As a nurse, you spend most of your life taking care of others — but who’s going to take care of you when it’s time to retire? A Fidelity Investments Money FIT Nurses Study revealed that 56 percent of working nurses don’t feel confident when it comes to financial planning. The same study found that 41 percent of nurses who don’t have confidence about financial planning cite lack of time to focus on financial goals as the reason. Cultural differences and language barriers can further stand in the way of working nurses as they strive to save for the future.
It’s tough being a nurse because you’re pulled in different directions every day, but taking the time to put your financial ducks in a row for retirement will pay off big when it’s time to hang up your scrubs for good. Here’s how to get started or bolster your savings efforts while there’s still time.
Know the Lingo
There are several programs that can help you save for retirement. These include 401(k)s or 403(b)s in the case of tax-exempt workplaces, like hospitals; IRAs; and Flexible Spending Accounts. If you don’t know the difference, now’s the time to learn the language of personal financial planning.
IRAs, which stands for individual retirement accounts, are funded solely by you whereas 401(k)s are funded partially by you. Employers typically offer matching 401(k) plans. For example, if you elect to contribute 5 percent of your earnings to a 401(k), your employer may match that rate, netting you an extra 5 percent in savings for retirement. In 2017, you can contribute up to $18,000 to a 401(k) account if you’re under age 50. You get an extra $6,000 if you’re older than 50.
On a related note, think carefully about your health care needs in retirement, especially if you’re not quite ready for Medicare, which starts at age 65. A high-deductible health plan paired with a health savings account may help you keep monthly premiums low while allowing you to save for unexpected medical emergencies. Understanding the different benefits and drawbacks to retirement saving options can be confusing, so it’s wise to talk to a financial adviser about your choices before committing to just one plan.
Start Right Now
You don’t need to set aside thousands of dollars right away. Make small changes, and focus on simple, achievable steps so that you can reach big milestones later. Here are a few simple ways to improve your saving habits:
- Start planning – today! Writing down your savings goals is the first step to implementing them.
- Focus on eliminating debt – you can aim to get each credit card paid off individually, try transferring your balances to one card, or negotiate lower interest rates.
- Cut back on unnecessary expenses – can you eliminate some small charges here and there, like a Netflix or Spotify subscription? Are you sure you’re getting the best deal on your cell phone bill? There’s more than one way to whittle down your monthly discretionary spending, so it can pay to get creative!
Nurses may tend to think less about their own future and more about the immediate needs of their families, such as paying tuition for adult children or taking care of elderly parents. However, you can’t take care of your loved ones if you don’t have any funds after you retire. Estimate how much you’ll need to live on comfortably once you stop working, and build a plan based on that figure.
Find a Support System
It’s critical to find a financial adviser who can guide you through this process. There’s no need to settle either. Seek out recommendations, do some digging and interview prospective advisers with the same scrutiny that you’d use to find a lawyer or doctor. A good financial planner will help you sort through your current finances, identify areas that need improvement, set up a solid retirement plan and answer your questions as you go. Look for advisers with the right credentials too, such as those certified by the Financial Planning Association.
Don’t let unfamiliarity about financial planning keep you from living the retirement life that you’ve earned. As a working nurse, it’s important to find a financial adviser who understands your unique needs and can get you on the right track. Start early, do your homework and be diligent about saving. Your post-retirement life will thank you!
Have you ever thought about changing career paths and teaching up-and-coming nurses? For those of you who have, we wanted to provide you with some information about what it’s like to teach, including the challenges and the benefits.
Michelle DeCoux Hampton, RN, PhD, MS, Professor and Doctor of Nursing Practice Program Director at Samuel Merritt University School of Nursing in Oakland, California, took time to talk with us about her experiences in teaching.
Following is an edited version of our Q&A:
What does your job entail? Do you specialize in specific topics that you teach? How many courses do you teach each semester?
I started in 2005 as a full-time faculty member teaching psychiatric mental-health nursing, health assessment, and synthesis for students throughout our accelerated bachelor’s program in nursing. Later, I began teaching an online course in research in the Master’s program and then the Doctor of Nursing Practice Program.
In 2013, I became the Director of the Doctor of Nursing Practice Program, and now I teach evidence-based research and several of the DNP Project courses that are geared toward providing mentorship to doctoral students as they complete their scholarly projects.
In my administrative role, 75% of my time is administrative work involving admissions, student advisement and progression, faculty support, as well as curriculum review and improvement, among other responsibilities. In my full-time teaching role, I taught about two courses per semester.
Why did you choose to teach?
My interest in teaching stemmed from my enjoyment of education from the student perspective and my many positive experiences with faculty and mentors.
I first tested myself as the Director of Staff Development in a skilled nursing facility to see how I would like being “on stage” before I ever applied for a teaching position at a university. I was able to learn a lot about adult education and enjoyed the opportunity to connect with the facility staff through our orientation and continuing education programs.
I advised many of our staff nurses about how to go about continuing their formal education and found it was one of the most enjoyable parts of my role in staff development.
What are the biggest challenges of your job?
Compared to being a staff nurse, one of the biggest challenges in teaching is that there is often no one to fill in for you—at least not at a moment’s notice. You often find that you work when you’re ill, on semester breaks to prepare for the next semester, and on your vacations. The flexibility is nice in a lot of ways, but the tradeoff is that you’re never really off the grid.
What are the greatest rewards?
One of my favorite parts of my job is to work with my doctoral students on their DNP Projects—usually an evidence-based practice implementation project. These students evaluate best practices through critical appraisal of the research literature, design practice change programs, implement changes that involve policy and procedure changes of the staff in a variety of health care settings, and evaluate the outcomes. Through each of their projects, they have provided improved health care to individual patients, communities, and within organizations. Seeing these projects develop from an idea to influencing real people’s lives is incredibly rewarding, and it never gets old.
What would you say to someone considering this type of work?
To me, the best teachers that I’ve known and worked with take a service-oriented approach to education—providing what the student needs to progress to the next level, to continue growth. This takes good observation skills, flexibility to change your approach based on where your student is and what his/her needs are, and a willingness to keep learning. The field of education, beyond what we need to know as nurses, continues to evolve and we have to evolve with it.
Is there anything else that is important for nurses to know?
In my early years of teaching, I felt like I needed to know everything—to answer all of my students’ questions on the spot. This expectation of myself produced a lot of anxiety and self-doubt for me.
Over time, I relaxed a bit more and accepted that even if students wanted me to have all the answers, that was not possible 100% of the time. Feeling confident in the knowledge that I had and my ability to research answers that I couldn’t answer right away effectively, enabled me to say that I didn’t know, but would find out or even enlist the support of other students to find the answer. It was a turning point for me. I don’t think I would have been able to sustain a career in education long term with my previous mindset.
Nursing is a stressful job. So when you think that a patient may have been misdiagnosed by another health care worker, it’s important to know exactly what to do—especially if the misdiagnosis could cause permanent harm or death. It’s important to protect your patients as well as yourself.
Jennifer Flynn, CPHRM, risk manager for Nurses Service Organization (NSO), took time to answer in detail what nurses need to do when they suspect a patient is not receiving the care they need.
What should a nurse do if s/he thinks that a patient is not receiving the care they need from another health care worker? What are the specific steps that s/he needs to take? Are these steps different depending on the procedures of the facility?
Every day, nurses are challenged to provide patients with the safest and most effective care possible. Many factors can affect clinical performance. For example, being sleep deprived, running late, being assigned to more patients than usual, or experiencing a breakdown in communication with other providers can influence a nurse’s ability to provide safe patient care.
According to the 2015 NSO/CNA Nurse Professional Liability Exposures Claim Report, failure to invoke the chain of command was identified as a common allegation. Nurses are responsible for invoking the medical chain of command when necessary, in order to trigger a practitioner’s intervention for the patient. Closed claims involving the failure to invoke or utilize the chain of command accounted for 7.5% of the treatment and care closed claims, and reflect a higher average payment as compared to all claims in the report.
Nurses must be comfortable with utilizing the medical chain of command whenever a practitioner does not respond to calls for assistance, fails to appreciate the seriousness of a situation, or neglects to initiate an appropriate intervention.
Consider this scenario: a nurse failed to initiate the chain of command when the practitioner would not respond to her concerns of identified non-reassuring fetal distress. The nurse called the practitioner several times to give an update on the patient’s condition, which continued to deteriorate. Each time the nurse requested that the practitioner come see the patient, the practitioner said it didn’t seem necessary. As a result, the infant suffered birth-related brain injury, requiring lifelong care. The nurse was named in the malpractice lawsuit alleging failure to invoke the chain of command and failure to report changes in the patient’s medical condition. While the nurse had documented making the phone calls to the practitioner, the nurse neglected to include what was told to the practitioner and the practitioner’s response.
Nurses know that treatment and care of every patient starts with timely attention to their needs and persisting to the point of resolution. However, nurses may feel apprehensive about chain of command issues. Fear of disciplinary actions, loss of their jobs, or being labeled as a “troublemaker” are other concerns.
The following strategies can help reduce apprehension regarding chain-of-command issues:
- Proactively address communication issues between nursing and medical staffs, and identify instances of intimidation, bullying, retaliation, or other deterrents to invoking the chain of command.
- Notify leadership of individuals or areas that prevent nursing staff from invoking the chain of command or impose punitive actions for doing so.
- If the organization’s current culture does not support invoking the chain of command, explain the risks posed to patients, staff, practitioners, and the organization, and initiate discussions regarding the need for a shift in organizational culture.
Are nurses usually taught this in nursing school? What should they know about speaking up?
Education in this matter is an ongoing effort. It starts in nursing school, but it must be continuously addressed, communicated, and supported for it to become part of practice.
The first step in protecting yourself from legal action is to know and understand your facility’s policy and procedures on invoking the chain of command to resolve concerns about patient care. In many facilities, policy and procedures manuals are readily accessible. If no chain-of-command policy or procedures exist, find out who in your facility is responsible to do so.
Don’t hesitate to call the appropriate practitioner when there’s a change in your patient’s condition. Most facilities have policies that require this. However, some nurses may feel intimidated by appearing to question a practitioner’s management of a patient.
Express clearly what, if any, action you would like the practitioner to take. If you think your patient needs to be seen, say so. After the conversation, document exactly what you told the practitioner about the patient’s condition.
If you believe the practitioner isn’t taking your concerns seriously, go to the next person in the chain. If necessary, go up your facility’s chain of command until the concern has been addressed. As you contact different staff members in the chain of command, be sure to make a note in the patient’s chart.
By invoking the chain of command, not only do nurses fulfill their obligations as patient advocate, but they protect themselves from liability.
What should nurses not do if they think their patients aren’t getting the care they need?
Advocating for a patient may not always be easy, but it is part of a nurse’s responsibility. Advocacy includes the duty to invoke both the nursing and medical staff chains of command to ensure timely attention to the needs of every patient, and persisting to the point of satisfactory resolution. Not following the chain of command puts the patient’s safety at risk and exposes nurses to the potential of a malpractice lawsuit.
Document each of the steps taken, and the reasons they were taken, to advocate for the patient’s care. Refrain from speculative or subjective comments, including ones regarding colleagues and other members of the patient care team.
Can a nurse get in trouble for reporting something like this? How should they approach this so that they do what is most professional?
To be an effective advocate, nurses first need to understand the laws and regulations governing their practice. Nurses who understand their scope of practice, state practice act, and facility policy and procedure are best able to use established processes to advocate effectively for their patients while protecting themselves from retaliation and litigation.
Effective communication is key. One technique available to nurses is SBAR, which is an acronym for Situation, Background, Assessment, Recommendation. This communication style can be used to facilitate prompt and appropriate communication. It is a way for nurses to communicate effectively with one another, and between the health care team. It allows for important information to be transferred accurately.
Allegations of malpractice can result from miscommunication or lack of communication between practitioners and nurses. By carefully documenting the information about the patient shared with other members of the patient’s care team, nurses can significantly reduce communication-related risks.
By enhancing their communication skills, nurses can minimize the risk of claims. Some communication strategies include:
- Clearly articulate your concerns so that others are able to respond.
- Consider what information to share, when to share it, and with whom it should be shared.
- Ensure communication among caregivers is professional and respectful.
- Carefully and timely communicate patient assessments and observations to other members of the health care team.
- Read back or repeat verbal orders to the practitioner who issued them to verify accuracy and understanding.
Nurses can ask to become more involved in developing and influencing facility policy around advocacy and communication. Nurse leaders, health care administrators, and organizations can change the culture of retaliation and blame, which tends to point fingers instead of recognizing issues and problem solving.
Does your mind easily wander? Do you find yourself performing tasks at work without much thought? Research shows that people spend almost half of their waking hours thinking about something other than what they’re doing, which weakens their performance, creativity, and well-being, according to Harvard researchers.
If this behavior describes your mindset, you belong to a club where membership only requires habitual ways of thinking, doing, and feeling. The bad news? It’s not a great place to be. Mindfulness – with all its benefits – is where you want to head.
Mindfulness, which means being focused in the present moment, can strengthen your job performance as well as your mind, body, and spirit. Mindfulness engages your senses to allow you to participate fully in daily tasks.
So how do you achieve it? Here are six steps to practice moment-to-moment awareness at work.
1. Reflect and plan.
Start the workday by focusing on your organization’s purpose and how you contribute to it by being present and engaged. End each day by preparing for the next to help avoid anxiety or procrastination.
Slow down. Set aside five minutes daily to breathe. For a minute or two, breathe deeply. Focus only on inhaling and exhaling. Consider adding a few minutes of stretching, which allows more oxygen into your body and encourages blood flow.
3. Walk more.
Concentrate on the sights, smells, and sounds that accompany your movement. If you can, spend a few minutes walking outside to observe nature.
4. Feel thankful.
Once a day, take a few minutes to think about an accomplishment or something else that fills you with gratitude. Practice finding joy as doing so you can change the direction of your day.
5. Enjoy your meal.
This sounds simple, but how often do you think about what you consume? Try to taste each ingredient or observe how thoroughly you chew. Pay attention to your food and how it makes you feel.
6. Breathe when there’s a ring or ping.
Instead of instantly reaching for a ringing phone or pinging computer, take several breaths before responding. Emails and calls raise stress levels, research shows. It’s important to pause and calm down before reacting.
Mindfulness is the antidote to multitasking and possible burnout. With practice, you can build your mental muscles to keep your mind from wandering and engage in what’s happening right now. That’s a win for you in and out of the workplace.
The government of Jamaica has asked the United States health sector to cease the poaching of its nurses. “Jamaica Says to Stop Poaching Our Nurses” was a report on National Public Radio earlier this year based on an interview with Mr. James Moss-Solomon, the chairman of the University Hospital of the West Indies in Kingston. He likened the situation to a crisis.
The exodus has forced Jamaican hospitals to reschedule some complex surgeries because of a lack of nursing staff on their floors, according to the report. Moss-Solomon says the United States, Canada, and the United Kingdom are, in his words, “poaching” Jamaica’s most critical nurses. “Specialist nurses is the problem. We have tons of regular nurses,” he told NPR. He was talking about nurses trained to work in such settings as intensive care units, oncology, infectious disease, operating rooms, and emergency rooms. They are the ones being lured away and their English language skills heighten their appeal. “We do very well training our specialist nurses here at a fraction of the cost of what it costs you in the United States or Canada or the UK; so, the issue is an economic one for us,” he explains.
In February, as part of the Jamaica Medical Mission, I discussed this issue with Althea Davis, RN, MHA, as I sat with her in a church hall in the city of Port Maria. For 27 years the mission has served the people of Jamaica under the auspices of the St. James Episcopal Church of Leesburg, Florida. The 55 members of the team represented physicians, dentists, hygienists, optometrists, pharmacists, nurses, physician assistants, and support staff. They came from Los Angeles, Ottawa, New York, San Francisco, Maryland, and Florida.
The team brought state-of-the-art health care to the people of that region for eight days and with tremendous energy and dedication delivered competent care to over 1,700 patients, who for the last 5 years have had their medical records computerized and accessible when the team visits.
Davis, a supervisory public health nurse, serves four health districts. “The nurses are expected to provide service in every aspect of care and are held to a very high standard. In the case of the public health nurse, the Jamaican nurses rank among the best worldwide,” she says.
According to Davis, the training model that Jamaica has followed came out of work done back in the 1970’s and is continuously updated. Over time, specialists have been added in areas such as nutrition, health promotion, information technology, and electronic records management, which is intended to provide a more robust care delivery system and improve patient satisfaction. “Because of training provided, we were well prepared to deal with the Ebola outbreak, and the highly contagious Chikungunya virus,” says Davis.
However, Davis quickly hastened to add that the problem facing the nursing sector is that the profession is “under resourced.”
Davis’ conclusion is an echo of Moss-Solomon’s. The skilled staff are stretched. The referral process for advanced treatment that cannot be handled at the nurses’ level is inadequate at best and unavailable at worst. “It is not just the compensation that influences nurses to leave the island,” Davis says. “It’s also the sense that nurses are not accorded the appreciation for what they do even by health care agencies.”
According to the World Bank, “these shortages have tangible impacts that may compromise the ability of English-speaking [Caribbean] countries to meet their key health care service needs, especially in the areas of disease prevention and care. In addition, the shortage of highly trained nurses reduces the capacity of countries to offer quality health care at a time when Caribbean countries aim to attract businesses, visitors and retirees as an important pillar of growth,” the report states.
In Jamaica, about three out of every four nurses trained have migrated to developed countries. But the Jamaican experience is not unique. In the case of the UK, a recent report by the Royal College of Nursing stated that the nursing workforce has moved from a situation of “net inflow of nurses to a position of net outflow in recent years.” This means that more nurses are moving abroad than are coming to the UK to practice. The main destinations are Australia, Canada, New Zealand, and the United States.
The NPR program stated that Jamaica has been offering free training for nurses to get advanced degrees. The nurses agree to work for three or four years in Jamaica in exchange for the heavily-subsidized education. “But U.S. recruiters,” says Moss-Solomon, “simply pay the fine for contract violation and the nurses fly off to lucrative jobs in the U.S.”
Jamaica’s response to these losses? They are bringing 25 nurses from Cuba to help staff some floors and have plans to recruit nurses from India and the Philippines and have recruited nurses from as far away as Burma/Myanmar.
Increased international recruitment of nurses requires that several policy issues be explicitly addressed. The international debate over the responsibilities of recruiting nations toward countries whose nurses are being recruited, many of which are developing countries, necessitates provision of ethical recruitment guidelines and codes of practice inclusive of possible financial compensation for sending countries in the face of a global nurse shortage.
All nursing jobs have instances of stressful situations in them. It’s the nature of the field. But working at a Shock Trauma Center can be even more so.
Rashidah B. Francisco, BSN, RN, CCRN, CPAN, TCRN, with the Lung Rescue Unit at the University of Maryland R Adams Cowley Shock Trauma Center (STC), took some time to answer our questions about her amazing job.
What follows is an edited version of our Q&A:
As a Shock Trauma Nurse, what does your job entail? What do you do on a daily basis?
On the Lung Rescue Unit, our shifts are extremely unpredictable. Taking care of some of the sickest patients in the state of Maryland—and possibly the world—at the only Primary Adult Resource Center is something that demands skill, dedication, communication, and a sense of teamwork like no other.
Our exclusive Veno-Veno extracorporeal membrane oxygenation (VV ECMO) unit at Shock Trauma is one of the only units of its kind in the country. Our patient population on this unit consists of patients in need of a machine that bypasses their lungs to deliver 100% oxygen to the patient’s blood, as their lungs are incapable of this function. Having the critical care skills, knowledge, and critical thinking to recognize when your patient is in trouble is half the battle of managing this patient population.
Our patients are suffering from acute illnesses and come to us at the most critical moment in their lives. Because of this, we have little time to think, but must come together as a team and put our skills and expertise to work. The interventions for our VV ECMO patients can also be very different from your typical ICU patients, but are directly in line with evidence-based practices. We may prone our ECMO patients, walk them, and get them out of bed daily and into a chair to optimize their recovery.
Why did you choose to work at Shock Trauma? How long have you worked there? What prepared you to be able to work in such a stressful environment?
Coming to Shock Trauma was not my initial plan, but critical care has always been a dream of mine. I have been in the nursing profession for almost 20 years (three as a patient care technician, 11 as an LPN, and seven as an RN). After going through a critical care fellowship at a large hospital in Virginia, and spending a couple of years on their complex critical care unit, I felt that I was ready for something bigger and more challenging. I wanted something that would enhance my skills, and push me to go further in bettering myself and my career.
When asking myself where I could go to be a part of the best, where only the best is expected of me, and where my skills and education would be the only determining factor in how far I can go in my career, I chose Shock Trauma. I have been at STC for over 4 years, and there is not one day that I have not been pleased with my career choice.
How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?
Gratefulness and self-reflection helps me to de-stress. Reflecting with my team and relying on them while I am at STC helps me to keep things into perspective.
What are the biggest challenges of your job?
The biggest challenge of my job is knowing that I cannot save everybody—that everyone’s story is not to be taken on as my burden, but it is my duty to do the best that I can. Knowing that I am human, and I can only do so much. Remembering that I am here by choice, and that some of my patients, no matter what choices they have made, are there because they have to be, and are depending on me to utilize my skills to help them in their most critical hour. Remembering that it could be me lying in the bed, and them taking care of me.
What are the greatest rewards?
Seeing a patient get off of ECMO and return home or go to one of our critical care units. Just seeing that they have reached a point where they are able to evade such a lifesaving piece of equipment is a reward. Hearing a patient’s voice after they have been extubated. Seeing them walk after being in the prone position intermittently for days. Hearing that a patient who has been waiting months for lungs has finally gotten them.
Being a part of a team—that these things are just as important to them as they are to me—is also a reward in itself. To have someone who is going through the struggle with you and cares as much as you do.
What would you say to someone considering this type of work? What kind of training or background should he or she get?
No matter what your background, come with a sense of teamwork, with a sense of family, and with the ability to take on the most challenging situations, but with the humblest attitudes. Be ready to learn, no matter what you think you know. At STC, you will see and learn things beyond what you even thought. Have a strong critical care background for some of our units, but if not, have an open mind and a willingness to learn. Be ready to see and care for people who are very different from what you may have experienced, but be ready to save them, and care for them as if they are one of your family members.
Is there anything else that is important for fellow nurses to know?
Wearing the pink uniform is something that for the last four years I have been very proud of. It is to me like putting an “S” on my chest when getting ready for my shift. However, it is something that comes with a heavy responsibility and a possession of skills that I am expected to have and use when I walk through the doors of STC. My days are not blissful, my days are not easy, but they have been more rewarding at STC than they have my entire nursing career.