Being a nurse, it’s often challenging to have a work-life balance. Everyone wants a balanced life because it’s good for their physical and mental health, their relationships with family and colleagues, and their work performance, but how can you actually achieve a work-life balance?
I always tell my nursing students how important time management is. More often than not, we’re too busy trying to keep up with our daily activities and workload, but good time management can help you achieve more in a shorter period of time and with less effort, and help you make better decisions. As a result, you will have more free time and more success, which in turn leads to lower stress and frustration.
Here are some useful steps to help you manage your time effectively and achieve a work-life balance:
- Identify your priorities and values between home and work. Always work on the most urgent and important goals and tasks first. Readjust the demands of work and home as much as possible.
- Assess how you currently spend your time. Keep a time log for a week and look for activities which you should set limits and boundaries on your time—both at home and at work.
- Make yourself a priority by practicing good self-care, and take care of yourself in a holistic way—taking into account both physical and mental health.
- Improve your nutrition by having a healthy breakfast, taking a break for lunch or healthy snacks, and spending time with family for dinner.
- Integrate exercise into your day. Enroll in a yoga, Pilates, or mindfulness meditation class or other relaxation activity that can help you reduce stress.
- Improve your sleep health by making your bedroom as inviting as possible.
- Learn to say “NO.” Sometimes you need to let someone know that you are not available to take on a new request or attend another meeting.
- Take time to reflect on the positive parts of your day and life.
- Make time for the things you love. Have a good time trying out other areas of well-being.
- Identify workplace and personal challenges that create stress, and develop an action plan for addressing or coping with them.
- Acknowledge losses and give yourself permission to grieve.
- Seek support from your families, friends, and colleagues in areas that seem to be the most challenging. Consider using your organization’s employee benefit program, peer associations, and support groups for assistance.
Have fun and enjoy a balance of your work and personal life!
Despite a nurse’s best efforts, some patients aren’t willing to follow instructions, but the impacts of patient noncompliance are too serious to ignore.
Prescription drugs provide an excellent example of the importance of adherence. It’s estimated that up to 30% of prescriptions go unfilled and as much as 50% of medications for chronic disease are not taken as directed according to a study published in Annals of Internal Medicine. The study’s authors go on to say that failure to follow prescriptions causes about 125,000 deaths per year and up to 10% of hospitalizations.
Nurses can enhance patient understanding of and adherence to their overall treatment plans by strengthening communication, rapport, and education.
It Starts with Communication
Asking the right questions and opening the lines of communication between patient and nurse can uncover critical barriers to treatment compliance.
- Pose questions in a constructive, problem-solving manner. For example, “I see that you have not been completing your daily exercises. I wonder if they are causing you too much pain, or if there is some other reason?”
- Try to relate personally to the patient to build a stronger therapeutic partnership. Get the patient to express what the nurse and care team can be doing to help them better meet their personal health goals.
- Set and adhere to a discussion agenda for every encounter. Begin with a discussion of the patient’s personal goals and issues before moving on, such as “First, tell me what concerns you most, and then we’ll discuss test results.”
Encouraging Cooperation and Participation
Explain to patients that they must take some responsibility for the outcome of their care and treatment. Let them know that everyone caring for them wants them to be successful in regaining their health. If barriers to compliance persist, try asking the patient what he or she believes would be more effective. The goal should be to achieve a mutually acceptable care plan.
- Clearly and explicitly convey the severity of the problem and the risks of not properly carrying out instructions. Give the patient an opportunity to ask questions and clarify the instructions.
- Find out if there are any underlying factors affecting compliance. For example, “It sounds as though you may be concerned about the medication’s possible side effects. Is that why you have not taken it as prescribed?”
- Identify any practical or logistical difficulties that may hinder compliance.
- End each encounter by having the patient verbalize at least one self-management goal.
Enhancing Patient Education and Understanding
Key barriers to communication – such as low health literacy, cognitive impairment, or limited English – need to be assessed early on to help uncover the best solution for successful communication.
- Have access to qualified and credentialed interpreters for use when necessary.
- Ask patients if they have any questions about their medications and ask that they describe in their own words how to take them.
- Consider involving a health coach, health navigator, and/or case manager for the patient.
- Ask patients to repeat critical instructions and paraphrase in everyday words the medical information they have been given.
Helping Patients Manage Logistics
Sometimes a patient’s noncompliance issue is out of their hands due to a lack of personal support at home or financial restraints. Uncover where those patients are struggling:
- Do health care information records note who can help your patient when they’re outside of the health care setting? Do they have the consistent help of a spouse, relative, friend, or paid caregiver to aid with their care?
- Are patients asked whether they can get to appointments via car or public transportation, and are responses documented in the patient care record?
- If a patient lacks the physical or mental capacity to perform such essential tasks as changing dressings or picking up prescriptions, has a relative or friend been asked to assist, with the permission of the patient or legal guardian?
- Does the patient lack the financial resources to comply with their current care plan? Are they concerned about the out of pocket costs for treatment, or having to take time off of work?
- Document these concerns in the patient care record, and work with the patient and their primary care provider (with the patient’s permission) to find solutions.
Supporting the Effort with Documentation
To help staff deal with hostile, manipulative, or uncooperative patients, written protocols should be in place to help all staff respond to and deal with difficult patients. This should include ways to document and procedures for such common concerns as:
- Repeated prescription refill requests of questionable nature
- Narcotic use and general pain management in drug-seeking patients
- Appointment or procedure cancellations
- Unacceptable behavior, such as belligerent voicemail messages or yelling or cursing at staff
- After-hours patient calls
- Refusal to consent to recommended treatment
- Neglecting to take medications, do exercises, or make necessary lifestyle changes
- Terminating the patient-provider relationship
Driving patient compliance often means health care teams need to repeat themselves again, and again, and again. Different tools and strategies can help nurses drive compliance.
- Remind patients of upcoming appointments, including referrals and laboratory visits, via telephone and/or email.
- Try electronic alerts to remind patients with a history of noncompliance about screening and monitoring requirements.
- Inform blind or visually impaired patients of subscription services that use wireless devices to deliver reminders to take medications or perform vital self-care activities.
- Schedule follow up and referral appointments before patients leave the facility.
- Document no-shows and conduct telephone follow-up within 24 hours.
Know if there is a written policy for terminating the patient-provider relationship if the patient is chronically noncompliant and fails to respond to reminders and other messages.
Keep at It
Patient noncompliance is a deep issue with no easy answers or simple solutions. Nurses in almost any setting will encounter noncompliant patients, but with consistent communication and a persistent, but cooperative, spirit nurses can work to overcome the risk of noncompliance one patient at a time. Nurses also can explore Nurses Service Organization’s patient self-assessment checklist to help facilitate open communications.
Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.
Approximately 85.11% of candidates passed the NCLEX RN on their first attempt in 2017, according to the National Council of State Boards of Nursing (NCSBN). You can be one of those who passes the exam on the first try, too; you just have to know how and work through it.
Here are five tips to help guide you.
1. Familiarize yourself with the NCSBN website.
The NCSBN website provides critical information that you need to know about the NCLEX before taking the exam. Check all the rules and requirements. You need to get to know anything and everything you can about the exam so you can take the NCLEX exam with confidence.
2. Start preparing early.
Give yourself enough time to study. Establishing a timetable for your study is essential. Manage your study as if it is your full-time job. Try and get rid of all distractions, and make sure you feel as comfortable and able to focus as possible. Everyone is different, so make sure you develop a study routine that works for you, whether that’s studying in the AM if you’re a morning person OR in the evening if you are most productive at night.
3. Discover your knowledge early on.
It is crucial that you figure out the areas where you feel especially weak and that you need to focus on the most. Make sure that you spend more time reviewing content material related to these areas and keep practicing.
4. Take practice exams every day.
One of the most effective ways to prepare for the NCLEX exam is to practice taking past versions. It is important to take multiple practice tests and answer hundreds of questions in order to become increasingly familiar with the test format and questions. Also, take more time to review the correct answers for the questions you got wrong. The NCLEX exam is designed to determine if you have nursing knowledge and critical thinking skills required to begin practicing as a nurse. You are required to analyze the test questions using your critical thinking skills and nursing knowledge to make decisions about common nursing situations. There are a great deal of online guides and test questions, many of them free or at an affordable price. Make sure that you take advantage of these resources. A particular resource that I would recommend is the NCSBN’s Review for the NCLEX Exam.
5. Last but not least, set yourself up for success on the test day.
Stay positive and expect to pass. What everyone says is true–a good night’s sleep can make all the difference. Make sure you go to bed early the night before the test and regulate a full night of sleep (at least 7-8 hours). Be relaxed during the exam and remind yourself that you are well-prepared for the exam and ready to pass.
Prostate cancer is the second most common form of cancer in men (skin cancer is first), with the American Cancer Society estimating 161,360 new cases in 2017. A nurse’s role in prostate cancer awareness, prevention, diagnosis, and treatment is essential. As a professional nurse, a loved one, friend, or peer, nurses are on the front lines. They have the knowledge to help people identify what’s going on and have the resources and expertise to help them with treatment options and cutting-edge developments.
Leanne Schimke, MSN, FNP-C, CRNP, CUNP, works with urology patients in private practice and also with the Lancaster Rehab Hospital, and uses Prostate Cancer Awareness Month as a great opportunity to inform people about the disease. Of all things a patient might hear, getting any kind of life changing diagnosis like a cancer diagnosis is overwhelming. A nurse can help educate patients and also offer support. “Nurses need to understand it will take multiple discussions for the patient to retain the information,” says Schimke. “It is helpful to include family members and correct any misconceptions.”
Involving the patient and their loved ones in discussions helps ensure that the information will be understood and retained. Nurses can help patients by answering their questions, of which they probably have many, and making sure they know where to find additional reliable and accurate information. Surfing the internet for information about prostate cancer treatment and prognosis isn’t going to give them the information a nurse can. “I help provide context on information they obtain through the Internet, friends and family,” says Schimke, “such as helping them understand if a certain treatment is an option for them, especially at later stages of disease progression.”
And she also acts as a reference. She encourages patients and their loved ones to write down questions and to understand that while they can’t delay treatment decisions, they should not rush into them. They can take the time to choose the best option for them, and they have time to get a second opinion. “I help them have realistic expectations – some assume when they are diagnosed with prostate cancer they are going to die soon when that is not the case – and in others I need to help them understand that their time is limited. I am a contact for patients to answer their questions and help with their symptoms.”
Schimke also helps dispel the many myths about prostate cancer. Prostate cancer may not be the leading cause of cancer deaths in men, but it is a killer. “I would like to discuss the statement ‘no one dies from prostate cancer,’” she says. “Approximately 14 to 20 percent of men diagnosed with prostate cancer will progress and die from advanced prostate cancer and not another cause. This statement trivializes prostate cancer and may lead men to make decisions that are not in their best interest.”
As a nurse working closely with patients, Schimke is able to work with men and notice signs of the disease’s progression. “When left untreated in an advanced stage, prostate cancer can spread to other bones in the body, which is difficult to treat and can impact survival,” she says. But there are new options for patients. “There are many treatments for prostate cancer depending on the stage of the prostate cancer when diagnosed,” Schimke says. “Our goal is to hopefully cure the cancer if at an early stage, but if it is metastatic at diagnosis, we want to maintain their quality of life and prolong their life through the various treatment options that are available.” One new option is a short-range radioactive treatment that kills cancer cells in men whose cancer has been resistant to medical and surgical treatments. They may have metastasized cancer that has spread but the spread is limited to the bones. Called Xofigo, the option can help extend the life of metastatic castration-resistant prostate cancer (mCRPC) patients.
What can men who do not have prostate cancer do to protect their health? Schimke says getting a PSA test is important. While some men think the test isn’t useful, Schimke says the test is a screening tool, not a diagnostic tool, that can spot potential red flags in men who are at high risk of prostate cancer or those in the 55- to 70-year-old age range who feel they would like the test and understand it. “PSA testing should be done in men with a high risk for prostate cancer, such as men who have a father or brother that has had prostate cancer,” she says. “The American Urological Association has guidelines for which men should be tested.” And while the test results might lead to a biopsy to rule out cancer, the biopsy isn’t always going to come back positive.
And if men do get a cancer diagnosis, each case is very different and finding a reliable and knowledgeable healthcare team with expert urology and oncology teams working together is essential. “Not all prostate cancer needs to be treated,” says Schimke. “Many men can be followed and treated only if their prostate cancer progresses.”
Neonatal nurses sum up their work very succinctly. As the theme of 2017’s Neonatal Nurses Day, celebrated every September 15, states “We Save Babies!”
Sponsored by the National Association of Neonatal Nurses (NANN), the “We Save Babies!” theme resonates with this clinical specialty of nurses who work with the tiniest patients.
Neonatal nurses care for babies who are born so early or with conditions or infections that just a mere decade ago they might not have survived. In fact, according to NANN, survival rates for these patients are 10 times better than they were 15 years ago. Preemies born months too early who barely fit in a hand are now able to survive, but the journey is often treacherous. These nurses might also care for newborns who have birth defects or who were born with life-threatening health problems. Some babies become ill or develop an infection shortly after birth and neonatal nurses care for these babies, too.
This specialty of nursing is very specialized and neonatal nurses are trained to watch for the smallest challenges that can face these newborns. Preemies are faced with a range of potential problems because they didn’t have enough time to fully develop in the womb. They might have breathing problems from underdeveloped lungs, difficulties taking and digesting food, and are often unable to regulate their body temperature. Neonatal nurses’ training prepares them to monitor all the smallest fluctuations in a baby’s health and vital signs.
For families of these babies, neonatal nurses are a lifeline to their babies. Nurses and families often become close as the nurses care for the babies and also help inform the families of how to care for their infants as well. Nurses help families cope with the emotional toll of having a sick newborn and have an impact on families that is often life-long.
Nurses who are interested in this field need experience with infants and children and that should include work in a level lll neonatal intensive care unit, according to NANN. With a current RN designation and work in the field that includes at least 2000 hours in the specialty in a 24-month period, you can obtain RNC Neonatal Intensive Care Nursing certification (RNC-NIC) through the National Certification Corporation.
As neonatal nurses are celebrated today, you can check out videos on NANN’s Facebook page from the people who have been touched by the life-saving skill and care given to their babies when they were in their most fragile state. Take photos of your unit to post on social media and tag them with #NeonatalNursesDay. Let people know of this challenging career choice and the incredible rewards it offers.
The compassionate work and care of all nurses deserves to be celebrated, and throughout the year, different branches of the nursing profession get the chance to spotlight their unique duties.
This week, September 10 to 17, is National Nephrology Nurses Week, sponsored by the American Nephrology Nurses Association (ANNA), and honors the work nurses do with patients who have kidney disease or are at risk for impaired kidney function.
The need in this area is great. According to the National Kidney Foundation, one in seven adults has chronic kidney disease. Many people don’t realize they have a current disease and many of those who are at risk are also unaware.
Many sub-specialties exist within nephrology nursing, so nurses in this area have many choices. To advance their careers and gain more knowledge, nurses can become certified through the Nephrology Nursing Certification Commission in becoming a nephrology nurse nurse practitioner, a certified nephrology nurse, or a certified dialysis nurse (several technical certifications exist as well).
With a varied and diverse population, nephrology nurses work with all ages of patients from the youngest patients to the oldest. They can work in healthcare settings ranging from hospitals to home care, but may also choose to pursue research, policy work in government, or a position in academia.
Renal disease can impact anyone, so nurses become comfortable helping patients with prevention, with deciding on treatment options, and guiding them to administer self care and monitoring. And while many patients are relieved to know their kidney disease can be managed, sometimes the care options (like needing dialysis) are a daunting prospect when patients first hear it. They rely on the compassionate, professional, and expert nursing care to help understand and adapt to their diagnosis. Nephrology nurses must have broad knowledge and care for the whole body as kidney function impacts so many physical systems.
Many kidney patients have additional conditions making their care especially complex, so a nurse who wants to get into the nephrology field needs to be able to work comfortably on a team to understand the complexities of care.
In a public letter celebrating National Nephrology Nurses Week, Alice Hellebrand, MSN, RN, CNN, and 2017-2018 ANNA president, said, “Nephrology nurses use their vision, knowledge, and skills to take action and improve patient outcomes. They make a positive difference in the lives of patients and their families every day. Individuals with kidney failure rely on the skills, knowledge, and expertise of nephrology nurses to ensure the safety and effectiveness of their life-saving care.”
Thanks to all the nephrology nurses out there!
With September designated as Childhood Cancer Awareness Month, it’s especially fitting to recognize the nurses who care for these young patients with a day to honor their compassionate work.
September 8 marks Pediatric Hematology/Oncology Nurse Day, the fifth such celebration of its kind. Spearheaded by the Association of Pediatric Hematology/Oncology Nurses (APHON), the day recognizes the work of caring for children, teens, and young adults who have cancer or blood disorders. In addition, the nurses are also supports and sources of knowledge for the families and loved ones of these children who have been diagnosed with life-threatening and life-changing diseases and disorders.
APHON is working steadily to have states recognize and celebrate September 8 as an officially dedicated day. Organizations and the health care teams within them can help these efforts by notifying legislators of the importance of honoring the work in this challenging and rewarding field.
If you are interested in taking action to support these efforts or just honoring a pediatric hematology/ oncology nurse in your life, there’s lots you can do.
- Write to your legislators to inform them about the day and propose legislation to have the day officially recognized in your state. You can also invite legislators to a presentation to tell them about this important role in the lives of children and families and health care organizations. Teach them about what you do—in short order they will be amazed.
- Use social media for one of its best purposes –spreading good news far and wide. Post on Facebook, chat on Twitter, and post pics on Instagram of you and your fellow nursing team. Use #pediatrichematologyoncologynursesday to bring it all together.
- Say thank you to your team or to the pediatric hematology/oncology nurses in your life. Working with children who are fighting these diseases is uplifting, emotional, and essential for the children. Let these nurses know how crucial their work is by spreading a little joy throughout the day and making them feel appreciated.
If you’re a nurse and are interested in exploring this field, contact APHON to learn about some of the requirements and skills you’ll need. A BSN is recommended for pediatric hematology/oncology nurses, and you’ll probably want to work in a general pediatric unit so you can get a feeling for what it’s like working with kids. After gaining some on-the-job experience, getting certification as a Certified Pediatric Hematology Oncology Nurse (CPHON) with the Oncology Nursing Certification Corporation will boost your confidence, your skill set, and your professional credentials.
Happy Pediatric Hematology/Oncology Nurses Day!
Starting a job search is exciting. Thinking about a new nursing role or working in a new organization is often energizing and helps get you through the work of looking for a new position. But if you are getting lots of rejections (or even flat-out silence), it’s time to shake things up.
Today’s job market is intense and competitive. If you’re a qualified nurse with a solid background of great work, finding a job shouldn’t be as hard as it sometimes is. If your resumes and inquires are being met with a solid round of no, it’s time to step back and see what you could do better.
1. Take a New Approach
If you’re only sending out resumes, it’s time to do something different. Branch out into professional organizations or networking groups. See if there are any seminars or lectures on LinkedIn or in local organizations. Get yourself out of your routine and meeting new people. Despite today’s incredible technological advances, many job offers come though personal connections not computers.
2. Check that Resume
Sending out the same resume you started with months ago could be a problem. Lots of rejections means it’s time to change it. Your resume isn’t getting replies so check it over for obvious things like spelling errors or grammatical mistakes. But also look at your resume with a critical eye. Should you try easy-to-read bullet points instead of a paragraph? Do you have an outdated phrase like “references available on request” that you should delete? Are you showing rather than telling your experience? Change it up.
3. Prepare for Your Interview
Even if you have an interview with people you know, you have to remember you’re probably up against some highly qualified candidates. Each interview has to be your best interview. There’s no way around that, so you have to be prepared. Know the job, know about the company, be ready to talk about your accomplishments, and ask relevant questions. Be prepared enough so you can listen to your interviewer without just thinking about what you’ll say next. You’ll respond better and will be more relaxed.
4. Do the Follow Up
Follow up after your interview with a handwritten thanks. Email is fine, but in today’s electronic world, many people appreciate a handwritten note.
5. Keep Your Momentum Going
Even after you land a new job, keep growing your professional networks and building your reputation. Careers are always changing and you might decide on a new direction a few years down the road. If you are ready, the next opportunity might seek you out.
Nursing students are a disciplined bunch. They balance coursework in both classrooms and labs, clinicals, a social life, and essential self care in a fast-paced and structured environment.
As a new nursing student, how can you make sure you keep everything moving forward but still take care of yourself? Set good habits and now and get your year off to a good start.
1. Be Open to a New Approach
The most successful students aren’t always the smartest ones. The students who do the best are often the ones who learn how to manage their time best and know what their strengths and weaknesses are. You might have been a top student before, but nursing school is a whole new game. Find the best method of time management for you by experimenting, researching time management approaches, and even taking a seminar (almost all schools offer these). One or two hours of learning a new approach can save your hours and hours of lost time and unnecessary stress.
2. Rethink Getting Help
Nursing students don’t always like to ask for help. But if you don’t ask for help when you’re struggling with an assignment or with an overall course load, you risk falling behind or getting grades that aren’t what you expected. If you’re reluctant to ask for help, look at getting help in a new way. Consider the effort as learning from the best. Ask people to let you in on their secret to success. You are asking to make yourself better, not because you lack skills or knowledge. Assistance doesn’t show your failings, it shows your strength.
3. Learn the Delicate Balance
Anyone in nursing school has the potential to burn out. There is always something more to do, another paper to finish, another exam to study for before your head hits the pillow. If you don’t take time for you, no one is going to do it for you. Now is the time to learn your limits and to respect how caring for yourself makes you a better person. Get enough rest and eat well, but also take time to spend with friends and family. Block off some time for solitude if that’s how you thrive. Be good to yourself now and you’ll reap the benefits throughout your career and your life.
4. Be Proud
You are going to have bad days. Nursing school challenges each and every student—that’s why we have excellent nurses. But it won’t always be fun and your confidence is going to take some serious hits. Throughout it all remember to be proud of yourself. Not everyone can make it as far as you have. Remember that and use that to fuel your fire to become the best nurse you can be. When a bad day knocks you over, just get up and keep going.
Although Angela Warnke, RN, director of nursing at the Greenhouse Treatment Facility of the American Addiction Centers, now manages a team of nurses doing direct patient care, until about six months ago, she was a “working” manager, working directly with patients going through withdrawal.
Warnke works with patients ages 18 and older. She says that people as old as in their 60’s and even 70’s are detoxing from opioids and other substances. “Day to day this work is similar to many other types of nursing in that it involves continuous assessment, interventions, medication administration, and caring for the whole patient and their family,” explains Warnke. “Some days I work to physically stabilize patients, some days I listen to people who need to talk, some days I teach groups on the physiology of addiction, some days I just offer hope. Most days are a combination of all aspects of nursing.”
With the opioid epidemic on the rise, many other nurses may be working with recovering addicts and people detoxing in the near future. “Everyone knows or is someone who has struggled with addiction,” says Warnke. “I have the gift of also seeing and experiencing the joy and freedom of recovery. This is a treatable disease, and recovery changes everything.”
During the first half of her career, Warnke worked in critical care in the Medical/Respiratory ICU of a hospital with 960 beds. Then, she worked in an ER that would often see between 250 and 350 patients each day. She thought that she would miss the challenges she experienced when she moved into substance abuse recovery nursing. Instead, she says, she found her home there.
“To be effective in helping people recover from substance use disorders (SUDs) one has to care for the whole person. People’s minds, bodies, and spirits are hurt by SUDs, and I get to engage people and help them heal on all these levels. I get to do the work of caring that I went to nursing school for,” says Warnke. “By far the most difficult challenge of this work is having a front row seat to the effects of this disease. Addiction gets worse as diseases do and kills as diseases do. The tragic loss of life—often very young life—is incredibly painful.”
As for the greatest rewards of her job, Warnke explains it in this way: “I think many people imagine my job is to be treated poorly by whatever they imagine ‘addicts’ to be. In reality, I work with people from a true cross-section of our culture who have quite unintentionally developed problematic relationships with opiates and other substances.
“In general, I work with people who will go on to live full lives, new lives, great lives. While recovery is intensely difficult and requires trying and trying again, our population literally ‘comes to life’ in our care. I get to see people who ‘come in hot’ stabilize. I get to see people who have been beaten down get life back in their eyes. There is nothing else like it.”
When asked what she would say to a nurse who might be considering this type of nursing care, she answers, “Do it.”
“This is the epidemic of our generation, and we need all hands on deck. Find a mentor. Be ready to research everything known about addiction. This is a developing field. Get serious about learning that nothing is personal. Take care of yourself. Give love,” says Warnke. “Every day I get the chance to be better than I was the day before. I feel like I get paid to become a better human being. Like all types of nursing, the job is to meet people where they are at and bring them out with me.”