The Seasons of Your Nursing Career

The Seasons of Your Nursing Career

When people in their 80s or 90s talk about their experiences, they may often refer to being in the autumn or winter of life. We can also think about our nursing careers in the same way. If you were to reflect on your career in terms of its various seasons, how would you describe where you’ve been, where you are, and where you’re heading?the-seasons-of-your-nursing-career

The Promise of Spring 

Graduating from nursing school is when your career begins formulating, with taproots making their way into the fertile soil of possibility. As you achieve landmarks like passing the NCLEX, getting licensed, and landing your first job, those taproots begin to take hold.

With the accumulation of new skills or knowledge, those taproots dig deeper, and your confidence in yourself as a nursing professional grows.

In the spring of your career, your trust in your abilities and knowledge increases with each successful patient encounter. Even though you’re a novice, with each blood draw, catheterization, medication administration, or correctly interpreted ECG, things begin to make more sense, and one day, you realize that certain things have become second nature.

The spring of your nursing career feeds on the moisture, nutrition, and compost of accumulating experience and confidence.

Sailing into Summer

You practice many skills entering the summer of your career with great certainty, and you may feel ambitious about your plans.

In the summer of your career, you begin to feel like a true professional. You know what you’re doing, and if there’s something you don’t understand, you can usually figure it out using your increasing powers of critical thinking. With more experience under your belt, the summer of your career is marked by a sense of increasing belonging and ease.

We must remember that things can get stormy even in the summer. You may be challenged by something you’ve never encountered, which may lead to temporary lapses of confidence. If you’re unlucky enough to be on the receiving end of bullying or incivility, you may not be as confident as you would have been. If you’ve been employed by organizations with weak leadership or toxic cultures, these experiences may have stripped away some of the natural joy of maturing into your career.

In the best circumstances, the summer of your career means you can dig deep into what you know, apply your knowledge and experience, and be confident enough to turn to mentors for guidance when uncertain. Sometimes, being confident means knowing when to admit what you don’t know.

The summer of your nursing career may see you changing specialties, pursuing certification, or going back to school. During the summer, you’re filled with the promise of the future. If things have gone relatively well and you’ve had a majority of positive work experiences, you continue to mature and grow into your role as a nurse with each passing day.

Settling into Autumn

Autumn is a time of transition when the leaves begin to change color, and you may even encounter a certain level of decay. The autumn of your career could be when you find yourself at the peak of your powers, perhaps mentoring others or serving as a leader.

Like the autumn of our lives in our 50s or 60s, the autumn of our nursing career may be marked by a certain level of maturity and certainty as a nurse but also a sense that the summer has passed.

This might be a time when some of the slings and arrows of the past come back to haunt you, and you feel somewhat bruised and battered by the experience of being a nurse. But in the best-case scenario, the autumn of your career can translate to knowing who you are, knowing what you know, and being aware that you’re an expert in your chosen area of professional focus.

The Quiet of Winter

In the winter of your career, you may experience a sense of winding down and completion. If you’re in a strong financial position, you may decide to work part-time, take a sabbatical, or actively plan for retirement.

If your economic situation means you need to continue working, you may choose a less strenuous position. Just as in the winter of life, your physical strength and endurance may be somewhat decreased, and you may be faced with the knowledge that the most productive years of your professional life are behind you. 

In the winter of your nursing career, attending conferences, gaining more certifications and skills, or returning to school may feel much less imperative. Then again, you may enroll in a master’s or PhD program more for your personal growth than for any professional gains that another degree could bring.

These later years of your career may or may not be about resting on your laurels and enjoying the fruit of your many years of labor. After all of your hard work, no one can argue that you don’t deserve it.

To Each Season its Time

Each season of your nursing career will not necessarily match the season of your personal life. Developmental life stages and professional development do not always happen in concert.

For example, if another nurse began their nursing career in the spring of their life (her 20s, for example) and your career began in your 40s (which one might call the summer of life), your career experiences may have been radically different. That nurse in their 20s may have been single and childless, while you may have jumped into a new nursing career when your family life was in full swing with marriage and children, and possibly aging parents to care for, to boot.

Whether the seasons of your life and career are a perfect match or seem incongruous to those outside, the most important thing is for them to feel cohesive to you. No matter where you find yourself on the personal and professional continuums, your job is to find your natural place in those processes and make the best of each.

In every season, there is a time, and no matter where you find yourself, that time is now.

Reflecting on Nurses Week: What Would Florence Think?

Reflecting on Nurses Week: What Would Florence Think?

Nurses Week occurs every year during the second week of May, and much fanfare is made of the pizza parties, tote bags, water bottles, and signs proclaiming heroes work here.”reflecting-on-nurses-week-what-would-florence-think

If we want to be more thoughtful and reflective about the phenomenon of National Nurses Week, theres much more to this annual moment of recognition than these familiar superficial trappings.

And since Nurses Week is built around the celebration of Florence Nightingales birthday (May 12, 1820), its appropriate to wonder what the veritable godmother of modern nursing would think of how we do (or dont) celebrate our profession.

What Would Florence Think?

The American Nurses Association (ANA) has chosen the theme Nurses Make the Difference” for the 2024 celebration. While not altogether original or overly inspiring, we can all agree that nurses make a difference in patient care, research, entrepreneurship, academia, technology, and other areas of endeavor.

Would Ms. Nightingale agree that nurses make a difference? She certainly would, and I would venture that she would have much to say about how that statement rings true. In her time, nurses were purveyors of comfort, cleanliness in the form of improved sanitation and hygiene, and the carrying out of physicians’ orders in caring for the infirm, the injured, and the dying.

In Nightingales theory, nurses aimed to ensure that patients were cared for in a manner that allowed nature to intervene in the interest of their health (e.g., the healing of wounds, the resolution of infection, etc.). If she saw nursing as the activities that promote health which occurs in any caregiving situation,” nurses make a difference by assuring patients are cared for in a way that maximizes their healing potential. And if, as can be asserted, Nightingales theory sees illness as the absence of comfort,” nurses’ ability to provide comfort can make all the difference in the world.

Theres no doubt that Ms. Nightingale would agree that nurses’ ability to provide positive interventions in the interest of patients’ healing is a central mission of the profession. However, what would she think of how we recognize nurses for their efforts during the annual celebration of her birthday?

In Nightingales day, there were no tote bags or water bottles bearing the hospital logo, nor were there pizza parties, greeting cards, and banners hung over hospital entrances. While its all conjecture on our part, one might hope she would look down upon such superficial acknowledgments of nursesworth.

Even though Nightingale was a revolutionary, out-of-the-box thinker as a Victorian woman, she might still be significantly shocked at the wages nurses command in the 21st century. She would also likely be shocked by the salaries earned by hospital CEOs, let alone the power of the insurance industry.

As a brilliant and forward-thinking woman, Nightingale would be likely quick to understand that womens place in 21st-century post-industrial society has dramatically evolved since her time, and one could imagine that she would be wholly supportive of nurses receiving increases in salary, benefits, and other forms of recognition that demonstrate acknowledgment of their value as healthcare professionals. Plainly stated, Nightingale might be heard to remark, Give those nurses a substantial raise — they deserve it.”

Reflecting on Nurses Week

Some hard-working nurses will likely appreciate an employer’s gestures during Nurses Week through food, gifts, and banners expressing gratitude for their contributions.

That said, salary increases, improved benefits, tuition and certification reimbursement, and other support for nurse professional development would likely be much more well-received. Improvements in staffing, protections against workplace violence, and updated technologies that truly make our work easier would also likely be much more well-received.

Nurses make a difference, and the satisfaction of a job well done can go far in creating ones personal sense of self-worth, especially when coupled with patients’ and colleagues’ respect.

Nurses Week is a moment to pause for the cause and reflect on our value in the scheme of things. Tote bags and pizza aside, our works true value provides meaning, and Nightingale knew this too well.

What would Nightingale think? She would think that 21st-century nurses have greatly advanced the profession. She might also remind us that what we feel in our hearts—and the thoughts we have about who we are and what we do—always matter most in the larger scheme of things.

Break the Inertia of Your Knowing

Break the Inertia of Your Knowing

We nurses know lots of things. Our heads are filled with innumerable ideas, thoughts, concepts, theories, observations, and facts. We know so much about pathophysiology, anatomy, chemistry, pharmacology, communication, informatics, psychology, sociology, and countless other topics that we’re almost bursting at the proverbial seams.break-the-inertia-of-your-knowing

But have you ever wondered if we sometimes know so much that our knowing can get in the way? What if our certainty and knowledge keep us from seeing something in an entirely new light or thinking outside of a box that we’ve more or less locked ourselves into based on our area(s) of expertise?

What would happen if we could break the mental calcification that our knowing can lead to and open our minds to new ways of thinking about a problem or challenge? Is this one of the places where inspiration and creativity are born?

The Inertia of Our Knowing

In some obscure corner of the internet, I recently heard someone say that we can “break the inertia of our knowing” by opening our minds to novel ways of looking at things. We can say plenty of positive things about the concept and experience of certainty. Still, we can also say that it can sometimes lock us into a frame of reference that prevents us from wearing a different lens at a moment when it could be helpful — or even revolutionary.

Did Einstein come up with his Theory of Relativity by only thinking thoughts he’d had before? Were Nightingale’s theories and concepts the products of a closed mind? Did Leonardo DaVinci devise sketches for flying devices and other fantastical machines by accepting commonly held beliefs about what was possible for 16th-century humans?

These groundbreaking innovators from different historical periods allowed themselves to break the inertia of their knowledge by opening their minds to what others in their time might have considered impossible or even crazy.

If your nursing career, your way of practicing, or any other aspect of who you are and what you do is stuck in the mud of stale thinking and close-mindedness, maybe it’s an excellent time to see how you might lift yourself into a new state of mind that transcends the boundaries of what you think you understand about the world around you.

“Maybe” and “Yes, And” 

Every parent knows that the dreaded word “no” is dangerous when it comes from a two-year-old’s mouth, but it’s equally dangerous when it comes from a 22-year-old medical intern or a 52-year-old charge nurse.

The word no is like the castle gates crashing down to keep anything new from entering the kingdom. No, it isn’t about creativity or critical thinking — it’s about staying stuck in the inertia of your knowing.

When a problem or challenge is apparent, and someone offers a potential solution, saying “no” turns off the faucet of creativity. However, if you instead say “maybe,” the possibilities are now open for discussion. And if you want to take it even further, saying “Yes, and…” as described by medical improv expert Beth Boynton, RN, MSN, opens the door even more.

For example:

Nurse A: “This family and patient are so difficult — there’s just no way of getting through to them.”

Nurse B: “Yes, and there might be a way to get their clergy involved to help them feel safer and less ganged up on by the team.”

Nurse C: “Maybe if we bring the deacon or pastor in for the next meeting, they’ll feel like they have allies in the room.”

Nurse B: “Yes, and if they feel safer, they’ll be more likely to hear what we say and be open to our proposed solutions.”

If Nurse B or C had said “no, but” instead of “yes” or “maybe,” the conversation may not have been productive. However, more possibilities emerge when building upon one another with positivity and openness. This breaks the inertia of knowing and opens the door to creative solutions.

Sailing to New Horizons 

The inertia of our knowing creates closed doors, whether in our careers, clinical practice, or even our personal lives. If Leonardo DaVinci had said to himself, “These are the things that I know, and nothing beyond that is possible,” so much of what he could have accomplished would have remained unrealized and unimagined.

If Florence Nightingale hadn’t allowed herself the luxury of thinking in new ways about hygiene, sanitation, and the emerging science of biostatistics, her breakthroughs would never have flourished in her mind and created new methods and strategies for improving the health of injured soldiers in the Crimea, not to mention patients around the world for hundreds of years to come.

If the inertia of your knowing is holding you back and keeping you from growing, then it’s up to you to short-circuit that inertia and think differently. Whether it’s your health and wellness, career growth, marriage, parenting, or any other aspect of your life, your certainty of how things “should” could stand in the way of a personal revolution.

So, the next time you feel stuck or somehow held back in life, ask yourself if the inertia of your knowing is the anchor that must be pulled up from the murky depths to allow your ship to sail to new horizons.

With unforeseen vistas and possibilities opening up in your mind’s eye, there’s no telling where you’ll go. This might seem like a scary proposition, but staying stuck in the inertia of your knowing might be even more terrifying.

Try this approach next time something new is called for, and see how breaking the inertia of your knowing can be the best decision you’ve ever made.

The Road to Becoming an FNP

The Road to Becoming an FNP

Nurse practitioners (NPs) are essential healthcare providers who are excellent, skilled clinical resources for newborns and elderly patients. While there are many available NP career choices, the family nurse practitioner (FNP) is a trendy option among nurses seeking to become primary care providers with the authority to diagnose illnesses, order diagnostic tests, prescribe medications, and manage the care of patients across the lifespan.Interested in becoming an FNP? Learn about the process and requirements for nurses to embark on this fulfilling career

If youre a nurse who wants to become a family nurse practitioner, what does that avenue look like, and what hoops do you need to jump through to achieve your goal? And if youre not a nurse, what additional work must be done to get there? Lets examine the landmarks along the way to becoming an FNP.

Why Become an FNP?

Becoming an FNP has pros and cons, so considering the many possibilities available in advanced practice nursing, its prudent to do your due diligence.

PROS:

Earning power: According to the U.S. Bureau of Labor Statistics (BLS), nurse practitioners, nurse midwives (CNMs), and nurse anesthetists (CRNAs) earned a median annual salary of $125,900 in 2022, with a mean hourly wage of $60.53. While the much higher salaries of CRNAs may admittedly skew the numbers higher, there’s no arguing that NPs are doing well for themselves.

Job growth: As another incentive for those considering the NP path, the BLS projects 38% job growth for NPs through 2032. When weighed against projected job growth of 6% for RNs and 3% for MDs, the attractiveness of a career as an NP can appear exceptionally bright.

Full practice authority: The state practice environment for NPs is improving slowly. The American Association of Nurse Practitioners (AANP) reports that in the states where full practice authority has been granted, state practice and licensure laws permit all NPs to evaluate patients; diagnose, order and interpret diagnostic tests; and initiate and manage treatments, including prescribing medications and controlled substances, under the exclusive licensure authority of the state board of nursing. This is the model recommended by the National Academy of Medicine, formerly called the Institute of Medicine, and the National Council of State Boards of Nursing.”

CONS:

Future license portability: At some point in the future, the APRN Compact will become a reality like it is for millions of registered nurses. However, more states still need to sign on to begin implementing even a fraction of a potential compact.

Stress and burnout: Recent statistics show a high level of burnout, depression, and anxiety among NPs, primarily due to workplace stress, overwork, perceptions of lack of respect from colleagues and patients, and insufficient salaries.

The 15-minute visit: Since most FNPs work in a clinic or office setting, the now common 15-minute office visit can starkly contrast with the relational aspects of bedside nursing that many nurses enjoy as RNs.

The FNP Career Pathway

For Non-nurses:

For non-nurses wanting to secure their future by becoming a family nurse practitioner, the first step is to become an RN through an associate degree in nursing (ADN) program or a bachelor of science in nursing (BSN) program.

Alternatively, a non-nurse can also pursue a direct-entry MSN program, an accelerated path where the student simultaneously earns a BSN and an MSN. Specific direct-entry programs bypass the BSN entirely. Most of these programs will require the completion of prerequisites that will likely include some combination of anatomy and physiology, biology, chemistry, nutrition, sociology, psychology, statistics, and microbiology.

For Registered Nurses:

Registered nurses with an ADN who want to pursue a career as an FNP will want to complete an RN-to-BSN bridge program and then apply to an MSN program with an FNP track. Registered nurses can also consider an RN-to-MSN program, which allows students to take core BSN courses while completing their MSN.

Potential MSN and FNP students should know there is a strong movement afoot to make the Doctorate of Nursing Practice (DNP) degree the entry-level requirement for becoming a nurse practitioner. While a goal of 2025 has been set, this change has yet to be codified as an absolute requirement, but the day for such a requirement is fast approaching.

The FNP Certification Exam

No matter what type of program is pursued to become a family nurse practitioner, graduates must apply for the 150-question FNP certification exam administered under the auspices of the American Academy of Nurse Practitioners Certification Board (AANPCB). Clinical domains covered by the exam include:

  • Newborn
  • Infant
  • Toddler
  • Child
  • Adolescent
  • Young Adult
  • Middle Adult
  • Older Adult

Students can expect to be tested regarding aspects of assessment, diagnosis, planning, and evaluation of patients across the lifespan in areas of knowledge that include:

  • Health assessment
  • Pathophysiology
  • Therapeutics
  • Evidence-Informed Practice

The Life of the FNP

Licensed and certified family nurse practitioners can work in a wide variety of settings, including but not limited to:

  • Physician practices
  • NP-run clinics and practices
  • Private practice
  • Community health centers
  • School-based health clinics
  • Urgent care centers
  • University and college health centers
  • Occupational health clinics
  • Acute care hospitals (e.g., emergency department)
  • Skilled nursing and long-term care facilities
  • Hospices
  • Retail clinics (e.g., in pharmacies)
  • Correctional facilities
  • Holistic health clinics and practices
  • Pain clinics
  • Insurance companies
  • Dialysis centers
  • Clinical research facilities
  • Substance abuse treatment programs and facilities

FNPs can earn additional postgraduate certifications in areas like psychiatric/mental health. APRNs can also become eligible for leadership positions in many clinical settings.

While those considering FNP certification may be worried about the limits of the increasingly common 15-minute patient visit, FNPs can find plenty of practice areas with other types of structures for patient interaction.

With predictions for astronomical job growth and opportunity in the years to come, family nurse practitioners will undoubtedly be in great demand nationwide. Pursuing the career path of the FNP is not for everyone, but the plethora of potential opportunities will attract students from all walks of life far into the foreseeable future.

Embracing Cultural Competence and Cultural Safety

Embracing Cultural Competence and Cultural Safety

Cultural competence and cultural safety are crucial to delivering effective care. They are also key to creating working environments where everyone feels valued and able to function at the highest level. If we invest time and energy in understanding and implementing these concepts, the dividends can be invaluable, both individually and collectively.embracing-cultural-competence-and-cultural-safety

Defining Cultural Competence and Cultural Safety

Dr. Raj Sundar is a physician, community organizer, and the Healthcare for Humans podcast host. As a healthcare leader, Dr. Sundar uses various platforms to bring a human scale to care delivery. In his view, the importance of cultural competence and safety cannot be overstated.

“Understanding cultural competence and safety is crucial when working with diverse cultures,” Dr. Sundar shares. “However, the definitions of cultural competence have evolved from diverse perspectives. One definition that’s commonly used is the following: having the capacity to function effectively within the context of diverse cultural beliefs, behaviors, and needs, as highlighted by the CLAS Standards (culturally and linguistically appropriate services).”

 He continues, “On the other hand, cultural safety goes beyond individual competency, focusing on creating environments where everyone feels safe and respected, particularly addressing historical and structural causes of inequity. It builds upon cultural humility, which involves recognizing personal biases while understanding and respecting others’ perspectives.”

 Where Does Cultural Competence Fall Short? 

However well-meaning cultural competence initiatives can be, they don’t always hit the mark. Dr. Sundar explains, “Competence-focused approaches can sometimes overlook individual differences, leading to stereotyping and neglecting unique experiences.” He continues, “Additionally, while cultural competence training is valuable, it often emphasizes surface-level cultural differences, neglecting deeper issues such as systemic biases and power dynamics.”

Sundar uses his cultural background and experience to illustrate how cultural competence can fall short. “My identity as an Indian-American from North Carolina who likes lacrosse, sweet tea, and country music illustrates the complexity [of individual experience] beyond cultural identity. Individual differences always matter, but my history and values are deeply connected to my Indian ancestry.”

A study published by the National Library of Medicine adds to this idea.

“A plethora of training is designed to expose providers to different cultures and expand their understanding of the beliefs, values, and behavior, thus achieving competence. Although this intention is commendable, training providers to become competent in various cultures presents the risk of stereotyping, stigmatizing, and othering patients and can foster implicit racist attitudes and behaviors.

“Further, by disregarding intersectionality, cultural competence training tends to undermine provider recognition that patients inhabit multiple social statuses that potentially shape their beliefs, values, and behavior.”

Parallel Concepts

When it comes to other concepts that parallel cultural competence, Sundar adds that two other terms to be familiar with are cultural humility and responsiveness.” He describes them thus: “Cultural humility is an attitude or mindset characterized by an ongoing willingness to engage in self-reflection, self-critique, and lifelong learning about one’s own cultural biases and the cultural backgrounds of others. It emphasizes recognizing the limitations of one’s perspective and being open to learning from diverse experiences and perspectives.”

He states, “Cultural responsiveness involves recognizing, respecting, and integrating individuals’ cultural backgrounds, values, and beliefs into designing and delivering services and interventions. It goes beyond cultural competence by emphasizing the importance of engaging with communities, co-creating solutions, and adapting practices to meet diverse populations’ specific needs and preferences.”

Strategies and Tools for Increasing Cultural Competence

There are many strategies and tools for increasing cultural competence. Dr. Sundar shares, “While insufficient, cultural awareness training can be essential opportunities to connect with peers to reflect on conflicts, tension, or care pathways that can be improved.” His examples include asking questions like:

  • Why does our Russian community have the lowest mammogram rate?
  • When a Jehovah’s Witness refuses blood in a life-threatening situation, are we all aware of what to do and have the support we need?
  • When families come together to care for an individual, can we navigate that context in our highly individualistic environment?

Sundar adds, “It’s often essential to have cultural liaisons, which allows for collaboration with community leaders and organizations serving diverse populations.” This strategy can provide insights into cultural norms and various practices and behaviors that community members engage in when seeking healthcare.”

As a community organizer, Sundar has other recommendations. “Building relationships with your community is helpful. Part of my podcasting journey with Healthcare for Humans is building relationships with local immigrant and refugee communities, amplifying their voices, and caring for them in the way they want in the context of their history and structural inequities.”

Patients’ perspectives must also be taken into consideration. “It can be beneficial to actively seek patient input about cultural preferences, needs, and concerns,” Sundar advises. “Take time to listen attentively and respectfully to patients’ perspectives and incorporate their feedback into your approach to care. Ask, ‘How can I be a better advocate and caregiver for your community?’”

Dr. Sundar reminds us that we must also reflect on our cultural biases, assumptions, and privileges. “If we consider how these factors influence our interactions with patients and colleagues from diverse backgrounds, that self-awareness is a step toward becoming a more culturally aware healthcare professional.”

A Learning Process

In the end, Dr. Sundar has specific recommendations for nurses.

Nurses should recognize cultural awareness as a continual learning process rather than a static achievement. For example, it’s been a journey for me to realize how to incorporate the values of the Native Hawaiians and Pacific Islander community in my care. I have had to be intentional about how I say hello and talk about suffering to meet the community where they are. It takes time and building relationships to realize this.”

Dr. Sundar believes that achieving health equity requires ongoing self-reflection and that we remain open to diverse perspectives.

“Health equity is the idea that everyone should have the same opportunities to be as healthy as possible, regardless of their circumstances, and we must be committed to it. Doing this work isn’t always easy, but it’s worth the effort and will always be needed in our diverse world.”

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