Professional nursing in the Middle Eastern nation of Oman has grown rapidly since the country’s 1970 modernization of its health care system. In fact, over the last 10 years nursing has become one of the fastest-growing professions in the country. Previously, nursing education was primarily vocational training, but since 1990 nurses must earn a diploma to practice as an RN. Despite many recent efforts to improve nursing education and practice, the profession is still attempting to catch up with nursing practices in the United States and other nations.
Oman is currently struggling with a rapidly growing population, rapid expansion of health care services and severe shortages of well-trained nurses to meet the demands. The Ministry of Health has made great strides by supporting nurses’ educational preparation, establishing and funding educational institutions and offering free education to individuals who choose nursing as a profession.
The Sultanate of Oman is located in the Persian Gulf region, bordered by the United Arab Emirates and Saudi Arabia on the west and by the Republic of Yemen on the south. It is divided into four governorates (country subdivisions) and eight administrative regions. About 82% of the country consists of sandy desert and rugged mountains with small agricultural areas. Muscat City, inhabited by more than 600,000 people, is the capital and the center of political, economic and commercial affairs. Nizwa, Salalah, Sohar and Sur are other large cities. Oil is the main source of the country’s income, followed by industry and natural gas. According to the 2004 national census, Oman’s total population was 2.57 million, with 33.3% of the population under 15 years old and only 2.2% aged 65 and older. Life expectancy is 74.3 years.
Oman is an Islamic Arabic country that developed its own branch of Islam, called Ibadhism. It is the only country in the Islamic world with a majority Ibadhi population. There are no major variations in the Muhammadan law between Ibadhism and other branches of Islam, such as Shia and Sunni. However, Ibadhism is known for its moderate conservatism and its choice of ruler by communal consensus.2 Although other branches of Islam exist in Oman, there is a unity in the society between all branches, and the country is known for its tradition of religious broadmindedness.3 In addition to the largely Muslim population, there is also a minority of expatriate non-Muslim groups, primarily Christians and Hindus.
Religion and culture play important roles in Oman’s health care practices, regulations and professional roles. Most hospital treatment areas are divided into male and female sections. In outpatient facilities, male patients are treated in the men’s allocated areas and female patients are treated in a different designated area. Inpatient care is similar, with male and female patients admitted into separate wards. However, exceptions sometimes occur in areas such as adult intensive care, coronary care and dialysis units.
Oman’s Health Care Renaissance
Before 1970, Oman’s health care system was one of the poorest in the world. The mortality rate was high, especially among infants and children, with infant deaths estimated at 159 per 1,000 live births.4 Many people suffered from infectious and communicable diseases due to lack of health care services, inappropriate treatment and poor sanitation. Malaria, mumps, trachoma, diphtheria, neonatal tetanus, polio, gastroenteritis and diarrhea were among the most common diseases at that time.5
In July 1970, Oman’s ruler, Sultan Qaboos bin Said, began to take steps to relieve his people’s suffering by seeking to establish an excellent health care system. He issued a royal decree to create the Ministry of Health (MoH), which was charged with the responsibility of providing high-quality health care to all Omani citizens. In the years that followed, the MoH established hospitals and health centers across the country and brought modernization into all health care professions.6
As a result, in less than four decades health care services in Oman have expanded throughout all regions of the country, greatly increasing people’s access to care. In addition, the MoH has initiated many public health programs, including a national birth spacing program and health education programs. Since the ministry’s Expanded Immunization Program (EPI) was introduced in 1981, diphtheria, neonatal tetanus and polio have been eradicated.
Oman has a government-funded National Health Service that includes general and speciality hospitals. The MoH is the main health care provider, followed by the Ministry of Defense and the Sultan Qaboos University Hospital (SQUH). According to the 2005 World Health Organization census, the country has 17 physicians per 10,000 population and the proportion of nursing and midwifery professionals is 37 per 10,000 population. Today, nearly 100% of the total Omani population has access to health services, depending on where they live.7
Currently, Oman has 58 hospitals, which are classified as primary, secondary, tertiary or referral. Combined, these hospitals contain 5,270 inpatient beds, which equates to 21 beds per 10,000 population. Fifty-four hospitals are government-supported and provide free health care services for Omani citizens and for foreign nurses working in the governmental sectors. Fee-for-service care is common for foreign workers in the private sector. Royal, University, Sultan Qaboos, Khoula, Al Nahda, Nezwa and Sohar are the largest tertiary teaching hospitals in the country. Royal Hospital is Oman’s largest health care institution, with about 700 beds and continued expansion to incorporate new facilities.
Other tertiary hospitals have inpatient capacity that ranges from 200 to 532 beds. Khoula Hospital is the Sultanate’s central referral hospital for orthopedic, neurological, cosmetic surgery and burn care. Al Nahda Hospital is the main specialty treatment center for ear, nose and throat surgery, eye care, dental and jaw surgery and skin diseases. Royal Hospital is the referral hospital for heart disease, heart surgery and cancer.7
The tertiary hospitals serve as specialty centers, receiving patients from primary and secondary health care services, emergency patients and patients referred from other hospitals for medical management. The secondary hospitals provide primary and secondary health care services with some specialty care, such as gynecology and orthopedic care. Primary care hospitals provide general health services and refer patients to facilities with higher levels of care when specialized treatment is needed.
In addition to the hospitals, there are 897 health centers, dispensaries and clinics spread across the country. These facilities provide primary health care services with a few specialized care units. Health centers, which are usually located in low-populated areas, are staffed by general practice physicians and nurses, who provide services such as vaccinations and pre- and post-natal care.
History of Nursing in Oman
Nursing in Oman is widely recognized as an admirable, caring profession. For centuries, nursing was practiced by untrained household women who used natural remedies to treat the sick and assist with the delivery of babies. In 1904, the first missionary nurses from America arrived in Oman to work in an organized health center. In the 1950s, a small group of U.S. nurses serving in the American Missionary Association in Muscat began training Omani nationals to become nurses. This marked the beginning of modern nursing in Oman.
At that time, the capital city had only two small hospitals to meet the health care needs of the entire population. The American nurses joined the staffs of the two hospitals and in 1959, a six-to-nine-month training program was established at Al Rahma Hospital for 16 Omani nurse trainees. That training center continued to educate nurses until 1970, when the American Missionary Association established a two-year nursing program, Al Rahma School of Nursing, in Muttrah.7
Oman’s modernization opened a gateway for the nursing profession. In 1972, Al Rahma School of Nursing was taken over by the Ministry of Health. The MoH increased the number of nurse trainees at the school and upgraded it to a three-and-a-half-year program offering a certificate in nursing. In 1980, the Directorate of Nursing was established at the MoH headquarters, an official acknowledgement that professional nursing was now seen as a vital aspect of health care.
From the beginning, the Sultanate’s ambitious plans to improve and expand health care services have been hindered by an insufficient supply of nurses, nursing education programs and nursing educators. Therefore, the MoH began recruiting nurses from abroad. Until very recently, most nursing jobs in Oman were held by foreign nurses, primarily from India, the Philippines and Sri Lanka.
For the last 15 years the Sultanate has been working to Omanize the nursing profession by increasing the number of homegrown nurses and nursing schools. In 1998 Oman had 7,453 nurses, of which less than a quarter (24%) were Omani. By 2006, however, the total number of nurses serving in the MoH had grown to 8,278 and 63% of them were Omani. In addition, the nurse-to-population ratio has risen from 32.6 nurses per 10,000 population in 1998 to 37 nurses per 10,000 by 2005. However, despite ongoing efforts to increase the numbers of both national and foreign nurses, Oman’s health care services still have a 30% shortage in nursing staff.
Nursing Education
At the present time, Oman has 12 basic nursing institutes that offer a three-year diploma program. These institutes operate under the administration of the MoH’s Directorate General of Education and Training. Muscat Nursing Institute (MNI) and Oman Nursing Institute are the largest nursing education programs in the country; each graduates about 100 new nurses a year. The other 10 schools, located in different regions of the country, each produce about 35 new nursing graduates per year.
MNI was the first school to graduate diploma nurses and is considered the heart of nursing education in Oman. MNI assists other institutes with curriculum design and educational resources. To ensure consistent quality of nursing education throughout the country, all nursing schools share an identical curriculum with some minor course plan variations. The Nursing Education Board regulates nursing programs, licenses schools and also helps establish curriculum content.
The country’s first baccalaureate nursing program was launched in 2002. The MoH continues to strive to prepare highly educated nurses and improve the quality of nursing care. Currently, there are two nursing schools in Oman that have BSN programs: Sultan Qabos University (SQU) and Niswa University. In addition to the four-year program, both schools also offer a two-year RN-to-BSN program.
Neither master’s nor doctoral programs in nursing are currently available in Oman, but the MoH and SQU intend to begin offering them soon. In the meantime, Omani nurses who earn BSN degrees are sent abroad to gain a graduate degree. Every two years, the MoH sends a group of 20 nurses to the U.S. to do graduate study at Villanova University in Pennsylvania. The majority of these graduate students major in nursing education and the rest study nursing administration. The education specialties emphasized include adult medical-surgical care, pediatrics, community health, and mental health, depending on the student’s area of interest and the MoH’s faculty needs. After completing their graduate degrees, the students return home to either join nursing institutes as faculty members or work at hospitals as nursing administrators or staff development officers.
The MoH also sends nurses to the United Kingdom and Australia for preparation as advanced practice nurses in specialties such as adult critical care, pediatrics, neonatology, nephrology, midwifery and emergency nursing. Graduates of these programs work as nursing educators and clinical instructors in the Oman Specialized Nursing Institute and teach post-basic nursing courses.
Oman currently has approximately 180 bachelor’s-prepared nurses, about 40 of whom have also completed master’s degrees. Many of these nurses who did their master’s studies abroad say they gained tremendous knowledge and experience from being exposed to education and health care systems in other countries. These growing numbers of nurses with graduate degrees are playing important roles in advancing the nursing profession in Oman. They are introducing new ideas in clinical and educational practice and they’re helping to increase the supply of highly skilled nurses available to meet the nation’s health care needs.
However, there are still not enough nurses with advanced degrees to meet Oman’s urgent demand for more nursing faculty. Because of the severe shortage of nursing educators, about 50% of current faculty positions are held by nurses recruited from other countries, such as Jordan, India, the Philippines and England. These foreign faculty work under temporary contracts with the educational institutions. Even with good pay for nursing educators, the faculty shortage continues to be a challenge. Frequent vacancies resulting from the end of these short-term job contracts, and from resignations of foreign educators who want to return home, exacerbate the problem.
Students’ admission to nursing institutes and university nursing programs is based on secondary school grades, passing an English proficiency exam and admissions interviews in Arabic and English. Each year, the Directorate General of Training and Education sets a predetermined number of slots for male and female applicants. Female students usually account for 80% to 85% of the typical nursing class. In fact, the proportion of female to male nurses in Oman is about seven to one.
This uneven gender distribution in nursing classrooms has created problems for men who are interesting in nursing careers. Although male students want to become nurses, they lack opportunities to enter nursing. The MoH’s justification for favoring female students is that female nurses can generally work in any area of health care, including obstetric and gynecology wards or delivery suites, whereas male nurses are prohibited from employment in some practice areas.
All nursing courses are taught in English by nurse educators prepared at the doctoral, master’s or baccalaureate level. The curriculum is designed to prepare nurses for a variety of roles in hospitals, health centers and community health settings. The coursework addresses content areas that prepare students to practice basic nursing—e.g., adult medical-surgical care, pharmacology, obstetrics/gynecology, pediatrics, community health and psychiatric health. Nursing students also take English language courses, nutrition and other basic science courses. The fall and spring semesters are a blend of theory and practicum experiences, while the summer is extensively practicum with few class meetings.
Licensing, Specialization and Research
Currently, the registered nurse is the only qualified level of nursing practice in Oman. To become an RN, students must graduate from a three-year diploma program or a four-year BSN program. After graduation, they are awarded a licensed RN certificate and are eligible to practice nursing. Nurses who graduate from one of Oman’s nursing education institutions are waived from taking the national licensing exam, because passing the course exams and successfully completing the nursing program are considered measures of clinical performance. However, the licensing exam is mandatory for nurses who graduate from programs outside Oman.
Newly graduated nurses employed in most health care services must work under the direction of a supervisor for six months and complete an internship period before they are allowed to work independently. During the internship, novice nurses are assigned to work with experienced RNs who continue to teach, mentor and perform periodic evaluations. These preceptors have at least five years of nursing experience and have taken some specialized training courses.
Recognizing that continuing education is an important part of maintaining high-quality nursing care, in 1977 the MoH began to establish post-basic training programs—i.e., a two-to-three-year clinical for RNs who have completed a basic nursing program.7 These post-basic programs prepare nurses to specialize in specific practice areas that will improve their performance in clinical settings. The first post-basic specialty program offered was in nephrology. To expand specialized nursing education across the country, the MoH has also initiated a four-month on-the-job training program in which nurses work in teaching hospitals to gain practical experience and theoretical knowledge.
In 2001, the MoH opened the Oman Specialized Nursing Institute (OSNI) in Muscat to increase the supply of nurses with specialized skills. OSNI provides an 18-month program of post-basic speciality courses for nurses across the country and awards certificates in several nursing specialities. These include emergency care, midwifery, mental health, nephrology, nursing administration, adult critical care, neonatal and pediatric critical care. The MoH has also expanded the midwifery program, adding three additional programs to train nurse-midwives in other parts of the country. Selection of nurses for these specialized study programs is based on community health needs, MoH priorities, nurses’ clinical achievements and employer recommendations.
At present, there are no formal nursing research organizations in Oman, but the MoH has several research committees that oversee local studies and surveys. These research projects are conducted by teams of health care professionals, including doctors, nurses and other practitioners. Nurses in Oman generally lack the skills, experience, motivation or financial support to undertake research studies in clinical or academic settings on their own. Although there is a great need for research studies about nursing issues in Oman, few such studies have been published. Increasing the number of nurses with advanced degrees would help remedy this deficit.
Nursing Employment
Nurses in Oman work in all types of health care settings. Thanks to the nursing shortage, newly graduated nurses have 100% job availability in one of the country’s health care systems or nursing institutes. Nurses employed by the MoH are guaranteed a job until the age of retirement (60 years).
In most cases, nurses do not have a choice of where they will work. Because most educational institutions and health care facilities are government-owned, graduating nurses are assigned to employment locations based on staffing needs. Furthermore, most graduating nurses cannot express a preference for a particular clinical area or unit. However, nurses who have specialized post-basic training are assigned to work in specialty units, such as intensive care, burns, renal care and dialysis.
Many nurses in Oman work full time in governmental health care facilities, such as hospitals, health centers and clinics. Most of these nurses have a diploma in basic nursing from one of the country’s nursing institutes and some have post-basic program certificates. Few baccalaureate-prepared nurses work in clinical settings.
Most nurses employed in health care facilities work 140 hours per month with eight days off each month. Duty roster plans vary depending on the facility. In some facilities, the work hours are distributed equally among three shifts, but in most cases nurses work more evening and night hours. Due to staff shortages, some employers often demand that nurses work more than the required hours. Extra work hours are generally compensated with time off. Overtime is rarely paid because most nurses prefer time off instead.
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Nursing, like any other governmental job in Oman, has a salary-based pay system. All nurses employed by the MoH are paid equally according to educational degree and years of experience, regardless of the work location. In other words, nurses working in Muscat earn the same salary as those working in rural areas, and critical-care nurses make the same money as those employed in outpatient clinics. RNs with less than five years’ experience are designated as staff nurses and paid the same wherever they work. Nurses are entitled to receive pay raises and job promotions every five years, starting at staff nurse and moving up to senior staff nurse, supervisor and, finally, nurse adviser.
Nurses in Oman often complain about staffing shortages, heavy workloads, lack of job choice and the difficulties of trying to meet their family obligations while working inconvenient shifts. In some hospitals, nurses have no formalized job descriptions and are therefore required to perform tasks that have nothing to do with nursing, such as dispensing drugs after midnight in the pharmacy and completing statistical reports.
While the Sultanate’s continued expansion of health care services, building of new hospitals and population growth are positive signs of progress, there is no denying that these factors also contribute directly to the nursing shortage. When foreign nurses working in Oman return home to care for family members or leave to take positions in other nations, the result is severe understaffing. The MoH has made significant strides in increasing the number of nursing education programs, nursing students and RN graduates, but these measures still seem inadequate to deal with the looming shortages. Professional nursing in Oman has come a long way in the last 38 years, yet it still has a long way to go.
References
1. World Health Organization (2003-2005). “Oman Demographic Indicators.”
2. U.S. Department of State, Bureau of Near Eastern Affairs (2006). “Background Note: Oman.”
3. Oman Information Center. “Primary Health Care in Sultanate of Oman.”
4. Hill, A.G. and Chen, L.C. (1996). Oman’s Leap to Good Health: A Summary of Rapid Health Transition in the Sultanate of Oman. World Health Organization/United Nations Children’s Fund, 1996.
5. Scrimgeour, E.M., Mehta, F.R. and Suleiman, A.J. (1999). “Infectious and Tropical Diseases in Oman: A Review.” American Journal of Tropical Medicine and Hygiene, Vol. 61, No. 6, pp. 920–925.
6. “The Celebration of the Omani Renaissance Day on the 23rd of July 1970.” Ain-Al-Yaqeen magazine, August 11, 2006.
7. Sultanate of Oman, Ministry of Health. “Oman’s Nursing Profession Comes of Age.”
Kimberly Cook, RN, BSN, is a highly accomplished nurse leader with a 30-year career in the healthcare industry. She graduated from the University of Virginia with a nursing degree and became a nurse in the Army early in her career. During wartime, Cook showed her dedication and commitment to patient care, which instilled in her a profound sense of duty, resilience, and an unwavering ability to thrive under pressure.
Throughout her career, Cook has held various management positions where she consistently demonstrated exceptional leadership qualities. She rose through the ranks quickly, earning the respect and admiration of her colleagues, staff, and executive team. Her visionary mindset has enabled her to drive positive change and implement innovative strategies within healthcare.
Cook holds the Director of Nursing Administration Staffing position at the University of Maryland Capital Region Health, a member organization of the University of Maryland Medical System. In this role, Cook leads a team of dedicated professionals, tirelessly ensuring that the right resources and personnel are available to deliver quality patient care.
Meet Kimberly Cook, RN, BSN, Nurse Director, Nursing Admin/Staffing at the University of Maryland Capital Region Health.
Talk about your role in nursing.
As the Director of Nursing Administration/Staffing, I hold a key leadership position responsible for overseeing the nursing administration and staffing functions within UM Capital Region Health. My key responsibilities include the following:
Provide strong leadership and guidance to the nursing administration and staffing team.
Develop and implement strategic goals, objectives, and policies related to nursing administration and staffing.
Foster a positive and collaborative work environment that promotes teamwork, respect, and professional development.
Develop and execute staffing plans to ensure optimal allocation of nursing staff across all departments and shifts.
Collaborate with unit managers to monitor and maintain appropriate staffing levels based on acuity and workload demands.
Implement effective scheduling practices to ensure adequate coverage and adherence to the Collective Bargaining Agreement and budgeted financial targets.
Prepare and manage the nursing administration and staffing budget, ensuring efficient resource allocation.
Manage and assess daily productivity and labor management.
Monitor and control staffing-related expenditures, identifying cost savings without compromising patient care.
Monitor and evaluate staff performance, providing regular feedback, coaching, and recognition.
Collaborate with quality management teams to identify improvement areas and implement initiatives to enhance patient outcomes.
Oversee the recruitment and selection process for staff and agency staff.
Onboard new staff and agency staff.
Manage all agency staff recruitment, onboarding, and billing.
How long have you worked in the nursing field?
> 32 years
Why did you become a nurse?
I attended a Catholic high school where volunteering was a requirement to graduate. I volunteered at a local hospital because it was close to my school. Prior to volunteering, the field of nursing had not crossed my mind. However, observing the fantastic work of nurses during my volunteer service triggered that “ah ha” moment, where I realized that Nursing was the profession I wanted to pursue.
What are the most important attributes of today’s nursing leaders?
There are several important attributes of today’s nursing leaders. The one that is most important for me is adaptability and resilience. The healthcare industry is continuously evolving, and nursing leaders must be adaptable to embrace change and lead their teams through transitions. They should be resilient in the face of challenges, remaining calm and composed while leading others.
What does being a nursing leader mean to you, and what are you most proud of?
Being a nurse leader involves inspiring and influencing others towards a common goal. I am most proud when I can create and sustain effective teams while fostering a positive work environment where staff feel supported and valued.
Tell us about your career path and how you ascended to that role.
My Career began as an Army nurse. After leaving active duty, I remained a federal employee working in a military hospital. My first job was as a manager of two 40-bed Med Surg Units. After several years in a managerial role, I transitioned to nursing supervisor. As a Nursing Supervisor, I had a keen sense of staffing and how it applied to budgeting and productivity. The role of the Director opened, and I was asked to step into the role based on my previous work and reputation.
What is the most significant challenge facing nursing today?
The biggest challenge in nursing today is our ability to change and adapt as healthcare changes. Since Covid, we have had to be creative with staffing to care for our patients. However, we must remember to care for our staff in the same frame.
As a nursing leader, how are you working to overcome this challenge?
By keeping the organization’s goals in sight, but always remaining humble and empathetic.
What nursing leader inspires you the most and why?
General Hazel Johnson-Brown was the first African-American woman to become a General in the United States Army and the first African-American Chief of the Army Nurse Corps. Her accomplishments and impact have had a profound effect. Her success demonstrated that black women could achieve the highest leadership positions with determination, perseverance, and skill.
What inspirational message would you like to share with the next generation of nurses?
Nursing can be challenging at times, and there may be moments when you feel discouraged. However, it’s essential to recognize that even the most challenging days present valuable personal and professional growth opportunities. Keep moving forward confidently, knowing that tomorrow will bring a fresh start.
There are countless reasons why some of us fall into nursing. And when we choose this particular professional journey, all types of motivations keep us in the game.
For many of us, a family member who was a nurse inspired us to continue the tradition. For others, it was witnessing the nursing care of a sick or dying loved one that opened our eyes. For still others, nursing seemed like a flexible, well-paying job that could support a family, especially since nurses will always be needed (until the robots take over).
But we all change, as do our lives, and this begs the question: if the nature of your life and your reasons for being a nurse change over the years, how do you continue to find meaning in what you do?
How it all Began
You became a nurse because your grandmother and mother were both nurses. Your grandmother told fascinating stories about being a nurse during World War II, with air raid sirens, soldiers missing limbs, and lives lost and saved all around her. Your mother also had good stories, though maybe not as romantic as grandma’s.
You could have finished high school and gone to nursing school, launching your career at 22. Or your story might involve, like yours truly, spending your twenties doing all sorts of different jobs and arriving at nursing in your early 30s when you had a family to support and a pre-adolescent son to set a good example for. And there are also those who come into nursing after an entirely different career: FBI agent (a true-to-life story I recently heard firsthand), accountant, office manager, etc.
No matter how you find your way, you have a story that includes the motivations that led you there. Maybe you truly felt a calling, or perhaps you just needed a reliable job. Whatever the vehicle, it delivered you to the door. But what happens when that original vehicle eventually pulls out of the parking lot, and you’re left wondering why you’re still here?
When the Sands Shift
The sands of your life can shift for many reasons: having children, getting married or divorced, finding a new passion, aging, getting bored, or moving to a new state or country.
The sands of your career and the healthcare industry can also change. Here are some observations I’ve heard from nurses I’ve spoken with:
Healthcare is becoming more corporatized, and the healthcare business feels more focused on money than human beings.
The bullying and incivility at work is terrible and demoralizing.
Unsafe staffing consistently puts our licenses at risk.
And the list goes on.
What do you do When things change— inside of you, in the world around you, or likely both? If your motivations for being a nurse feel different than they used to, you’re not alone. And if you’ve lost your motivation and passion entirely, how do you continue?
Acknowledging and Accepting Change
For some nurses, when the world shifts around them, they bury their heads in the sand, perhaps doing okay for a while. Others become bitter, burnt out, and resentful, and may themselves become bullies who make the lives of those around them miserable. Either that, or they fall into depression, anxiety, or addiction.
You may also arrive at a place where your kids have left the house, and you have the freedom to explore. You can study massage therapy, learn astrology, write a book, or become a podcaster. It’s all valid, and the world is essentially your oyster.
But the original question remains: how do you continue to find meaning in your actions?
Much of this comes down to your core values. The Barrett Personal Values Assessment and the Schwartz Portrait Values Questionnaire are both valid tools for identifying your values. You can also work with a mentor, faith leader, therapist or counselor, career coach, or other trusted individual to help you uncover what’s currently most important to you.
Aside from your values, you also need to examine the current state of your life:
What are your needs?
How have the nature of your home life and relationships changed?
Do you have more people dependent on you, or are you more independent than ever?
Has your health changed over the years? Do you have less physical stamina? Have you developed chronic illnesses?
Acknowledging the changes in your life, your family structure and relationships, your body, and the world around you is one of the keys to examining what’s currently making you tick and how to continue.
Based on what’s changed over the years, there may be a way for nursing to continue to be a natural fit, but you may also find that nursing no longer offers the fulfillment it used to. Being honest with yourself is an excellent place to begin since a critical assessment of your life and career must start with clarity.
As you examine your values, the current state of your life, the things that feel important to you, and your needs, things will become more apparent.
If you began your nursing career because of grandma’s inspiring stories but now find that the inspiration is no longer there, it’s not shameful to acknowledge the truth and seek other career options. And if nursing is now simply a job and no longer feels like the calling it once was, you may still be able to continue.
However you move forward, keep in mind that change is the only true constant, and the path that you once traveled may need some readjusting. Be patient, have self-compassion, and forge ahead towards whatever the future may hold.
Nursing is a second career for Derek J. Flores, RN, CHPN, BS, a hospice nurse in Colorado since 2012.
In 2020 Flores was a featured guest on the TV Show, The Doctors, sharing his expertise on end-of-life hospice care. He’s also written two books to increase knowledge of end-of-life care. Flores’ first book, Seven Keys to a Peaceful Passing, walks patients and families through common challenges and decisions they must make during their hospice journey. His second book, Letter to a Hospice Nurse, celebrates the lives of hospice patients and gives a format for surviving family and friends to process grief.
Flores has a Spanish mother and Mexican father and credits his background, education, and experiences for helping him connect with his patients to provide good outcomes.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Derek Flores, RN, CHPN, BS, and hospice nurse in Colorado.
Talk about your role in nursing.
I’m a hospice nurse case manager in the Denver Metro area. I work with a varying census of patients facing a terminal diagnosis. Besides regularly visiting my patients, I coordinate care between other disciplines, including CNAs, social workers, chaplains, and volunteers. Our team serves a widely diverse community of beautiful people from various backgrounds. Many of my patient visits can be considered ‘routine,’ others unexpectedly are filled with urgency to treat symptoms at the end of life. I work in the world of the ‘dying.’ It is a place and space where the dignity of each person is cherished and celebrated.
How long have you worked in the nursing field?
I earned my LPN in 2011, then passed the NCLEX-RN in 2012 after graduating from Laramie County Community College in Cheyenne, Wyoming. Nursing is a second career for me. I graduated from Colorado State University in 1991 with a BS in business administration. I spent a dozen years working in various industries in marketing and sales departments. I even had my own business for a few years.
Why did you become a nurse?
The seeds for me becoming a hospice nurse were sewn while observing both of my parents care for their aging, then dying parents. The love and compassion I saw from them was an inspiration. My mother, whose name is Crisela, has family roots in Spain. The Archuleta family arrived in Mexico in the 17th Century, then migrated to northern New Mexico, where they were farmers and ranchers. My mother’s first language was Spanish. She worked as an elementary school teacher in Pueblo, Colorado for many years before retiring. My earliest memories are of my mom and grandma speaking Spanish in the kitchen while the smells of a delicious dinner were in the air. The love, devotion, and endurance she showed in the care of her parents moved my heart. My mother and her siblings cared for Grandma Rita and Grandpa Ambrosio for fifteen years before Grandma passed peacefully at the age of 103.
My dad’s family was from southern Texas and Mexico. My late father, Jim, worked as a teacher specializing in special education. He was also a former Green Beret, champion runner, and weight lifter. He showed compassion for his students and the tenderness he had in the care of his parents at the end of their life. My parents were the first generation to earn bachelor’s and master’s degrees, breaking down societal barriers during my formative years in the 1970s and 80s. Their example set a standard for pursuing higher education and service to others.
I began the journey to become a nurse during a difficult period of my life as I turned 40 years old. During this time, I began to work as a CNA. My experience as a CNA helped form me into a well-rounded nurse. I learned how to provide basic care to my patients, who often lived in difficult conditions. After watching some of my supervising nurses do their work, I realized, ‘I can do that’! The next thing I knew, I was in nursing school. My family’s example of hard work and never giving up helped me make a career change.
What are the most important attributes of today’s nursing leaders?
In the hospice environment of today, a nursing leader has many hats to wear. In nursing school, we are taught to become multitaskers. As a hospice nurse case manager, I lead my interdisciplinary team by being responsive and communicative. If someone asks me a question, I respond as quickly as possible. I like surprising people with very quick responses. This level of communication sets a ‘Nursing Leader’ apart.
A hospice organization is multi-faceted with clinical, administrative, and management pieces. The clinical part of my work is also just as important because our patients depend on us to manage symptoms in often very stressful situations. When this happens, everyone looks to us for good nursing judgment, a cool head, and a soft heart.
What does being a nursing leader mean to you, and what are you most proud of?
I have been and will probably always be a bedside hospice nurse because my personality makeup doesn’t do well behind a desk or in the same location all day. I work out of my car, driving to each patient’s location. I lead my hospice team as a case manager by being attentive to my patients and team. My hope is they are inspired and motivated by my actions.
I’m most grateful for recognizing that nursing is a vocation I have been called to do. It’s rare that I don’t feel I have contributed to someone going through the most difficult time in their life. I’m most proud that I live out the legacy of my parents, Jim and Cris. Their example of serving others drives me each day. I’ve always wanted them to be proud of me.
Tell us about your career path and how you ascended to that role.
I’ve alternated throughout my career in hospice between case management and on-call roles with both for-profit and not-for-profit companies. The caseloads in some hospices can exceed twenty patients, so my career path has been marked by individual experiences with patients in difficult situations and measured by how I assisted them to be free of the symptom or symptoms they were struggling with.
Hospice nursing can be very emotionally trying, so I have taken sabbaticals by working in pediatric home health. I found that medically challenged children bring joy to everyone around them. They have helped heal my heart when I needed it most, preparing me to return to hospice nursing to do the work I’m called to do.
What is the most significant challenge facing nursing today?
My nursing work must be completed within a limited amount of time. There isn’t any wiggle room for this, so I can’t even list this as a challenge. It simply has to get done, no matter what. I never have a day like the previous one, so planning every moment of my week is almost impossible. I always have to try and stay ahead of the next patient emergency or death by pushing to get tasks done in the moment. I know if I don’t get something done now, it might not get done at all.
My family is most important to me. I am recently married at 54 to a wonderful woman, Kirsten. After many years alone, I now have a wonderful and kind companion. We enjoy our life together, including time with three adult daughters, one lovely granddaughter, and another who is making her debut in a few months. Our hearts are full.
I share my professional challenge of having enough time to meet all my work and personal responsibilities because it is common for hospice nurses to quit after their job takes over their lives. It’s not uncommon to work a full day, kiss your loved one as you arrive home, then head to your home office to work another few hours before you go to bed. It’s super easy to have hospice take over your life. Quite often, hospice nurses are paid on salary, so at some point, you may decide you’re working for a much-reduced rate than you thought you were. Then you choose to leave. The result is that patients get shortchanged by nurses who are rushed to get everything in their day completed. I encourage hospice nurses struggling with situations like this to ask their manager for adjustments. Caseloads can be lightened, geographic work areas can be shrunk to decrease time driving each day, and changes can be made if a manager wants to keep a nurse. Don’t be afraid to speak up if you have difficulty getting everything done.
In the end, if nurses and their managers don’t find solutions, the result can often be rushed nursing visits or nurses who aren’t fully present to their patients because they multitask. Our patients aren’t aware of all of the demands of our positions. They want to share what is happening with themselves on that particular day – needing us to meet their needs.
As a nursing leader, how are you working to overcome this challenge?
I try to put my patients first by being present to them. If I were to fail them by supporting them with my full attention, then not much else matters. I think my efficiency and proficiency in this role have improved over time. I also get up very early in the morning when I have work to do so I don’t take time away from my family.
I also have a mission outside of my bedside nursing practice. I write and publish books to increase knowledge of end-of-life care. My first book is Seven Keys to a Peaceful Passing and my second is Letter to a Hospice Nurse. I’ve also created journals that nurses and families can use to communicate with each other and keep track of important tasks like medication administration.
What nursing leader inspires you the most and why?
I had a colleague named Ted in the first years of my nursing career. I identified with him in several ways. He looked a lot like my dad with his black wavy hair and chocolate brown skin and had a similar background. Seeing another person like me, with Spanish and Indigenous roots, gave me the strength to look outward to solve our patients’ challenges. Ted is one of the most knowledgeable hospice nurses I’ve known. I still use his recommendation to help patients suffering from chronic nausea.
What inspirational message would you like to share with the next generation of nurses?
I’d encourage anyone considering a career in nursing to look deep and find the one thing that fills their heart. If it is helping those in need, you’ll never have a day in nursing where you don’t take away a feeling of satisfaction for your hard work. If you are a young nurse struggling to get traction in your career, please reach out to an experienced nurse to find a solution to your challenges. I’d also suggest that once you have a few years of successful experience, you realize you are a hot commodity. Don’t be afraid to ask for a competitive wage or salary. Negotiate the time off from work you need for your family and yourself. You are in high demand!
Is there anything else you’d like to share with our readers?
Nursing should be a vocation for everyone who chooses to do this work. By finding the intersection of your heart and mind, you’ll never work a day. Instead, you will have a life filled with purpose, struggle, and satisfaction for the benefit of others. You’ll have a life that matters.
Marilyn “Nia” Wright, MSN, MHA, RN, CNOR, is a retired nurse who can’t stay away from the industry she loves.
As a nurse student, Wright was nicknamed Nia, an acronym for Nurse in Action, because she was eager to care for people and often volunteered to do whatever she could for as many patients as she could, whether or not those patients were part of her assignment. Wright exemplified this enthusiasm throughout her entire career.
Wright is an author, teacher, international speaker, and nationally certified nurse and was recently named a 2022 Nurse of the Year for the state of Maryland by the Maryland Hospital Association and The Daily Record.
She retired from her position as senior nursing director of one of the largest and busiest surgical services in Maryland at Luminis Health Anne Arundel Medical Center (LHAAMC) after serving in that role for over a decade.
Wright is a passionate, enthusiastic advocate for the promotion of diversity, equity, and inclusion in the workplace, serving for four years as the co-chair of the Cultural Diversity and Workplace Advocacy Nursing Initiative and was instrumental in expanding the committee’s membership to include members from the community as well as other hospital departments. As a result, the initiative’s name was changed to the Cultural Diversity and Workplace Advocacy Collaborative, and in 2018 Wright became the Executive Sponsor of the Collaborative.
She was also the executive sponsor and founding member of the African American Business Resource Group, a Luminis Health grassroots endeavor formed by employees across all demographics focused on creating a welcoming environment for underrepresented demographics and removing barriers that impact diversity, equity, and inclusion in the healthcare system.
Wright now serves as senior justice, equity, diversity, and inclusion (JEDI) consultant for Luminis Health. Her philosophy is that diversity is a valuable asset to any organization, allowing for creativity and productivity that incorporates multiple perspectives and perceptions and enabling the organization to cast a wider net and meet the needs of a larger population, including the employees themselves.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Nia Wright, MSN MHA RN CNOR, Senior Justice, Equity, Diversity, and Inclusion consultant for Luminis Health.
Talk about the roles you held in nursing.
I started as a staff nurse on a med/surg unit in 1979. Through the years, I have progressed in leadership roles to continuously improve the patient’s care and the support and shared governance of the clinicians and support staff.
How long have you worked in the nursing field?
45 years.
Why did you become a nurse?
I’ve wanted to be a nurse since I was seven. As a child, I was prone to upper respiratory infections; the nurses were always kind and gentle and made me feel better. I knew I wanted to be like them. I was that little girl with the nurse’s bag who bandaged my dolls and my friends if they had little cuts or scrapes. So I wanted to do anything I could do to help people heal and feel better.
What are the most important attributes of today’s nursing leaders?
Caring for the caregivers, fostering resilience, and leading by example regarding self-care. Nursing leaders must Look for opportunities to ensure shared governance and support their staff’s professional growth.
What does being a nursing leader mean to you, and what are you most proud of?
Being a nurse leader means providing strategic direction, tactical operations guidance, resources, and support to the nurses and all of the members of my team of healthcare associates. I am most proud of how I led my team during the pandemic with caring, compassion, transparency, tenacity, and resilience.
Tell us about your career path and how you ascended to that role.
My career path has been one of progressive leadership in education and management. I have served as a preceptor, educator, and clinical specialist. Honestly, the leadership roles chose me. I’ve always been the kind of person to see a problem and want to solve it. I offered suggestions to resolve issues. My first leadership role was as assistant head nurse of otolaryngology. I transitioned from med/surg nursing to the operating room, and my leadership path began as a team lead of Ophthalmology. I progressed to a clinical manager, assistant director, director, and senior director through the years. In each role, I endeavored to incorporate others in the decision-making process. I believe that each of us, regardless of title or job category, has something to offer to improve and enhance the care we provide continuously. The leader’s role is to tap into each team member’s knowledge, talents, and skills, enable them to do their best, empower them to be change agents, and help them grow professionally.
What is the most significant challenge facing nursing today?
The most significant challenge facing nursing today is the stress of the job. The stress originates from staffing challenges that include re-designing staffing structures, such as re-visiting the team nursing model and adding licensed practical nurses to personal life challenges.
As a nursing leader, how are you working to overcome this challenge?
As a nurse leader, I must ensure my staff knows I support them. Just as the challenge is multi-faceted, so is the approach to resolution. I worked with the staff and leaders to revise the on-call program, which gave the team more control over their schedules and reduced the number of on-call shifts. We worked together. That’s the key. I had an open door policy so that staff and leaders knew they could come by to discuss a personal or professional concern confidentially. I always encouraged them to practice self-care. If they did what was best for them to thrive, it would positively influence the care provided to the patients and the other team members, and the work environment.
How are you helping advocate for promoting diversity, equity, and inclusion in the workplace?
Previously, I established a platform for open, honest dialogue on diversity and inclusion issues. As a result, Luminis Health became the first Healthcare System to sponsor a local chapter of Coming To The Table – a national organization focused on healing the wounds of inequity caused by racism. The Luminis Health chapter seeks to heal the wounds of all biases and injustices. As the first executive sponsor of the Cultural Diversity and Workplace Advocacy Collaborative, I led many informative and interactive educational events to heighten awareness of the need for diversity, equity, and inclusion in every aspect of the organization.
Tell us about your new role as the Senior Justice, Equity, Diversity, and Inclusion (JEDI) consultant for Luminis Health.
I work with the various Business Resource Groups (ex. LGBTQIA), Inclusion Groups (ex. Counter Racism Task Force), Human Resources partners, and leadership in providing guidance, being a sounding board, offering assistance with seeing concerns through the lens of Justice, Equity, Diversity, and Inclusion, provide group and individual education, assist with policy development and revisions, analyze metrics that measure our JEDI progress and collaborate with leaders and staff in developing strategic plans and goals for our Luminis Health JEDI Journey.
What nursing leader inspires you the most and why?
Today, I am most inspired by the president of Luminis Health Doctors Community Medical Center, Deneen Richmond, MHA RN. She is a nurse who has been a stalwart advocate for justice, equity, diversity, and inclusion throughout her career. She is a formidable force, particularly in quality and population health. She is well respected by her peers and those she supports. Additionally, Deneen is an African American woman who graduated from my alma mater, the University of the District of Columbia. She is a stellar example of how true grit and determination can make a difference in the communities we serve and the industry we love.
What inspirational message would you like to share with the next generation of nurses?
You are in the world’s most trusted profession. Your work is vitally important. So stay in the driver’s seat. Let your voice be heard. Advocate for your patients, your community, and yourself.
Is there anything else you’d like to share with our readers?
My professional mantra for over forty years has been, “I touch the world one person at a time. I make a difference in people’s lives every day… I am a nurse.”
