With dozens and dozens of nursing specialties, some nurses take varied paths to end up in the specialty that is the best fit. Many try different health care situations or medical training before deciding that one area of nursing is the career where they will make the impact they want and will satisfy their professional goals.
Jose M. Maria, MS, FNP, RN, CEN, director of emergency services at Brookdale Hospital and Medical Center in Brooklyn, New York, says he came to emergency nursing after gaining training and experience as an EMT and paramedic. “Emergency medicine was the next logical choice in starting my nursing career,” he says. “I haven’t looked back since.”
Maria, a native of the Dominican Republic, says his specific EMS experience really gave him a solid foundation to know what he wanted and provided him with the essential capability for any emergency nurse. “It allowed me to develop the skills to adapt to any situation while keeping a cool head,” he says.
But emergency nurses also benefit from having more than a cool head and a great skill set, says Maria. The flexibility to move from one situation to another one that is entirely different is essential for a successful emergency nurse. And then there’s the part where you work your tail off. An emergency nurse who doesn’t complain about the task (or 20 tasks) at hand and does what’s needed will have a much easier time working in such a fast-paced environment.
And when it’s time to transition a patient to inpatient nurses, challenges remain. In fact, Maria says that transition point is one of the most challenging aspects of emergency nursing. “This is a common challenge at every organization I have been a part of,” he says.
Preparation and planning, as with any part of the emergency nurse’s job, can help. And finding out how other nurses work also helps inform your own practice. “I try to stay current in practice and use resources like ENA CONNECT and to speak with colleagues across the states,” says Maria. “Like many professions, preparation is key for success in the emergency department.”
But with those skills and responsibilities, emergency department nurses encounter a lot of critical and crisis situations to adapt to. For Maria, those situations reveal why he does what he does. “The most satisfying and most important part of my job is to save lives,” he says. “It’s a powerful and overwhelming feeling to have brought someone back from death and see them walking out of the hospital.”
Anyone considering emergency nursing as a career path can follow Maria’s advice to rotate through other specialties before deciding on the ED. Each area offers you a new set of experiences and training that will be useful in the emergency department.
“Because we see a wide range of complaints, we can actually help our patients,” he says. “Working in psychiatry for example, helps you build conflict resolutions skills, improve communication techniques, and builds patience needed in the acute psychiatric emergency. Working in the ICU, with their attention to detail, improves your documentation. Working on a medicine floor helps in time management skills. Working a surgical unit, improves your teaching techniques with patients.”
And while the emergency department is intense and fast, emergency nurses do find a way to offer each other the kind of support and camaraderie that is distinct. Their humor might even be considered dark, says Maria.
“People have a hard time understanding that even in the darkest of times, humor helps us deal with our internal anxiety about the cases we work,” he says.
This week, the American Association of Nurse Practitioners is highlighting all the work nurse practitioners (NPs) do with National Nurse Practitioner Week.
The week kicks off today and runs through November 18 and honors the work NPs do both on the job and as ambassadors for the nursing profession.
Minority Nurse caught up with Dr. Scharmaine L. Baker, FNP, FAANP, FAAN, CEO at Advanced Clinical Consultants, to talk about the role of a nurse practitioner. After Hurricane Katrina, Baker’s New Orleans patient caseload swelled from 100 to 500 in three months. With a critical shortage of health care facilities and providers, Baker’s skills as an NP not only saved her patients, but also clearly showed how invaluable her thorough NP training is.
National Nurse Practitioner Week, says Baker, is a way to give nurse practitioners the recognition they often don’t receive. “National Nurse Practitioner Week gives us the positive spotlight that we deserve,” she says.
This kind of national attention to the nurse practitioner’s work shows the devotion nurses have to caring for a patient, and also helps clear up any misunderstandings about the role and how an NP works within a health care team. “Nurse practitioners don’t just prescribe a medicine and send you out of the door,” says Baker. “We take the time to listen to the patient stories about their children, spouses, pets, and job promotions. These stories often solve the complicated puzzle of making an accurate diagnosis. It’s called holistic care of the total man.”
When prospective nursing students are deciding on a career path, Baker urges them to consider a few things. Top in their minds should be the honest assessment of their commitment to making this career decision. Taking the time to complete the challenging NP studies isn’t easy, she says. “Once they have decided that this is indeed the right time to pursue an Advanced Practice Nursing degree,” she adds, “then the necessary preparations as far as letting family and friends know that they will be somewhat unavailable for the next three to four years because the schooling demands all of your time for successful completion.”
But when the degree completion and training are done, the potential for a lifelong career that challenges you, uses all your skills, and lets you connect with and help people is gratifying on many levels. As a nurse practitioner, you’ll be diagnosing, assessing, and treating medical conditions. You’ll also look at the whole patient. NPs take into account the interplay between a patient’s physical and emotional well-being as well as the environment they live in. By doing so, they can help treat every part of a patient’s condition.
“I get to hear the stories that make my patients happy or sad,” says Baker. “Then, I get to connect those stories to their physical state. They are always related. I enjoy providing health care on this advanced level. I get to take care of the whole patient.”
Baker also points out that while NPs continue to earn recognition and some states are allowing them to practice on their own, there is still work to be done. “The most challenging and frustrating part of advanced practice nursing is the many restrictive laws that prevent us from practicing to the full extent of our scope,” she says. “It’s downright ridiculous! I long for the day when all states will actively have full practice authority.”
Currently, nearly two dozen states allow nurses to have full practice authority where they practice without physician oversight. Baker continues to advocate for full practice authority among all nurse practitioners. She also urges NPs and the nursing profession to continue to honor the nurses who worked so hard to get all nurses where they are today.
“Many have fought for us to be where we are,” says Baker. “Every time we show up and provide stellar care, we make our founding nurses beam with joy. We must never forget their sacrifices.”
Celebrate National Nurse Practitioner Week this week and spread the word about these highly skilled professionals. Use #NPWeek to share photos and tags on your social media posts to help others see just what satisfaction a career as an NP can bring.
Every nurse will experience that first day on the job and all the emotions that go with it. “This has happened to me a dozen times since I graduated from my nursing school. The first day on a job is the most memorable experience in my life,” says Mary Wiske, a retired community health nurse who has experienced several first days at jobs throughout her 25-year nursing career.
No matter whether you’re a new graduate or an experienced nurse, the first day at a new job or new location can be exciting, stressful, or overwhelming. There is so much to learn in addition to the duties or responsibility related to the job. If you are a new graduate, congratulations on your first job! This is your chance to begin your career in health care.
Here are four steps that will help you prepare for your first day.
1. Learn all you can about your new employer.
Read through any contracts, induction packs, or emails you have received. These will have important information about your employment, responsibilities, and what you may need to bring with you when you start. When you are familiar with your job description, you will be able to work more safely and efficiently.
2. Plan the route you will take to work as well as some alternate routes.
Find a map, get directions. Incorporate contingency time for bad traffic, public transport delays, or getting lost. If you are driving, remember to find out where you can park.
3. Get yourself ready – pens, a notebook, and a high-quality stethoscope.
Look for comfortable and durable scrubs that make you look professional. You should also plan to wear comfortable shoes that offer strong arch support and a roomy toe box, in addition to heels that do not pinch or slip and a no-slip sole.
4. Take care of yourself.
Be calm and relax. Remember to go to bed early the night before and have breakfast before you go to work. Give yourself plenty of time to get to work so you do not show up late.
Finally, you are here–the first day on the job. It is normal to feel nervous or excited. It is wise to remain calm and carry yourself with confidence; that is the key to this. Keep a positive attitude and an open mind. Remember to take an active role in your orientation and do not be afraid to ask questions. Make an effort to learn new things and learn how to do something a new way. All you can do is try your best and do your job the best way you know how.
Emergency Nurses Week kicks off today and offers a reflection of the lifesaving efforts and skill of emergency nurses who are called on to deal with catastrophic conditions, both natural and human-created, with little or no notice.
Karen Wiley MSN, RN, CEN, and president of the Emergency Nurses Association, says recent events highlight the unpredictability of the job and the exceptional need for emergency nurses.
“I am most proud of the way our nurses have come together in the past several weeks,” she says. “With the devastation from multiple hurricanes and the unconscionable event in Las Vegas, we have seen countless acts of sacrifice, selflessness, and dedication in emergency care from our nurses. I am proud of my colleagues every day, but the effort I have seen through these tragedies is truly remarkable.”
Wiley says emergency nursing is a complex role that involves treating the physical reasons for the visit, but also careful and expert communication with the team and the patient, families, and loved ones. “Most people do not realize the diversity of work emergency nurses must perform besides treating physical injuries,” she says. “Patients enter emergency departments struggling with addiction, mental health issues, as victims of sex trafficking, and, all too often, are violent themselves.”
If nurses are considering moving into emergency nursing or are wondering if the path would be right for them, Wiley says it helps to consider the range of what nurses encounter on a given day. “Thinking quickly on your feet is an essential skill for emergency nurses,” she says. “Situations change in a moment in the emergency department and nurses must react effectively.”
In the midst of an environment where many things are happening simultaneously, emergency nurses are still in charge of the patient’s comprehensive needs. “Emergency nurses must keep patient advocacy foremost at all times,” says Wiley. “The care, safety, support, and education of patients is our primary focus and dominant concern during a shift in an emergency department.”
Because they will take care of patients with many different conditions and situations, emergency nurses have to stay current on the latest medical information, so they have to be willing and able to constantly reeducate themselves about new developments, treatments, and methodologies. Emergency nurses continuously hone their craft, says Wiley, and that means being able to multitask effectively, efficiently, and accurately in a high-stress situation.
Emergency nursing is physically taxing, but it can also be an emotional challenge as well. Because of the very nature of an emergency room, patients don’t always survive despite the heroic efforts to save them. “Emergency nurses need to be prepared for the death of patients while not letting emotions affect their care,” says Wiley. Many hospitals have supports for their emergency room teams, especially after a trauma event, but the day-to-day exposure to death is something emergency nurses must cope with for their own job performance and their own mental health.
In addition to the challenges of treating so many physical and mental health issues, emergency nurses have to be able to quickly decipher and assess patients’ needs and conditions. “Choosing which patients need the most immediate care is challenging because the number of factors that need to be taken into consideration,” says Wiley.
For some nurses, the emergency room is where they perform best. And the ability to make such deep connections during that time is powerful. “Caring for patients who are in the most vulnerable state of their lives is an absolute privilege and an honor,” says Wiley. “The ability to comfort the patients and their loved ones when they need it most is humbling.”
One of the many specialties in the nursing filed is nephrology—working with kidney patients.
Shamekia Gullatte, RN, BSN, CPN, the Lead Post Kidney/Pancreas Transplant Coordinator at the University of Alabama at Birmingham, has served as a nurse with many different kidney patient populations, including working as a dialysis nurse, a pediatric nephrology nurse, and currently as a transplant coordinator.
What follows is an edited version of our communication.
As a nephrology nurse, what does your job entail? What do you do on a daily basis?
My current job entails educating and managing care of kidney transplant recipients. After working nine years in an outpatient pediatric nephrology setting, I decided two years ago that I want to care for patients who overcame chronic kidney disease and received a transplant. As a kidney transplant coordinator, I meet with newly transplanted patients while they are still in the hospital and provide education about their care. After the patient leaves the hospital, I continue to be a resource for the patient in the outpatient setting.
Why did you choose to work in nephrology? How long have your worked in the field? What prepared you to work in this kind of environment?
As a dialysis nurse, my first professional nephrology position, I became passionate about the disease processes in this patient population. Over the last 13 years, I have worked in various areas of nephrology. I was prepared to work in this environment because I worked 12 combined years as a dialysis nurse and pediatric nephrology nurse caring for children with chronic and acute kidney disease.
My parents laid the foundation for me to be a compassionate person and appreciate every aspect of life, which really are essential attributes of a nephrology nurse. Then I was awarded an excellent education at the prestigious Tuskegee University, where I obtained by Bachelors of Science in Nursing.
What are the biggest challenges of your job?
One of the biggest challenges of my job involves the lack of resources for patients. Some of our patients have limited financial resources and may have difficulties paying medications and sometimes have transportation issues. Although this is a challenge, UAB Transplant has a multidisciplinary team that includes amazing social workers who assist patients with these obstacles.
What are the greatest rewards?
The greatest reward in being a nephrology nurse in transplant is walking into a patient’s room to educate them on their new organ and saying, “Congratulations!” I certainly understand that some patients may have had a tough journey. For example, I can remember when one of my patients told me her story of when she was diagnosed with a rare disease, and she was getting prepared for transplant. This patient had been struggling from dialysis complications. Just to listen to her story leading up to kidney transplant was definitely a tear jerker, but now I was sharing a moment with her that she thought would never come.
I know that I was meant to be a nephrology nurse at UAB Hospital in post-transplant because I get this flutter of joy in my heart and soul every time I receive a new patient.
What would you say to someone considering this type of nursing work? What kind of training or background should s/he get?
To become a nephrology nurse, one would have to earn a degree in nursing and gain clinical experience in nephrology. To become a transplant coordinator at UAB, you have to get all of the above, but also have that little flutter of joy in your heart and soul when a patient receives a kidney transplant. UAB has performed more kidney transplants than any other transplant program in the nation since 1987, and we all take great pride in the care we provide our patients.
Being a nephrology nurse really takes more than just credentials. You have to be a person who is truly compassionate about your patient population, and someone who has a real love and desire for them. I love my patients, and appreciate the opportunity I have to care for them every day.
Ethical challenges, such as professional-personal boundary conflicts, end-of-life decision-making, and maintaining patient privacy and confidentiality, occur in everyday nursing practice. New graduate nurses and those with less experience tend to face these challenges more frequently.
Regardless of where they practice, nurses are always faced with ethical challenges, and they can impact nurses’ day-to-day practice and patient care outcomes. Therefore, it is important that every nurse has knowledge and strategies to manage these challenges appropriately. Here are some tips to guide you:
- Understand the Code of Ethics for Nurses and be able to address and apply them effectively. The Code of Ethics for Nurses, developed and released by the American Nurses Association (ANA), is an important document that can provide direction and guidance for nurse’s day-to-day decisions and actions.
- Be familiar with the hospital/organizational values.
- Identify and use the ethics resources available within your organization, such as the hospital ethics committee, for consultation.
- Consult with others, such as the head/manager of nursing or supervisor, when a complex ethical situation arises.
- Talk with your patient and his or her family to gain perspective or an understanding of their choices.
- Be aware of the effectiveness of nursing interventions and activities – and standards of practice.
- Stay up-to-date with policy changes in your hospital/organization.
- Engage with the hospital ethics committee and attend the meetings when time permits.
- Collaborate and network with professional organizations/associations to gain more insight and understanding of various emerging ethical issues.
- Read nursing ethics articles to gain knowledge and ethics perspective.
- Take ethics education or training to increase ethical competence.
Not only are ethical challenges time-consuming and stressful, but also they can potentially negatively impact the patient’s quality of care and the nursing professional’s role. Managing these challenges will require ethical knowledge, work experience, and personal commitment to do what is right. Continuing ethics education is of the utmost importance to help nurses suitably manage these challenges, providing tools and skills necessary for their ethical decision-making and competence.