not accepted here, I am not known. I have been certified in high-risk neonatal nursing for 25 years, I was one of the first in my hospital to take the certification exam. There are a few nurses who trust me, but for the most part, I am new and therefore without skills. This a hard concept to accept, I sometimes take it personally, I wonder if indeed I'm "too old". Providers also question my capability to care for my assigned babies. I often hear "I haven't seen you here before" or "are you floating" or "where do you usually work?" I feel like I am constantly trying to validate my qualification to be here, and that's frustrating and sometimes humiliating. So here I am two years later, still explaining carefully that I know what I am doing, still hoping to be accepted and have coworkers acknowledge my skill and knowledge. I am trying really hard to accept that this is the way it is, that most likely the culture of nursing will not change. Sometimes I think about retiring early and doing something else with my time, but I do love my patients and for the most part, love my job. For right now I will just settle for being not known.
  25. Maureen Bonatch MSN

    Is Your Nursing Career in a Rut?

    After years of nursing school, and then choosing what seemed like the perfect job, sometimes it's hard to consider that your job may have lost its luster and that it might be time for a change. That change could be as drastic as a new job, or perhaps as little as joining a committee, taking a class, or looking for a transfer. We all have days when we're feeling bored or unmotivated, but if you're feeling like this often, and a few days off doesn't alleviate that feeling, perhaps your nursing career is in a rut. Most people find comfort in familiarity, and may hope that something will change, but often we must make a change to put the passion back in our career. Check for Signs of a Rut Does it seem like you're going to the same job, with the same people, doing the same tasks all the time? It might be hard to pinpoint why you feel unhappy. Perhaps it's just a phase, or a work project that has you feeling this way. Reflect on the source of your dissatisfaction or lack of fulfillment. You might be in a rut if: You get a sick feeling Monday morning, or the day before Jealousy stirs when others are excited about their job You've lost your pride in your work When people ask about your job you change the subject You feel angry and as if you're stuck in your job You secretly browse job listings, but have no idea what you're looking for Company events or trainings that you used to look forward to now feel like an obligation If this sounds like you, your work may start to suffer as you become more disengaged. If you're not committing time or energy to tasks and just go through the motions, it can be physically and mentally exhausting. Most of us want to be challenged and learn, but if we're feeling tired and lethargic then we might believe it's not worth the effort. Determine the Source of Dissatisfaction Even if it's a great job, and you're successful with what you do, you might have lost that loving feeling somewhere along your career path. Before jumping at the first available opportunity, examine what is dissatisfying to avoid getting stuck in another position that may quickly become unfulfilling. Identify what you like and dislike about your job such as: Are you happy with your schedule, or do you feel run ragged, or as if you lack time off? What is your favorite part of the day, or the tasks that bring you the most enjoyment? Are there opportunities to learn, or do you feel bored, or unchallenged? Is the work environment, or culture, unsatisfactory? Do you feel like you're suffering from burnout, or compassion fatigue? Do You Have an Itch to Switch Jobs? If you're ready to move on and find a job you're passionate about, begin by taking time to clean up your personal and professional brand. If your unhappiness has leaked onto social media you don't want a potential employer gaining a bad impression if they stumble across your complaints or blatant unhappiness. Then consider what you're looking for in a job and how it aligns with your strengths and weaknesses. Consider if a hobby, or other passion, can be incorporated to create a more satisfying position Update your resume and LinkedIn profile with new accomplishments and have your cover letter ready to go Consider if you need additional education for the role you desire, it may be as little as taking online classes, or listening to Podcasts, to gaining a new certification or degree Attend available networking events Let friends, family, and colleagues know you're looking for opportunities Can You Rediscover Your Love? Maybe you're unhappy in your job, but perhaps there are ways to put excitement back in your position so it doesn't feel like a grind. Challenge the status quo by shifting your mindset. Pretend you're new to your job and ask questions and make suggestions instead of accepting how things have always been done. Other ways to inject passion, and change your role into something you enjoy more, including creating your own opportunities by: Looking for a mentor, or volunteering to be one Getting to know colleagues better Finding a better fit with a position transfer Asking for more responsibility Discovering interests outside of work to stimulate your mind Get Unstuck from Your Rut Most of us spend a large part of our day, and our lives, at work so it's important to find something that doesn't make us miserable. Each of us has different things that bring us joy. Only we can determine what makes us happy, or unhappy, in our job. Sometimes it takes devoting time to consider just what drew us to the position in the first place, and what's driving us away now.

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