Around the world, patients rely on transplant nurses to help them navigate the complicated path to a transplant.
To honor the work these nurses do, the International Transplant Nurses Society (ITNS) established Transplant Nurses Day to be held annually on the third Wednesday in April. On April 18 this year, transplant nurses around the globe will celebrate the life-saving, life-giving, and life-changing work they do.
From its Chicago, IL headquarters, the ITNS helps nurses around the world connect with others in this specialized field and offers information to remain professionally current.
Transplant nurses work with patients who are having or have had solid organ transplants, so in addition to patient care, they also must stay current with the advances in transplantation itself. Education and professional growth are topmost issues for ITNS and nurses are encouraged to remain continually engaged with learning.
Transplant nurses have particular concerns about their patients and will interact with them along the entire spectrum of their transplant care. Theses nurses can specialize in one particular area—transplant coordinator, staff nurse, or post-operative, for instance—but understanding the entire transplantation spectrum helps them offer better care.
And while Transplant Nurses Day is a highlight of the year, the society also offers awards for transplant nurses and a yearly essay contest (the winner is announced on Transplant Nurses Day). The organization helps nurses interact with other nurses in the same specialty. Hearing from and learning from others in the field helps bring a fresh perspective and a new drive to their personal and professional commitment. Celebrations and struggles are understood and tips about certification or insight into transplant patient care can be shared.
And because transplant nurses work with more than just the patient, they are also able to address issues related to the family and loved ones of transplant patients. The ITNS Foundation offers grants and scholarships for professionals who want to further knowledge in the field as well.
Help the transplant nurses in your life celebrate their success on Transplant Nurses Day!
Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.
One morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study?
Lack of study time was also noticeable in the part-time evening students. I recall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that they had not prepared for the evening’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and ill-prepared nursing student.
Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our students’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers.
I have contemplated methods to assist nursing students, which have resulted in better outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting:
- Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological support, which surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing.
- Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner.
- Remind the student of your availability. I state my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction.
- Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers, and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational.
- Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them one-on-one would be.
These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere.
A nursing career in public policy was considered unique decades ago. However, increasingly nurses have developed the skill and expertise needed to inform the policy-making process through their professional and voluntary endeavors. Nurses now serve in numerous leadership roles where they use their health policy expertise to shape the policy discourse, monitor the impact of legislation, and oversee regulatory processes.
In addition to the increased numbers of nurses working in governmental and nongovernmental agencies, nurses serve as elected officials and work as health policy consultants or health care lobbyists. Regardless of role or setting, nurses working in the policy arena are required to use their public policy acumen to inform legislation, oversee regulations, or advocate for policies that are of benefit to consumers, patients, and the profession.
Nurses serving as elected/appointed officials or health care lobbyists are immersed in the policy-making process and have a front row seat in influencing the public policy agenda. Both opportunities require a comprehensive knowledge of the complexities associated with lawmaking and a willingness to listen and assess varying perspectives. The ability to communicate well and build partnerships while working with diverse stakeholders cannot be overemphasized.
Noteworthy, three nurses are serving as elected officials during the 115th Congress. Representative Karen Bass, APRN, represents California’s 37th congressional district and is in her fourth term. Congresswoman Bass serves as a ranking member of the Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations.
Representative Diane Black, BSN, has represented Tennessee’s sixth congressional district since 2010. She serves on the House Ways and Means Committee.
Representative Eddie Bernice Johnson, BSN, is the first nurse elected to the U.S. Congress and is now in her thirteenth term representing the 30th congressional district of Texas. Representative Johnson serves on the House Committee on Science, Space and Technology; House Transportation and Infrastructure Committee; the Aviation Subcommittee; the Highways and Transit Subcommittee; and Water Resources and Environment Subcommittee.
Many nurses are familiar with former representative, Lois Capps. Capps represented California’s 24th congressional district after winning the seat in 1998 after her husband died in office. She championed numerous nursing and health care issues and started the Congressional Nursing Caucus.
No doubt, other nurses are well poised to follow suit bringing their expertise to an elected office. For example, Lauren Underwood launched her campaign last fall to represent the fourteenth congressional district in Illinois. Underwood brings a wealth of nursing and government expertise and is passionate about ensuring access to high-quality health care for all.
Nurses are also well suited to serve as health care lobbyists because of their vast knowledge of nursing, health, and health care. An extensive knowledge of these and other areas is critical to advocating for legislation aimed at improving access to health care, enhancing health outcomes, and transforming our health care delivery system. Additional competencies needed for such a role include strong interpersonal communication skills, research/analytical skills, detail orientation, knowledge of political, legislative, and regulatory processes, and the ability to create and deliver messages to a wide array of diverse stakeholders including legislative officials. Health lobbyists are responsible for conducting policy analyses and summarizing information that is suitable for a variety of audiences. Nurse lobbyists may work as a consultant employed by a professional/specialty nursing or non-nursing organization, health care facility, insurance company, or pharmaceutical company, to name a few.
The current push to increase the number of nurses serving on boards provides yet another opportunity for nurses to become more engaged in aspects of the policy-making process. Depending on the mission of the organization, board members may be responsible for shaping a legislative or advocacy agenda on behalf of the constituents they serve. To illustrate, I acquired some of my health policy skills while serving as the Chair of Public Policy for my local Susan G. Komen Affiliate. In this capacity, I along with board members advocated for breast cancer funding for underserved women and helped to shape and monitor the organization’s legislative agenda. This experience provided a unique opportunity for me to serve as a lead spokesperson providing testimony before my state legislature regarding the “Reducing Breast Cancer Disparities bill.” This bill includes significant provisions designed to reduce breast cancer disparities among underserved and underinsured women across the entire state.
In addition to some of the previously mentioned career opportunities in the health policy arena, nurses in the following roles utilize their policy knowledge and expertise to advance the nursing profession and transform today’s health care delivery system:
- Dean/Associate Dean of a School or College of Nursing
- Director of Government and/or Regulatory Affairs
- Office of Government Relations
- Director/CEO of a Government Agency
- CEO or Executive Director of a Nonprofit Health Care Organization
- CEO of a Professional Nursing Organization
- Chief Nursing Officer
- Surgeon General/Assistant Surgeon General
- Chair of Health Policy Committee for a Professional or Specialty Organization
- Health Commissioner
- Board Member for a Health Department, Hospital, or Community-Based Health Care Organization
- Chair of a Health Policy Committee for a Voluntary Organization
- Nurse Attorney
- Hospital Administrator
- Executive Director of a State Board of Nursing
- Health Policy Analyst
- Nurse Regulator
Nurses wishing to pursue a career in health policy can begin by first identifying what is most important to them. Nurses who do not have a background in political science or law may need to invest in professional development through formal/informal education. Taking health policy courses is a good step as such course work provides an overview of the policy-making process and may provide some exposure to in-person or virtual lobbying.
Getting involved with the advocacy/legislative arm of one’s professional or specialty organization is yet another great way to gain exposure and experience related to the policy-making process. Many nursing organizations have a policy agenda and work to ensure that their voices are heard on things of importance to the profession and those they serve. Serving as an intern in a legislative office for an elected official may also provide some beginning exposure to the policy and legislative process. These types of experiences can enhance one’s credibility when launching a career in public policy.
Participating in health policy fellowships, internships, or other structured immersion activities can go a long way in laying the foundation for future engagement in the policy arena. I cannot overestimate the value of talking with those already in the field. Elected officials, nurse/health care lobbyists, and individuals currently running for office as well as other nurse leaders can provide valuable insights regarding the expectations for this type of role. Attending a state board of nursing meeting is another excellent way to become acquainted with the regulatory aspects of the policy-making process. Finally, staying abreast of current and emerging issues in health care and nursing provides a critical foundation for future advocacy and political activism in the health policy arena.
Ernesto Holguin, RN, BSN, CNN, dialysis clinical coordinator at Las Palmas Medical Center in El Paso, Texas, was saddened to see his elderly patient arrive for her dialysis appointment in 2003 with a foot infection caused by a diabetic ulcer.
“Diabetes had affected her eyesight and caused her to lose feeling in her feet,” says Holguin. “It was only when she smelled a foul odor emanating from her foot that she realized something was wrong.”
Wishing there was a tool that could assist diabetic patients in preventing foot ulcers from developing, Holguin decided to invent a device.
Holguin is one of many nurses across the country who have envisioned inventions they believe will help improve patient care. One of the earliest nurse inventors, Bessie Blount Griffin, an African American nurse, invented a feeding tube during World War II to help feed paralyzed veterans. Since then, many more nurses have tapped into their natural problem-solving skills to invent devices to improve the patient experience.
Ernesto Holguin, RN, BSN, CNN
For Holguin, that meant finding a way for patients to avoid diabetic foot ulcers or in the event they did develop a foot ulcer, to prevent it from becoming infected. The American Podiatric Medical Association (APMA) says that foot ulcers are one of the most common complications in patients with diabetes and if not treated properly, can lead to infections and in some cases, diabetes-related amputation. According to the APMA, foot ulcers occur in approximately 15% of diabetic patients and are commonly located on the bottom of the foot. Among patients who develop a foot ulcer, 6% will be hospitalized due to infection or ulcer-related complications, and 14–24% of patients with diabetes who develop a foot ulcer will require an amputation.
“The current protocol for prevention of diabetic foot ulcers involves patients checking their feet on a daily basis for cuts, cracks, blisters, and signs of an open wound,” Holguin says. “Patients who have trouble viewing the bottom of their feet are often told to stand over a mirror at home, but this can be difficult for patients who are overweight, arthritic, or elderly and don’t have good balance.”
Holguin envisioned a device that patients would use at home to prevent and effectively monitor their diabetic foot ulcers. The apparatus would inspect, dry, and take pictures of a patient’s feet and then send that information to their clinician.
His idea began to gain traction in 2007 when the first iPhone was released, and the idea of doing remote patient consults became a distinct possibility. In 2015, Holguin was invited to a workshop that the MakerNurse program was holding in Texas. Founded in 2013, MakerNurse works with nurses to bring their ideas for inventions to fruition, believing the best ideas for patient care are often developed by those on the front lines who work directly with patients.
“I told Anna Young and Jose Gomez-Marquez, the cofounders of MakerNurse, about my invention and they were very enthusiastic and encouraged me to build a prototype,” Holguin recalls. “Even though I’ve always liked to tinker, I never imagined I would one day design and build a device that could help my patients.”
Gomez-Marquez says MakerNurse launched in 2013 with support from the Robert Wood Johnson Foundation. MakerNurse provides the tools, platform, and training to help nurses like Holguin make the next generation of health technology. Two years ago, MakerNurse partnered with the University of Texas Medical Branch at Galveston to open their first MakerHealth Space in John Healy Hospital.
“Too often nurses have a great idea on how to but aren’t sure how to make it a reality,” says Gomez-Marquez. “We encourage nurses who have an idea for an invention to build a prototype and run with their idea.”
Working out of his garage in El Paso, Holguin recently finished the fourth prototype for his device. The first three he says were too large and cumbersome for patients to use. The U.S. Patent and Trademark Office recently certified Holguin’s patent, and is now working with a local medical incubator to turn his idea into a medical grade device.
“The next step is to have the device tested in clinical trials, and if successful, to submit it to the Food and Drug Administration (FDA) for approval,” Holguin explains. “I’ve talked with several doctors who believe my invention could be part of an important part of a diabetic patient’s treatment plan.”
In addition to making it easier for diabetic patients to monitor their feet for foot ulcers, Holguin believes his invention would reduce hospital readmissions. And more importantly, it could also help patients maintain a better quality of life.
“Some diabetics are only in their forties or fifties when an infected foot ulcer leads to amputation and disability,” says Holguin. “I’m confident this device can help diabetic patients to remain employed and live fulfilling lives.”
Making Your Idea Reality
Do you have an invention you think would improve patient care? Here are some tips on how to get started.
Conduct Due Diligence
It’s important to research whether there are any similar products in development, and also to decide whether you want to sell your idea to a company or to start your own business. Organizations such as the Small Business Administration can help you with these decisions.
Design a Prototype
Ideas are great, but you need to have something tangible to demonstrate how your invention works. MakerNurse can help nurses learn how to sketch and design a prototype and test out their ideas.
Seek out Support
MakerNurse has MakerHealth Spaces across the country that provides nurses with direct access to tools, materials, and expertise to build prototypes and test their ideas. Interested hospitals can host a MakerNurse workshop or invest in a MakerHealth program for their hospital. Visit MakerNurse.com to learn more.
Additionally, companies like Edison National Medical lend their expertise to help inventors to make their ideas a reality. The company says inventors will never pay more than $25 so it’s low-risk.
Consider a Patent
After you’ve developed a prototype for your idea, consider getting a patent to protect your invention. Visit the U.S. Patent and Trademark Office.
Nurses as Makers
Roxanna Reyna, BSN, RNC-NIC, WCC
Roxanna Reyna, BSN, RNC-NIC, WCC, a wound care coordinator at Driscoll Children’s Hospital in Corpus Christi, Texas, calls herself “MacGyver Nurse.” True to her moniker, she invented a unique skin and wound dressing for infants with abdominal wall defects.
Reyna’s workplace, Driscoll Children’s Hospital, was one of five “expedition sites” initially launched at hospitals in California, New York, and Texas, by MakerNurse.
Reyna got the idea to make a dressing for children born with omphalocele, a type of birth defect that leaves intestines protruding from the body and covered only by a thin layer of tissue. Surgery repairs the defect, but in the interim, the infant is at risk of infection.
“There weren’t any dressings or bandages made for kids that provided the same level of healing,” says Reyna. “So, I started experimenting with bandages, sponges, and tape.”
Reyna’s invention not only helped her colleague and young patients, but she was also invited to the White House in 2014 to meet President Obama and to take part in an event honoring “makers.”
Since Reyna’s product is tailored to a specific group of patients and there’s not enough demand for it to be manufactured on a large-scale basis, she did make directions on how to construct her dressing through MakerNurse.
A Path of Beauty
Monique Rodriguez was working as a labor and delivery nurse in Indiana when she decided to launch her own beauty company, Mielle Organics.
“While looking for natural solutions for my own hair challenges, I began creating products in my kitchen and blog about my hair journey on social media,” says Rodriguez. “I gained an audience and people began to
ask if they could purchase my concoctions. A light bulb went off and Mielle Organics was born.”
Rodriquez initially stayed in her nursing job to save money to fund the company.
“I strongly believe in speaking things into existence. I wrote my resignation letter in May and dated for November and was actually able to quit my job sooner,” she says.
Although she had little entrepreneurial experience when she started her company, Rodriguez did have drive and determination. In an effort to learn as much as she could, Rodriguez read books, listened to podcasts, and scoured the Internet to obtain as much information as possible.
“When I launched my business in 2014, natural hair products for black hair was an emerging market and I was attempting to stay on the cutting edge,” she says. “Today, the market is much more competitive, and although there’s room for all brands to succeed, we strive to be number one.”
Rodriguez, who worked as a nurse for nine years, says one of the biggest barriers she faced in launching her own business was not letting fear overcome her.
“It was very scary leaving my career as a RN, because of the fear of the unknown,” says Rodriguez. “I also wish that I had a business mentor or someone to talk with in the beginning.”
Rodriguez says her background in nursing also proved helpful in developing the Mielle Organics line.
“I understood the importance of using high quality ingredients that are effective for hair growth,” she says. “When we formulate our products, we don’t just focus on hair care, but also how healthy are the ingredients.”
Today, Rodriquez leads a corporate staff of 13 and her business is thriving. Mielle Organics are now sold at Sally Beauty, Target, and CVS locations.
An Invention Leads to a New Business
Lisa Vallino, RN, BSN
Lisa Vallino, RN, BSN, still remembers when she and her nurse colleagues would turn plastic cups into makeshift intravenous (IV) covers for their pediatric patients. Although it worked to prevent patients from accidentally dislodging their IVs, Vallino thought there had to be a better way.
“Nurses are inventors by nature,” says Vallino. “I looked at these IV cups we were using to keep our young patients from snagging and pulling out their IV tubing, and it occurred to me that someone should invent a pre-cut IV insertion site cover.”
Vallino mentioned the idea to her mother Betty Rozier, and the two worked to design their own version of an IV site protector. They started with a specimen cup and tweaked the dimensions into a prototype they called “IV House.”
“The first feedback we received from nurses was that the device was too big,” says Vallino. “We went back to the drawing board and made a smaller size, as well as providing ventilation so we weren’t providing a warm, dark, and moist environment under the IV House.”
She and her mom then worked with a plastics manufacturer to produce the product in bulk.
“The first attempt was a disaster,” explains Vallino. “The manufacturer delivered the IV House shipment to the hospital without labels and we also discovered the finished product was full of flaws.”
The experience taught Vallino to fully vet and test a prototype with a manufacturer before committing to the process. While continuing to work as a nurse, Vallino spent her off hours developing her invention.
“We started with the UltraDome for pediatric patients, a clear, plastic IV site protector designed to shield, secure, and stabilize the catheter hub and loop of tubing at an IV insertion site,” says Vallino. “Since then, we’ve invented a new and improved UltraDome that is used in hospitals around the world.”
Since her first invention, Vallino has gone on to develop 19 other products under the IV House name and to also work with other nurses to develop their inventions.
“Several years ago, a nurse friend had an idea for an invention that I bought,” says Vallino. “That idea resulted in the new TLC UltraSplint, featuring an ergonomic design and see-through openings. We found that with traditional arm boards there were injuries occurring that could be avoided.”
Vallino says she still hears from a lot of nurses who have ideas for inventions. Many just want to know if their idea is viable. After signing a nondisclosure agreement, Vallino offers feedback on the ideas, and for those that show promise, she encourages those nurses to find the right buyer.
“Our business is concentrating on working to create the most effective and highest quality products available to IV therapy patients,” says Vallino. “In addition to maintaining our current products, I have ideas for an additional five to six inventions I’d like to roll out in the near future.”
Our health care system today has made tremendous progress in providing care to individuals and families. Change is good, but as the health care industry rapidly responds to emerging trends, markets, and opportunities, how staff nurses respond to different kinds of work culture is important, particularly when work culture highly impacts a nurse’s job function.
Work culture is made up of the norms, values, and beliefs that characterize an organization. Several factors, including management, workplace practices, policies and philosophies, employees and their interactions, leadership, expectations, rewards or recognitions, communications, transparency, and support within an organization, can influence work culture. Work culture,which can make or break a workplace, is powerful. It can inspire health care employees to be more productive and positive at work, or it can make them feel undervalued and frustrated. Thus, it plays a crucial role in shaping behaviors in organizations.
Your Work Culture
Ask yourself the following:
- What is the culture like in your workplace?
- Do staff naturally unite and collaborate?
- Are the leadership and executive teams available and transparent?
- What values and principles does your organization express?
Sometimes, you might say “it’s challenging.” Defining work culture can be difficult; nevertheless, it is fundamental to good (or poor) practice. Work culture is not often discussed, but clearly, nurses can be negatively or positively influenced by their work culture.
Work culture in nursing is critical to job satisfaction, nurse retention, and patient outcomes. A toxic work culture can lead to increased sick days, stress-related symptoms, and nurse turnover. It also plays a large role in the ability to provide quality nursing care. Work culture can impact everything from the safety of patients to job satisfaction. If yours is negative and discouraging, you cannot just wait for it to change. The first thing you must realize is that it might not change at all without you taking some kind of action.
Understanding your work culture is key to developing practice that aims to improve care. Although a positive work culture is mostly created from the top down, it often happens from the bottom up. Nurses should not undervalue the power of their work culture. Understanding work culture as a learning environment is related to how nurses choose to engage in their workplace and how the workplace normalizes their involvement in activities and interpersonal relations. Nurses can take inspired action, engage in networks, and initiate work culture change. This is not a simple task, but nurses can utilize their own personal power and create cultural transformation in their workplace. Keep in mind that work culture can—and will—change and evolve over time. The first approach is to define and evaluate your work culture—both what it is now and what it should be in the future.
Every workplace has its own work culture. Most of this is unspoken, but a lot can be learned from an employee handbook or company policy. Observation, assessment, and communication are key approaches to help you uncover your work culture. These key approaches can also be utilized by someone who has unique developmental and socialization needs, such as new graduate nurses, international nurses, student nurses, and nurses who are undergoing role status changes or transitioning to a new area. No matter what your status is, here are five ways to help you thrive in your work culture.
- Watch and learn. Give yourself some time to understand the reasons behind workplace behavior and you will be much more successful in understanding the causes. Observe how things are done. Take notes. Keep track. Building relationships with people in your workplace and connecting with someone on your team who has a good understanding of how the workplace culture works can help you better understand and avoid making a mistake.
- Don’t be afraid to ask questions. You don’t need to know everything. Questions are a great way to clear up differences and get to know people. Also, be sure to ask for help whenever you need it. Asking for assistance or an explanation should not be considered a sign of weakness.
- Remain motivated at work. Nurse burnout is real, so it is important to recognize the impacts you make on your patients and workplace every day. Focus on yourself and how you can be a positive influence.
- Be transparent. Let your coworkers know about your background and your career goals. Don’t hesitate to share your ideas and let your team and supervisor know what other skills you have to offer.
- Acknowledge your mistakes. Apologize and laugh it off. Keep your sense of humor and learn from every mistake you make.
Developing the skills and ability to understand and communicate effectively with all your coworkers (including your supervisor) is critical to your success in your own career, as well as the success of your organization. These skills are not innate; they require practice, but anyone can develop these skills. Adapting to a new work culture is an ongoing process. Once you have the skills, you can work more effectively with different groups of people and adjust easily to working in different cultures throughout your career.
Nurses aren’t just meant for hospital work, as they have plenty of career options to choose from now. Spending time and money to prepare for nursing school opens a wide variety of opportunities, which can help you recover your investment even without the need of pursuing a job at the hospital. Here are five non-hospital jobs you should consider.
1. Cruise Ship Nurse
This position provides many registered nurses the benefit of work and travel at the same time. Working as a health care provider on an ocean liner definitely has some similarities and differences with those of land-based jobs. Like most hospitals or clinics, you would need to have a Bachelor of Science in Nursing degree, but nurses who have earned their master’s degree are given priority.
Those who aspire to work on board would need to have their registered license of course and certifications for both Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ASL).
Below are the expected skills of a cruise ship nurse:
- Organizational skills for document sorting
- The ability to stay calm under pressure
- Critical thinking
- Excellent communication skills with a pleasing personality
- Good problem-solving skills
- Must be emotionally stable at all times
Employers hire those who have at least two to three years of working experience, preferably in emergency or acute care. Since you will be working with a small staff and limited supply, these responsibilities will be divided between each personnel:
- Direct patient care (from first aid to a serious medical case)
- Oversee proper patient documentation
- Provide first aid training
- Assist in staff drug testing
- Conduct lifeboat safety drills
- Check and restock medical inventory
- Accompany patients or evacuees to land facilities via small boat or helicopter
Typical schedules would be 10 to 12-hour shifts with one day off (on rotation) and a high possibility of on-call situations. The contract presented to nurses would run a minimum of 6 months to 1 year depending on the cruise line and the salary offer would be around $3,000 to $5,000 per month.
Some pros for this job include: all-expense paid travel, large workloads earning better experience, and great for those who settle for short-term and recurring contracts.
However, the cons of this job would be the very strict and competitive market (e.g., employers preferring nurses with bilingual skills or work experiences in multicultural settings), small salary rate, and having to be away from loved ones, especially those who are tied with responsibilities at home.
2. Nurse Coach
Are you considered a great influencer? Then being a health coach might be the perfect career for you! A lot of companies (including insurance firms) hire these nurses to assist employees (especially those with chronic diseases) with achieving their health goals.
Nurses who have a BSN are qualified to apply for this job, but note that a master’s is preferred for this role as well. You can be board-certified as a nurse coach (NC-BC), a holistic nurse coach (HN-BC), or a health and wellness nurse coach (HWNC-BC). The American Holistic Nurses Credentialing Corporation is the agency that administers the certifications. To learn more, visit ahncc.org.
Here are the skills that are expected for this particular career path:
- Must be confident
- Exercises self-control at all times
- Very patient and understanding
- Must have knowledge regarding lifestyle-related topics and chronic diseases
- Must be optimistic
- Excellent communication skills and influence
- Excellent personnel management
- Must be willing to cooperate and collaborate with the client
- Excellent problem-solving skills
- Must have initiative
Employers expect each health coach to work closely with their clients and make sure that each responsibility is met:
- Empower patients with chronic illnesses to live a healthy lifestyle
- Teach proper health care to avoid further medical complications
- Help client realize health goals and construct a SMART (Specific, Measurable, Achievable, Realistic, Time-based) plan to achieve it
- Conduct health-related wellness seminars and training
There are many pros to this career, such as a possible salary of $66,000 per year, the benefit of working with diverse personalities, and a wide range of employers.
Personal stress, uncontrollable shifts (on-call situations), and unruly clients/patients could be some of the cons to this job. However, you should always have yourself ready for these can be present in any work environment.
3. Insurance Firm Nurse
If you have a knack for organizing documents, interviewing clients, and resolving complaints, then you might want to consider working for an insurance firm.
Of course, aspirants would need to have a BSN or MSN degree and a RN license to practice. On top of that, a minimum of 2 years work experience is needed.
An insurance firm expects that every candidate possesses these skills:
- Organizational skills, such as documentation and bookkeeping
- Problem-solving skills for case handling
- A keen eye for analytical situations
- Interpersonal skills
- Good personnel management
In this field, multiple positions are available for both LPNs and RNs, such as:
LPN available positions
- Appeals Nurse Associate: handles member appeals and resolves complaints and grievances.
- Health Coach Associate: works with the employees of an organization where health challenges are identified to create wellness campaigns and incentive programs to reduce member complaints.
- Quality Management Nurse Associate: conducts interviews and reviews along with health care providers to promote the highest quality of medical procedures and outcomes.
RN available positions
- Health Coach Consultant: manages lower level associates and conducts campaigns for both organizations and facilities to improve overall performances for companies or hospitals.
- Nurse Educators: educates patients on an academic level regarding selected medical professionals as well as appropriate medical treatment. This is only for rerouting and no medical advice can be provided by these nurses.
With the diverse tasks given out to nurses who work in an insurance firm, they are able to earn as much as $80,000 per year.
The pros of this career include being home-based work wherein they can just appear in the office for about 2 to 3 times a week, which leads to another pro: more family time!
A disadvantage is that it is more clerical than medical and if needed, you might be called to work in out-of-state field cases.
4. Medical Sales Representative
This field needs nurses who have very influential vocabularies and can close sales. If you think you can turn a hard “no” into a graceful “yes,” then being a “med rep” is the job suited for you!
It doesn’t strictly need a bachelor’s degree in the medical field, but one requirement is that your degree is health care, life science, or marketing-related. You should also consider becoming certified, which you can apply for with the National Association of Pharmaceutical Sales Representatives (NAPSR).
To be a successful sales representative, these skills are must-haves:
- Pleasing personality
- Well-versed and influential
- Excellent communication skills
- Knowledgeable about medical updates, especially in the field of technology and treatments
- Have a keen eye for analytical situations
- Organizational skills for document preservation and revision
This field is very competitive and challenging because of the following responsibilities:
- Establish and maintain relationships with possible clients
- Provide newly developed samples of medicinal products or equipment
- Document and organize the records of all established contacts
- Monitor and analyze competitor’s products and actions
- Appointment setting with clients with a well-presented discussion of new products
Of course, with every difficult task and every sweet “yes,” sales reps are rewarded with a high salary that could reach up to almost $96,000 PLUS a bonus or incentive for each sale that one makes. Based on a 2017 salary report, the average overall compensation for a sales rep reached up to a whopping $147,424. Hard work definitely pays off!
Building connections with suppliers as well as creating ties with clinical offices that could possibly be the next workplace are just some of the pros of this job. Don’t forget the high salary and incentive!
However, the price comes with a demanding workload and honesty. Even the best salesman still gets a “no” from time to time so expect that another con would be the days without commissions.
5. Parish Nurse
This field is a combination of tasks that are present in both health coaching and insurance firm nurses. This focuses on a more holistic approach to a person’s health.
To enter this career, applicants would need to have a BSN or MSN degree. A nursing license registered in the same state as that of the parish is required along with 3 to 5 years of nursing experience.
Some parishes also require that candidates undergo theological classes, which could run for about 1 to 2 weeks.
Here are the skills needed for this role:
- Excellent communication skills
- Pleasing personality
- Familiar with spiritual and cultural activities
- Ability to refer patients to other medical professionals
- Knowledgeable about nursing practices, medications, tools, and equipment
Responsibilities for parish nurses may include:
- Personal health counseling to the faith community
- Training volunteers
- Assisting in developing support groups
- Educating the community on self-care and personal first aid
- Referring patients to medical facilities and professionals for direct treatment
Taking all of the responsibilities into consideration, it comes as no surprise that the salary range for a parish nurse is anywhere from $45,000 up to $92,000 per year, according to Payscale.com.
A few benefits of this career include the perks of working close to home since you will be at your local parish daily and the power to gain complex knowledge that only priests can provide.
On the other end, you will not be providing any direct treatment and there will be instances of out-of-city work that you would need to attend along with the authorities of the parish.
Helping other people is not bound by the white walls of an emergency room or by the great halls of a hospital. These settings certainly allow nurses to further diversify their experiences and gain more knowledge as a basic and holistic health care provider. With this, nurses can definitely expand the use of their medical expertise.
The stress of nursing can take quite a toll on nurses emotionally and psychologically. Learn to recognize the signs, what to do, and when to seek help.
Abbegail Eason, RN, remembers some of the most devastating moments she’s witnessed as a nurse: a teenage girl learning she would never walk again after being shot by a gang member, a mom who gave birth but then died from a cerebral aneurysm just days later, and a baby who was left in a store’s parking lot and ended up dying.
“In these types of situations, it’s almost impossible not to be affected after your shift is over,” says Eason, a holistic coach at Abbegail Eason, LLC.
“Every nurse is susceptible to suffering from emotional distress,” explains Lucia M. Thornton, RN, MSN, AHN-BC, a consultant, educator, and author of Whole Person Caring: An Interprofessional Model for Healing and Wellness. Thornton and other sources we interviewed say that while all nurses can be affected emotionally, those in particular specialties may be more apt to experience this kind of issue. Some of the areas where nurses are especially at risk: emergency departments and trauma, intensive care unit (ICU), hospice, oncology, pediatrics, HIV clinics, homeless medicine, high-risk pregnancy clinics, palliative care, and neonatal intensive care unit (NICU), among many others.
“Anyone who is empathetic and works in a caregiving role—including nurses and certified nursing assistants—are at risk for developing compassion fatigue and increased caregiver stress, which affects emotional health,” explains Karen Whitehead, MS, LMSW, DCC, CCFP, who provides counseling in the greater Atlanta area and at TurningPoint Breast Cancer Rehabilitation. “Nurses who over-identify with patients and blur boundaries, as well as nurses with personal trauma histories, poor social support, isolated working conditions, or a previous history of unmanaged anxiety are at greater risk. Feeling a lack of control about your work environment—including schedule, lack of recognition, or sense of community—can also contribute to caregiver stress.”
“Working in these areas with these types of patients triggers the sympathetic nervous system and keeps the body in fight or flight mode. This heightened stress reaction can, over time, lead to compassion fatigue and ongoing emotional distress,” she adds.
It can also be especially difficult for nurses because they are on the frontline of patient care, says Carl J. Sheperis, PhD, NCC, CCMHC, MAC, ACS, LPC. “Aside from the ongoing stressors of variable schedules, budget cuts, and constant technology changes, nurses are faced with a broad range of emotions experienced by patients,” explains Sheperis, a licensed professional counselor as well as the program dean for the College of Social Sciences at the University of Phoenix. “According to the American Nurses Association 2011 Health and Safety Survey, over 56% of participating nurses had experienced some type of threat or verbal abuse from patients. All of these stressors compound and result in high incidences of compassion fatigue and burnout for nurses.”
Compassion Fatigue, Moral Resilience, and Burnout
Mary Bylone, RN, MSM, CNML, president of Leaders Within, LLC, and a former board member of the American Association of Critical-Care Nurses (AACN) often lectures and writes about the AACN’s healthy work environment standards. Bylone says that while compassion fatigue, moral resilience, and burnout are terms often used interchangeably because they do have a lot of overlap, they also have some differences.
“Burnout is best used to describe a situation in which an individual feels overwhelmed and exhausted. It can be seen when people sacrifice themselves for work or become overwhelmed with the feeling that the work is never done. Compassion fatigue refers to the weariness that develops from caring for individuals when the caregiver feels saddened that they cannot change the situation and give of themselves in the hope of relieving pain or suffering in the patient,” explains Bylone. “Moral resilience refers to the aspect of an individual’s character to rise above situations creating moral distress, such as being asked to provide futile care or care against a patient’s wishes. Resilience comes when the nurse is able to restore and maintain their integrity by challenging or pushing back when asked to do things they do not feel are right. It involves using one’s bold voice to speak up when others would remain silent—to ensure that the morally right thing is done.”
For the past decade, the AACN has addressed all these issues. Its National Teaching Institute recently held a special interactive session during which more than 300 nurses spent an afternoon sharing the types of experiences that would cause these feelings and sharing their solutions with their colleagues as well. “The AACN puts a lot of energy into hope and resilience rather than dwelling on the negative,” says Bylone.
Recognizing the Signs
“Experiencing emotional reactions is human and appropriate,” says Sheperis. “The key is recognizing when the emotional reactions are out of proportion to a situation or when they have a negative impact on you or others around you. Nurses are often good at compartmentalizing emotional reactions, but sometimes the compartments become full, and the emotions spill out.”
Some of the signs that a nurse is experiencing negative effects from emotional overload are: using a greater number of sick days and/or dreading going to work; feeling exhausted; problems sleeping; using drugs or alcohol to sleep; having work-related dreams, nightmares, or intrusive thoughts; being angry a lot either at work or home; yelling at patients or families; changes in mood or behavior at work; crying all the time; feeling angry at supervisors or coworkers; developing fears about the safety of friends or family; feeling less engaged in their personal and/or professional life; the inability to think clearly; headaches; gastrointestinal problems; irregular breathing patterns, feeling devalued, and losing the capacity to care about themselves, their patients, their family members, or really anyone.
This doesn’t even touch on the signs of clinical depression, which nurses may also experience. The point is that if nurses notice vast changes in themselves or in their coworkers, they may need to seek or suggest help.
The first action that nurses can take to keep their emotional health intact is to set boundaries, says Gail Trauco, RN, BSN-OCN, a grief mediator, owner of Front Porch Therapy, and author of Conquering Grief from Your Own Front Porch. Nurses can do small things to make themselves happy. “Be sure you have things that you visually see which create an immediate ‘happy sensation,’” suggests Trauco. “This can be a favorite coffee mug, bright-colored scrubs, flowers on your desk, or even a funny stethoscope cover.”
One of the biggest problems nurses have is that they tend to put everyone else’s care above their own, says Jill Howell, MA, ATR-C, LPC, a board-certified registered art therapist, professional counselor, and author of Color, Draw, Collage: Create Your Way to a Less Stressful Life. While she works at Pocono Psychiatric Associates, Howell worked with many nurses at the Pocono Medical Center. “It’s all about self-care—nurses will, of course, react by saying that they don’t have time,” says Howell. “Please remember what they say on the airplane—put your oxygen mask on first before you try to help others.”
When working with nurses, Howell would check in with them to see how they were dealing with work, give them an opportunity to vent, and make small self-care suggestions. She would also do quick guided meditations with them, teach a relaxation technique, or set up large sheets of mural paper and have them draw out their frustrations.
“I have found that most nurses, while they can care for others continuously, have a very difficult time in caring for themselves,” says Thornton. “Self-compassion is an important and useful practice for nurses to develop.”
“Nurses are givers. We go into the field because we are caretakers,” says Eason. “Many of us feel we are at our best when taking care of others.” She says that it’s important, though, for nurses to understand that they have to take care of themselves first. “Ensure you are getting adequate, quality sleep. You are eating a well-balanced meal. You are getting adequate exercise. You are spending time cultivating a life that is meaningful, rich, and deep outside of work,” says Eason.
After a particularly stressful experience at work, Lisa Radesi, DNP, CNS, RN, academic dean at the School of Nursing, College of Health Professions, University of Phoenix, says that nurses and other staff should have a debriefing session and remember that, despite all of the “bad” that occurs in their jobs, the “good” is the most rewarding part of what they do.
“Nurses should work together to ensure that they are okay after an incident. If a nurse notices a coworker is not doing well, they should talk with the coworker and bring it to the attention of the supervisor or manager,” says Radesi. “Above all, nurses should feel comfortable seeking treatment and communicating about emotional issues they may experience. Keeping this information bottled up can lead to issues and stress that have long-lasting effects. Know that it is not weakness, but strength, to acknowledge emotional disturbances and respond to them accordingly.”
If you see a coworker in distress, you can do something as simple as strike up a conversation with her or him, advises Bylone. “Use open-ended questions to find out how they are doing. Sometimes hearing the other person’s story really puts things into perspective. Let them know you care, and you are there to help, if only to listen. Please do not watch them suffer alone. Left unattended, these feelings only deepen and create lasting impact, often causing them to leave the profession,” she says.
Seeking Professional Help
Let’s face it: there are times when a spa day, time out with friends, or a bubble bath just won’t cut it in alleviating emotional problems. That’s when nurses need to seek professional help.
“If you are experiencing distressing symptoms over an extended period of time, it’s a good idea to check in with a professional therapist or counselor,” says Whitehead. “Whether it is distress from work or something related to your life outside of work, connecting with a professional can help you be a more effective caregiver and build your own resilience to mitigate the effects of your chosen population at work.”
If you need professional help, first see if your workplace has a program for staff members. If not, Sheperis says that the National Board for Certified Counselors has a directory of board-certified counselors across the United States (visit nbcc.org for more info). PsychologyToday.com also has a therapist directory that includes profiles of providers who can help.
There’s no shame in seeking help to get better. Sheperis says, though, that all nurses should do whatever they can to prevent their emotional stress from getting to this level. “Most people only seek professional help after something in their life had caused significant distress. While it is important to seek help if you are reaching a level of burnout or compassion fatigue, it is much better to take proactive steps and to work with a counselor to build resilience prior to hitting an emotional wall,” he says.
Sheperis also suggests that nurses focus on wellness practices at the onset of their careers. “It is easy to become engrained in a high-pressure system and to become emotionally overwhelmed if you don’t have a set of wellness practices in place.”
Few nurses have a solid grounding in personal finance about making decisions about their own financial future. Money management can be overwhelming. But you don’t need to learn the fine points of microeconomics – just the fiscal facts that pack a wallop on your wallet.
The good news is that the economic outlook for most nurses is rosy. Employment prospects are strong, says Donna Cardillo, RN, nurse entrepreneur and inspirational/motivational speaker. “The job market for nurses is much better. The market is cyclical and always has been. The last slump lasted about seven years, but that has all changed and many employers are now offering sign-up bonuses,” she explains.
The bad news? Many nurses still struggle to lead financially empowered lives, rather than being slaves to debt or just getting by paycheck to paycheck. Here are nine ways to make powerful personal and career decisions.
Evaluate an Employer’s Salary and Benefits Package
Often nurses decide to accept a job offer based only on the hourly wage, without being aware of the entire salary structure and how it can drastically pump up your pay.
Jon Haws, RN, CCRN, nurse educator and founder of NRSNG, wrote a popular article about how he doubled his first-year earnings as a new nurse. In “How I Made Over $70,000 My First Year as a Nurse (how I learned to game the system),” he recounts his experience as a newly graduated critical care nurse at a Level I Trauma center in Dallas, Texas.
According to Haws, that article “is a bit dated and I realize the $70,000 is nothing to a California nurse, but I outline some step-by-step ways to really maximize what you can make right out of school.”
Some of his steps included grabbing the pay differential for nights and weekends, getting an automatic raise after 6 months and a year, and working overtime and bonus shifts. That strategy requires that you make yourself an expert on your HR department or union contract rules, of course, which may be difficult before you’re hired. Not every employer is transparent about its pay policies. It’s easy enough to check Payscale.com or Salary.com for comparisons. Also, be sure to consult with a tax professional about the ramifications of higher compensation—you want to be ready when the tax bill arrives.
“The benefits package is something that employees don’t always take into consideration, but it can be significant,” says Launette Woolforde, EdD, DNP, RN-BC, vice president for nursing education and professional development at Northwell Health in New Hyde Park, New York.
She encourages nurses to plan for the next step of their education and especially note those related benefits. “Some organizations offer employees some sort of tuition reimbursement plan. When you get a job and get through adapting to your new role as nurse, that’s the time to take advantage of those benefits.”
According to Woolforde, some organizations provide employees with a discounted rate or deferred payment options for a number of nursing schools. “So a $500 a credit may be reduced to $400 a credit and the student isn’t invoiced until after the class is over. By then the tuition reimbursement will have kicked in so students don’t suffer out of pocket expenses that disrupt their cashflow,” she says.
In addition, many organizations pay a stipend or differential based on a nurse’s educational achievements. “For example, let’s say the salary is $50,000 a year to start, but if a nurse has a bachelor’s degree, they may add $5,000 a year. If you’re certified they may add even more,” she explains.
Decide on Your Financial Priorities and Make Every Step a Learning Point
There may be a sunny employment outlook for nurses, but you still have to earn and save to fund your priorities. Not every nurse will have the same financial needs and not every nurse will experience life transitions in the same order. Yet, there are some goals, such as starting a family, buying a house, or early retirement, which many nurses aim to achieve and can—with some work on their inner and outer game.
“I made $35,000 or $45,000 my first years in nursing and had to figure out a way to increase income or reduce spending,” says Brittney Wilson, RN, BSN, nurse influencer at TheNerdyNurse.com. “I opened the door to those possibilities.” Wilson carried $40,000 in student debt that she now believes was avoidable, if she’d lived at home, attended a community college, worked a part-time job, etc.
As a young wife and mother, she tried many methods to economize, as she wasn’t emotionally able to work more hours at the bedside. “One example, I tried extreme couponing and was able to take our $600 grocery bill down to $100. I had to figure out a way to get diapers and formula for my baby,” she explains. Wilson started her blog a couple of years later, mainly for personal expression, but she also started getting free products and fees from brands. “People kept offering me money but initially I felt some guilt about it,” she says. “When I came to terms with it and actively decided to monetize my blog, I hung the ‘I’m available to be paid’ shingle directly, and even more offers came in.”
As Wilson felt more and more confident that she was providing a valuable service, she increased her ad and consulting rates, and focused her blog on her nursing specialty. “Earning extra income is like walking down a hospital hallway. It’s a journey. You can open each door and look around or keep going down the path. Just keep opening doors until you find the one that is right for you,” she advises other nurses.
Wilson got so good at earning and saving that she and her husband are on-track to pay off their house mortgage in a little over five years.
If you’d like to get better at the nuts and bolts of budgeting, bill paying, and tracking various financial accounts, you may want to try apps and programs like Mint.com. By corralling everything into one place, you get a better handle on your spending and saving, and can see in charts and graphs how well you’re doing with your finances.
There are also minority personal finance experts you can follow for advice from someone who figuratively speaks your language. For example, African American pros include Michelle Singletary, who writes “The Color of Money,” for The Washington Post and syndicates. Or, if you prefer podcasts, Rich Jones and Marcus Garrett host Paychecks & Balances for Millennials aiming to pay down debt
Decide When to Make Major Purchases
Even if a purchase is appropriate for your life stage, try to minimize your total household overhead. Even well-paid nurses risk fatigue from worry or overwork to manage bills and payments for one-time splurges or ongoing financial commitments.
Woolforde encourages nurses to carefully consider whether a major purchase is a sound money investment. “I see this often—the first thing a nurse graduate buys is a flashy, brand new car, as a reward for all that hard work in school. A flashy new car is nice but it’s a rapidly depreciating item as opposed maybe holding out for a down payment on a new home that appreciates for a good long-term return,” she explains.
You might decide that your next major investment will be in your own higher education or specialized training. If so, be sure to take advantage of employer-provided assistance programs before taking out large student loans. Maybe your current workplace has a tuition reimbursement plan if you’ll commit to working there after graduation, but you hesitate to limit your options. Find out how often graduates using that program decide to stay with that employer; usually the figure is high. If your circumstances and goals match theirs, you’re likely safe in taking the same route.
So many students lament how little they knew about educational loans that a free interactive game called Payback was created by a financial literacy non-profit. The makers warn: “College can help you realize your dreams, unless it leaves you with a student loan nightmare.” Students navigate an online maze of decisions: What school to attend, what major to declare, whether to focus on studies for a higher GPA or social life for more connections, etc. At the end, if a player does decide to borrow educational funds, it’s with eyes wide open.
Choose a Specialty That’s Fulfilling—And Remunerative
Whether you’re a new nurse graduate or you’ve been in the field for years, now might be a good time to switch to a specialty or workplace with better long-term prospects for pay and benefits.
Cardillo encourages nurses to explore non-traditional career options and to take risks. “Your next job may not pay as much, but may have many other advantages. When it comes to being a bedside clinical nurse in a hospital, there’s only so much you can make, even with overtime. Some other health care related industries have greater earning potential over the long run even if you have to take a pay cut in the short term,” she says.
Cardillo points to a variety of popular nurse settings and roles that pay well, such as: Nurse informatics, quality management nurse, corporate wellness nurse, insurance nurse, or nurse consultant.
You may also want to check out DiscoverNursing.com for interactive features that guide you through the process of choosing from scores of specialties. Some under-the-radar titles have surprising rewards, including high demand or ease of entry. You’ll get information on the education, training, and certification required to fill a role, as well as its average salary and employment outlook.
Decide to Cut Hours or Leave the Bedside Altogether
Reducing your hours to, say, care for a family can be a difficult choice that depends on many conditions, but it can be the right choice, if done right.
“If you opt to get out of the job market for a while, stay in touch with nursing colleagues through professional associations [and] keep up with credentials and licenses,” advises Cardillo. “Keep yourself current, marketable, and connected.” She warns that nurses who let their licenses lapse—accidentally or not—won’t be ready to jump back in when they need to or want to.
“Some nurses drop out of the workforce to take care of elderly parents, but then the parents die and they’re left with literally nothing and can’t find a job,” she warns.
Cardillo recommends that you first explore opportunities to work at home, which are more common today for nurses. If that’s not possible, check to see if your state allows for an inactive status license, rather than outright letting it lapse.
Another life stage when nurses may be tempted to let their license lapse is at retirement, but Cardillo sees downsides to that. “Nurses retire, but after so many years they get bored or financially need to work again because they don’t want a lower standard of living.”
Care for Yourself and Your Career Longevity
“Nurses are leaders—they advocate for their patients, but they struggle with advocating for themselves,” says Diane Neustadt, director of operations at New York-based Forest Hills Financial Group.
Her firm supports the National Association of Hispanic Nurses New York chapter, of which Neustadt is an active member. Because of her involvement with the chapter, she’s able to explain the importance of managing one’s own financial life in terms that nurses relate to. “I tell them it’s like being proactive about your own health. Nurses work long, unpredictable hours so self-care is so important: physically, emotionally, and spiritually. I’m a spiritual person and also know the importance of financial well-being—live one day at a time but not just for today.”
Neustadt believes in “protection first,” which means having enough insurance and the right kind. “Employer-sponsored benefits are a good thing,” she explains, “but not only may company benefits not be portable and go with you, generally those employer-provided benefits are minimum benefits and should be viewed as the base of benefits to build upon. Three areas that normally need attention are disability, additional retirement income, and long-term care.”
Make the Most of Expertise from Family, Friends, and Coworkers
Woolforde received informal money mentorship from two unexpected sources who guided her to become financially savvy. The first was her older brother, who went to college when she was in her senior year in high school and was surprised at the expenses beyond tuition that he hadn’t anticipated. “When he came home at his first break he told me frankly, ‘You’re going to have to get scholarship money if you plan on going to college.’ So, we spent countless hours in the library combing through books and catalogs looking for scholarships. That was before everything was available online.”
She was doubtful about her ability to garner scholarship funds—others will have a higher GPA, more financial need, better applications. “At first, I said, ‘there’s no way I’m going to get it’ and he said, ‘you don’t know until you try,’” she explains. After piecing together several small scholarships—$600 here and $2,000 there from various sources—Woolforde was able to fund her freshman year at a commuter college. Good grades allowed her to garner full scholarship funding for the rest of her bachelor’s degree in nursing.
Woolforde next got valuable advice from a nurse preceptor who insisted they visit the hospital credit union after one shift. “She helped me open a retirement account and set up direct deposit of part of my paycheck into that account. I was just starting my career, so retirement was the farthest thing from my mind as a 21-year-old,” she says.
Try to find a money mentor who understands your situation and connects or relates to you in that way, advises Woolforde. “My brother understood the home situation and my preceptor maybe recognized me as her younger self—she was an African American female, too. Everyone who has walked this path, grown in professionalism, grown in a nursing career, it’s our responsibility to share what we’ve learned,” she says.
Make the Most of Your Employer’s Financial Programs
Your organization may offer employee benefit education, such as having an HR representative provide short updates at staff meetings, or making a vendor available for one-on-one consultations. Take advantage of these resources if they can help you fill in the financial puzzle pieces of your life.
“My family emigrated from Armenia when I was nine years old,” says Anna Dermenchyan, RN, MSN, CCRN-K, senior clinical quality specialist in the Department of Medicine at UCLA Health and a PhD student at UCLA School of Nursing. “At the time, my parents didn’t know the language or the culture, and thus we struggled financially as a family.” When she worked at a bank as a senior in high school, she learned about financial concepts and became more proactive about managing money.
Dermenchyan now actively engages with the University of California system’s excellent financial program for employees and students, which include onsite classes as well as live webinars on financial wellness and retirement.
“I’m an early Millennial and we think about work-life balance and living in the moment, and this necessarily doesn’t help us save enough money for the future. We want to earn, spend, travel, and just enjoy life,” she explains. “However, financial health is part of achieving wellness and maximizing potential benefits for the future. Just like with Maslow’s hierarchy of needs—personal finance is at the basic level, and everything rests on it.”
Most nursing schools don’t include a financial component in the curriculum, so many workplaces fill in the gaps with seminars, consultations, and program “nudges” to encourage fiscal health. “At first, I just put in $100 a month towards retirement; that’s what I could afford after paying loans and family expenses,” says Dermenchyan. “The automatic deduction from each paycheck makes it easier, and some institutions make a matching contribution. In addition, I was advised by a financial consultant that with every salary increase, I should increase my contribution to retirement,” and she has continued to ramp up her rate of saving and investing.
Prepare for Retirement
Some nurse leaders point to numbers of disengaged older nurses who are forced to continue working because of under-funded retirement plans. They didn’t put aside enough money for the future, and early social security payouts at 64 are too small to support even modest lifestyles.
“Nurses are unlike other caring professions—police, firefighters, and teachers—because they don’t earn pensions from municipal government employers,” says Ric Edelman, a #1 New York Times bestselling author of personal finance books such as The Truth About Money and The Truth About Retirement Plans and IRAs. “That puts their financial future in jeopardy.”
Edelman is also the founder of Edelman Financial, one of the nation’s largest independent financial planning firms. His firm offers a free financial plan to nurses, waiving its customary fee for the two-meeting process—either in person or via teleconferencing—which results in recommendations for investments, insurance, estate planning, and more.
By starting the process toward financial stability and independence, you can empower yourself as an earner, saver, and investor. It is possible to experience the feeling of security that comes from having your financial life firmly in hand. This moment is the best time to take that first step.
Working overnight shifts is a big change for many nurses, but it’s also extremely common. With the 24-hour demands of the bustling, modern health care system, there’s a good chance you’ll have to work the night shift at some point in your career, especially when you’re starting out. But don’t fret! There are many ways to ensure that the transition from day to night goes as smoothly as possible.
All nurses need to be on their A-game with technical medical skills and emotional resilience no matter what time of day they’re working. Night shift nurses have to shoulder even more burdens because they often work mostly or entirely alone for their shift. While there’s no one “right” way to adapt to the night shift, there are several common mistakes that you’ll want to avoid to build good habits.
Common Mistakes to Avoid When Switching to the Night Shift
Going against your circadian rhythm is no small task. However, resorting to quick fixes will only make your shifts more difficult in the long run. Avoid these five common mistakes and you’ll adapt to the swing of a night shift quickly.
1. Not getting enough rest before starting a shift.
As a nurse, it’s important to always be sharp on the job. The staff at Gurwin Jewish Nursing and Rehabilitation Center emphasize that not getting enough rest is the number one mistake that new night shift workers make, and it’s one of the most dangerous. Since shifts are often upwards of eight hours long, there’s no safe way to “power through” on too little sleep. This goes for both on-shift work and driving when sleep-deprived.
How to Avoid It:
- Install blackout curtains where you sleep and get a fan or white noise generator.
- Turn off your phone, get a “Do Not Disturb” sign, and inform loved ones of your schedule.
- Staying up for a few hours to relax and take care of yourself may be easier for some nurses than going straight to bed at the end of a shift. You’ll figure out what works for you with time, so don’t be afraid to experiment.
- Take proper care of your legs and feet while on your shift, so you won’t be troubled by pain or soreness when you’re trying to sleep.
- Light soothing candles and practice stretches to relax yourself before bed.
2. Leaning on sugary foods, alcohol, or caffeine instead of proper nutrition.
It can be tempting to snack on chocolate or chug coffee to keep yourself going through your night shift. Keep in mind that, if consumed in excess, coffee can lead to jitters at first, followed by a crash. You’ll be far better off if you instead focus on getting more sleep.
How to Avoid It:
- Plan and pack your meals ahead of time to avoid relying on vending machines.
- Schedule your heavy meals so they won’t interfere with sleep.
3. Letting your personal life fall into disorder.
Sometimes it’s hard to keep your personal life in order while working the night shift. Errands, social gatherings, and childcare all battle for your attention when you’re not at work. This reduces your ability to get good sleep and, in turn, to focus at work.
How to Avoid It:
- Yoga and meditation help you relax and leave work behind so you can be present when you’re engaging with family or friends.
- Establish a schedule for sleep, chores, and activities. This will reduce the stress of missing out on things.
- Plan gatherings ahead of time with friends and family to ensure you can make it to fun gatherings.
4. Not asking for help or feeling like you have to “do it all.”
Yes, there are fewer resources available overnight at the hospital. This can lead to superhero-esque thinking, where you refuse or even genuinely forget to ask for help. Being honest about needing a hand is better than dropping the ball because you’re juggling while tired.
How to Avoid It:
- Get to know the others who work nights so you can trade favors.
- Get to know the resources available to you during your shift.
- Ensure that your roommates or family are sharing the load with you at home.
- Choose sleep over chores when possible at home. Others can help you with chores, but they can’t sleep for you!
5. Missing out on workplace bonding, training, or resources due to night shifts.
It’s easy to feel forgotten when working the night shift. Try not to miss out on opportunities for bonding, continuing education, or extra support because of your schedule. It can be hard to make time or schedule changes for these opportunities, but they’re integral to your career development down the line.
How to Avoid It:
- Check announcement boards and learn about opportunities available at your workplace.
- Make it known to your boss and coworkers that you’re interested in additional training, support, resources or team bonding even if you work the night shift.
- Ask if there are online resources available for any opportunities that you simply cannot attend.
Your job as a nurse is important. Don’t let working the night shift get in the way of providing the best care possible to your patients and yourself. Getting enough sleep is integral to your job performance and personal health, but that’s not always enough. You also need to make sure you’re practicing good self-care and focusing on your health along the way. With these great tips, you’ll adapt to the night shift in no time!
How often should a man get breast and cervical cancer screenings? Should a woman get screened for prostate cancer? The answer to these questions and more depends on knowing if your patient is transgender.
The Williams Institute estimated the transgender population in the United States to be 1.4 million in 2016. A recent study in Minnesota of 9th and 11th graders found nearly 3% of students identify as transgender or gender non-conforming. When it comes to health care, are we ready to meet these patients’ needs? Several cases where a transgender or gender expansive person was not properly identified or their provider simply was not aware of issues regarding transgender individuals have been in the news lately.
My county hospital is rolling out changes to our HIMS to try to capture this complete information on all of our patients, including transgender and gender expansive patients. These questions are called SOGIE, which stands for Sexual Orientation, Gender Identity, and Expression, and we ask them at intake:
- What is the sex listed on your original birth certificate?
- What is your gender identity?
- What is your sexual orientation?
Source: Benny O’Hara, Office of LGBTQ Affairs, County of Santa Clara
Our initial goal is to capture 10% of our patient population with rolling increases as we move forward. In the hopes of meeting all of our patients’ needs we will ask these questions just one time over the patient’s lifetime. However, the patient can initiate changes at any time in the future.
Our LGBTQ patients can have health issues that are occult if we don’t have correct data. A female-to-male, or FTM, person with residual breast cancer did not know he needed breast cancer screenings. By the time it was diagnosed, the cancer was advanced. Another patient, male to female, or MTF, did not discover her prostate cancer until it metastasized to her bones.
What are the barriers to care for transgender patients? The first is the patient’s comfort with disclosing information about their sex assigned at birth and current gender identity. For a variety of reasons, transgender and gender expansive patients might not trust their caregiver or the health care system in general. A person who has transitioned has spent a great amount of personal capitol to live the life they need to live. It’s not a lifestyle change. It is the core of a person’s being.
A 16-year-old patient who has made the transition from female to male tells me, “I’m not transgender. I’m a boy.” He does not identify as transgender. Practitioners find this a common outlook in their transgender patients. Some transgender individuals may feel that they have always known their gender, and that it was society and other persons who incorrectly assigned or perpetuated a gender identity on their behalf – one that did not ring true for them. Sharing of this information with a caregiver who is not familiar with the patient might not happen if the patient is not trusting or believes the information is not germane to the situation. For a primary care provider not in the know, this creates problems with preventative care with serious consequences. The SOGIE questions start a conversation that might not otherwise have occurred.
Another barrier is on our side of the street. Are we comfortable asking a patient if they are gay and/or transgender? While rolling out our new SOGIE questions, we find push back in unlikely places. Care providers and nurses at our in-service had these objections:
“My patients will be insulted.”
“Patients of some cultures will be offended if I ask that.”
“Some patients will not understand the difference between sexual orientation and gender identity.”
“This will take too much time.”
For some, a supposed patient objection is a mirror of their own feelings. “I would be offended if someone asked me if I’m gay.” For others, cultural taboos of their own might get in the way. Are we projecting our issues onto our patients? Personally, I’m excited to see my patients’ reactions to the questions and I look forward to educating them on the meaning of the terms. It’s a valuable tool to identify health care needs and an opportunity to destigmatize a subject that might seem uncomfortable.
You can’t tell if a patient is gay, straight, or anything else just by looking. The original birth certificate does not indicate the patient’s current sexual orientation. Often, a transgender person will legally change their birth certificate to reflect their correct gender identity. We just don’t know by looking at a person or their documents what gender identity or sexual orientation they are. Health issues can’t be addressed if we don’t know.
Annette Smith, a nurse at Santa Clara Valley Medical Center in San Jose with 35 years of experience, has insight into changes in practice like the new SOGIE questions: “At the beginning, there is a lot of push-back. ‘The sky is falling! The sky is falling!’ But after a while, the process becomes normalized and it’s not a big deal. We end up wondering what all the fuss was about!”