A study from 2017 defined caregiver burden as, “the strain or load borne by a person who cares for a chronically ill, disabled, or elderly family member.” Nurses are all too familiar with the instinctive concern for patients, and often equally so for the person sitting at the patient’s side. Many caregivers give up proper sleep, nutrition, recreation, and financial resources to care for a family member with a disease that requires comprehensive, and often constant, care. Many caregivers work in addition to caring for their loved ones and have personal and family commitments of their own. The caregiver burden begins when the caregiver sees that something has got to give, and the first thing to go is their own well-being.
Because the nurse is responsible for patient care, it may seem like it’s outside a nurse’s scope to address issues with caregivers. In fact, nurses are equipped to empower patient family members to lighten the burden of caring for sick family. This can be done by nurse researchers who can expand on current awareness, and by direct-care nurses who participate in caregiving with family.
Research
In recent years, research has demonstrated the very real physical consequences of caregiver burden. Studies show that caregivers literally age faster. Research is growing in this area and with that, resources are expanding. The devastating effects of caregiver burden reach beyond temporary distress and eventually create an emotional and physical strain on the caregiver. Too often, the caregiver becomes a patient.
Nurse researchers can contribute to the solution by researching and publishing on this topic, empowering family members to take care of themselves, and urging health care professionals to create health care systems and policies that patients and families can trust.
Nurse as Caregiver Support
Nurses can introduce family caregivers to resources that alleviate the stress of being a caregiver. Social services can step in and address insurance, facility transfer, and patient service allocation. Nurses can also encourage family members to leave the bedside and sleep in their own bed, get a coffee or a hot meal, or encourage them to go for a walk and offering to call if anything urgent comes up.
Many caregivers insist on performing nursing tasks, such as bathing, toileting, and positioning, so they can be assured it is done “right.” Perhaps they have had experiences that have weakened their trust in nurses and other providers. Nurses can gain this trust back by offering to perform tasks in front of, or in conjunction with, caregivers, and eventually, give the caregiver the comfort to step away. Lastly, nurses can give caregivers information about support groups which may act as a pressure release valve and allow caregivers to share their experience and concern, and connect to others going through similar circumstances.
Nurse as Caregiver
Any discussion of caregivers is incomplete without acknowledging the possibility of burnout in nurses themselves. The major difference between a nurse as caregiver and a family member is that boundaries of care between nurses and patients are finite. Nurses have a scope of practice that only encompasses a specific range of skills and tasks, and their work as caregivers ends when their shift does.
This assumes that nurses are not caring for their own family members, which many are. Furthermore, nurses are trained to augment their skill set with the practice of compassionate care and empathetic interactions with patients. Many nurses also work more than full time increasing the time they spend as professional caregivers.
Finding a Solution
The analogy of the oxygen mask on airplanes offers caregivers a guiding principle—put the oxygen mask on yourself first. The yardstick of caregiver burden is misery. Caregiving from a state of personal deficit is not only ineffective but creates a situation where there is not only an ill patient, there is also a depleted and distressed family member. There is nothing wrong with being a caregiver unless it starts to take from the giver.
As a highly specialized skill set, nursing is in high demand. As such, nurses can make a lucrative career by their full-time work alone, and by supplementing it with a variety of nursing side hustles. For those entrepreneurial spirits, there is seemingly no limit to the possibilities.
Home Health Care
There are certain areas of nursing where per diem work is more abundant. Many specialties within the hospital, such as critical care, emergency, surgery, and telemetry, require specific skill sets that the only nurses who fill in are already trained in that specialty. This is because per diem work comes with the expectation that minimal training is required.
There are however, some areas where skills do translate from one area of nursing to another. This is especially true outside the hospital. For example, adult inpatient nurses can work as a home infusion nurse, or in other home health care work, such as overseeing ancillary nursing staff, doing intensive assessments, and advocating for patients with their providers and insurance carriers.
Home health care is a growing field of opportunity as it benefits the patient by allowing them to maintain quality of life in their home; it can also help reduce the logistical strains on the health care system to provide inpatient care.
Aesthetic Nursing
For nurses with an eye for beauty, aesthetic nursing offers a wealth of opportunities. As technology advances, there are more and more non-surgical procedures with anti-aging and aesthetic benefits. Nurses are increasingly able to perform or assist physicians with such procedures in medical spas and dermatology clinics. Furthermore, often this work is available as part-time or per diem. This allows nurses to build up a clientele through a side hustle that works with their schedule and is generally high-paying. Qualifications and credentialing for work as an aesthetic nurse vary by location, but frequently nurses go through certification programs in order to attract employers for this type of work.
Teaching
Working as adjunct faculty is the side hustle of the teaching world. Many nursing schools offer opportunities to instruct a limited number of courses per semester on a part-time basis. This allows nurses with specialized knowledge or skills to disseminate what they know to the next generation of nurses. There are opportunities for both online and classroom teaching today. Requisites for teaching vary by state, school, and specific courses. For example, many nursing schools require five years of experience in a given specialty or an advanced degree in nursing, in order to teach.
Coaching
Coaching is another growing field for nurses. For coaches who are nurses, they mostly function as health coaches or career coaches to other nurses. In the former role, nurses work with clients to mobilize them in the direction of their own personal and health goals. This is done through motivational interviewing, establishing accountability, goal-setting, and most of all-empowering the client to be experts on their own lives and bodies.
This role does not involve medical oversight and instead draws on the nursing skill of patient education combined with the holistic approach to patients that is fundamental to nursing. Nurse career coaches are often experienced and successful nurses who have built lucrative and fulfilling careers in nursing and coach other nurses or aspiring nurses to do the same.
Legal Nurse Consultants
Legal nurse consultants (LNCs) serve as expert nurses that work in medical-legal matters. LNCs are usually experienced nurses that can address technical matters specific to nursing, which a layperson may not know. They may work in law offices, HMOs, hospitals, risk management, workers’ compensation, and so on.
The legal nurse consultant utilizes their clinical and logistical expertise to extrapolate or clarify matters related to medical-legal cases. There are many full-time legal nurse consultants but it is incredibly valuable as a side hustle because it allows the nurse the opportunity to simultaneously work clinically, honing expertise and skills, while contributing the value of such real-time experience to their work in legal matters.
Nursing is a growing field for many reasons, not the least of which is that it offers a multitude of avenues by which to obtain a high income and a fulfilling career. For the nurse who wants to branch out beyond what they specialize in full time, there is certainly no lack of side hustles in nursing for them to explore.
Even when a nurse is satisfied with their job and skill set, there are many nurses who are talented in areas outside of their work. For those who are writers, there is a growing opportunity where they can combine their expertise in nursing with their talents in writing. The best nurse writers can translate nursing practice into interesting, sensitive, and effective language that informs and influences readers.
Know Your Audience
An essential component of nurse writing is to write for the reader. It won’t be effective to write a piece about disease using jargon if the audience consists of novices or laypersons. Similarly, it is wasteful to elaborate on the meaning of fundamental language when the audience consists mostly of experts. A nurse writer discussing heart disease would write a different way if their audience consists of nursing students vs. writing for cardiac nurses. Fortunately for nurse writers, the publisher will make clear who will be reading it.
In addition to adjusting the language to the audience, there should be a specific tone of the writing. Most textbook publishers would not appreciate content written in a conversational tone. On the other hand, blogs, including informative blogs, should not be written academically. A successful nurse writer will write in accordance with the context.
Know the Content
It may not be wise to accept assignments that cover topics outside of one’s expertise. However, when covering a topic that they do not specialize in, a nurse writer can consult with experts, and if possible, develop the content in the format of an interview. For example, a labor and delivery nurse asked to write about heart disease should consult with outside sources. In some instances, it is best to turn down work when a nurse is not qualified to cover the subject and does not have adequate resources.
Furthermore, as every nurse is well-versed in applying the evidence-based practice, nurse writers should be well aware of the quality of their sources. The type of citation will depend on the character of the content; but no matter the context, any technical information discussed or claims made should be supported by valid sources. Most nurses have access to academic databases, particularly if they work for teaching hospitals; therefore, they should favor this resource over basic web searches whenever possible.
Know Your Limitations
In order to be effective, nurse writers have to navigate deadlines, the politics of writing, internet trolls, and stringent fact-checking and sourcing. In addition to their own lives, which may include full-time work as a nurse and a family, the time needed to write must be available to meet deadlines and create articles worth publishing.
Nurse writing at its best is a joyful extension of the practice of nursing. For those nurses who are enthusiastic about their work and talented in writing, nurse writing can be a fulfilling channel of creativity and income that allows them to combine their talents. Nurse writing enables nurses to extend their knowledge and experience beyond patients to readers.
September is National Cholesterol Month, making it a great time for nurses to revisit tools for educating patients about maintaining healthy cholesterol levels.
Nurses learn in nursing school about the two types of cholesterol: low-density lipoprotein cholesterols, or “LDLs”, and high-density lipoprotein cholesterol, or “HDLs”. Some cheeky nursing professors might teach their students that LDL’s are lousy, while HDL’s are happy, or the good and the bad cholesterol, respectively.
The goal for many patients is to elevate their HDL and lower their LDL levels, and nurses can play a big part in helping them achieve this. Maintaining healthy cholesterol levels is essential to well-being, and the consequences of not doing so can cause a great detriment to one’s quality of life and even death. The most notable sequelae of high cholesterol are a heart attack and stroke.
The Value of Patient Education
Many nurses take pride in their more technical skills such as phlebotomy, insertion, management of venous catheters, medication administration, and the development of nursing diagnoses and care plans. In many ways, however, patient education is a nurse’s most important task because it can prevent the need to carry out those more technical tasks that treat disease. Patient education instead is wellness-promoting. When it comes to cholesterol, it is a nurse’s greatest asset in assisting patients to avoid the potentially devastating consequences of unhealthy cholesterol levels.
Individualized Lifestyle Patient Education
Perhaps the most obvious factor to focus on regarding cholesterol is diet. For every fad diet, new superfood, and fasting regimen, there is a simple solution suitable for each individual patient. In order to effectively educate a patient about diet, the nurse must be armed with a straightforward understanding of where the patient is both physically and emotionally.
This means the nurse must know the patient’s existing dietary restrictions and needs based on physical conditions, such as carbohydrate restriction related to diabetes mellitus and salt restriction for heart disease. Emotionally, the nurse must also have an understanding of the patient’s dietary preferences and level of willingness.
A patient who claims to hate vegetables is unlikely to comply to eating a healthy cholesterol diet that is predicated on heavy vegetable consumption. This patient might do better if directed toward other dietary sources that support healthy cholesterol levels like oatmeal, berries, and other foods high in soluble fiber. Similarly, if a nurse works with a patient who makes clear that they are unwilling to stop eating fast food, the nurse might suggest a bowl of soup, a large glass of water, or a generous slice of watermelon helps hydrate before a meal. Hydration offers a wealth of health benefits besides relieving thirst, which many dehydrated patients confuse for hunger.
Stress management is not only a tool for a more pleasant daily life, but it is also an essential component of healthy cholesterol levels and overall wellbeing. Chronic stress can throw off our bodies’ cortisol release cycle, and there is a clearly defined relationship between abnormally elevated cortisol and high cholesterol.
Again, individualized patient education is key. Relaxation, sleep, and exercise are three fundamental components of managing cortisol and its effect on cholesterol. This doesn’t mean that every patient will be willing to start meditating, following a strict bedtime, and running marathons. By meeting with the patient and learning about their hobbies, the nurse may discover the patient loves to knit, dance, and read. For this patient, the nurse may recommend knitting to relax, dancing to music for fifteen minutes a day, and going to bed with a good book rather than watching the news.
The Role of the Nurse
Patient education is the nurse’s greatest asset in helping patients to establish lifestyle measures that support healthy cholesterol levels. In order to do this effectively, nurses must establish a rapport with a patient that engenders trust and understanding. This allows both the nurse and the patient to create a plan for the patient that is both effective and feasible to promote a patient’s cholesterol levels. Use September as a time to remind patients they are worth it!
There are those who consider themselves ineligible for nursing because they are afraid of needles, shriek at the sight of blood, or believe they couldn’t handle the pressure of caring for sick patients.
So-called “squeamish” individuals need not write off nursing as a career. There are many nonclinical roles in nursing such as research and leadership, but they often require nursing experience. The following is a broad overview of careers for the squeamish nurse.
Within the Hospital
Many mental health nurses are not exposed to trauma, and depending on patient acuity, they may only administer oral medication. Similarly, nurses in narcotic detox facilities give out medication by mouth and rarely, if ever, deal with the more physically graphic aspects of nursing. Naturally, there are other considerations one would need to take into account in terms of disposition when addressing these patient populations.
There are hospital positions that require little to no medication administration. For some pre-procedure nurses, their work often focuses on preoperative interview and assessment. This may involve minimal physical contact with patients, such as assistance with surgery prep, disrobing, or preoperative skin prep. It requires well-developed assessment skills and familiarity with different surgical procedures. These positions will depend on how the facility distributes perioperative responsibilities among nursing.
Mother-baby nursing may be an appropriate position for the mildly squeamish nurse who can handle the occasional unexpected event. To the extent that mother-baby nurses are not required to rotate through labor & delivery or work with high-risk births; their role is mainly assessing newborns and managing the care of young, and mostly healthy mothers. This type of nursing involves a unique, highly specialized skill set for working with the youngest patients.
Outside the Hospital
Home health nursing positions are increasing where registered nurses oversee the work of ancillary nursing personnel, such as home health aides, and certified nursing assistants. Home health nursing may involve direct patient care where nurses assess patients, administer medications, and refer to advanced practitioners for any changes in patient regimens. Home health nurses may also work with insurance companies to protect patient coverage and advocate on their behalf.
Similarly, case management uses nursing expertise in a nonclinical setting. Nurses utilize their understanding of patient population-specific needs, but they do not provide direct patient care. More commonly, case management involves advocating for patient access to necessary services and following up with patients to ensure their health needs are being met.
Outpatient clinic and primary care nursing focus on assessment and treatment of minor illnesses. Under this umbrella are school nursing and specialized outpatient clinics, such as internal medicine, pain management, psychiatry, and orthopedics. Primary care nurses do administer medication and perform wound care, therefore, the squeamish nurse may want to investigate site-specific duties.
Aesthetic nursing may be a good choice for a nurse who doesn’t want exposure to sick patients. This is a growing skill set within nursing and nurses can generate a lucrative income. Nurses in these roles will often administer injections.
A Caveat
It is important to keep in mind that every employer has different expectations and policies. Each individual must understand their own personal limits and job requirements before taking a nursing position. Furthermore, even positions suitable for the squeamish nurse require highly specialized skills and critical thinking.
All nurses are trained to work with a variety of patient populations, including the acutely ill. There is no way through nursing school without exposure to situations that many would consider either upsetting or even repulsive. That being said, there are many nurses who formerly identified themselves as queasy in the face of illness who find the reality of patient care much more tolerable than they anticipated. For many nurses, the spirit of service, and perhaps a bit of repeated exposure, together outweigh the upsetting sensory experience they formerly identified with nursing.
