Obtaining an Associate Degree in Nursing (ADN) or Baccalaureate of Science in Nursing (BSN) is the pre-licensure pathway to becoming a Registered Nurse (RN). This is the required academic path for entering into the nursing profession. Earning a Master’s in Nursing (MSN) leads to many new paths and opportunities.
An MSN prepares practicing RNs for advanced practice by developing skills and knowledge in specialized areas of nursing. The nurse’s scope of practice expands with increased autonomy and expanded practice roles. The health care delivery arena broadens beyond acute care hospitals and other traditional healthcare settings. The MSN contributes to the financial, social, emotional, and professional worth of the individual. The experience will both challenge and change you.
Some practical and significant rewards associated with the MSN include:
Employment options increase. With an MSN degree, a wide variety of career opportunities become available. A nurse can specialize in a particular area or take a leadership role. If being the boss and leading others is appealing, then you should strongly consider earning a master’s in nursing. MSN programs teach the advanced clinical skills and management strategies that can help an individual supervise employees.
Master’s degree prepared nurses will lead nursing teams, manage departments, and may become part of the hospital’s executive team. Many MSN degree holders choose to become nurse educators. Nurse educators work in nursing schools, universities, hospitals, and vocational schools. The shortage of nurse educators is increasing with the average age for nurse educators being approximately 50. A nurse educator will directly influence how professional nursing is practiced in the future as they direct and guide the pre-licensure education of future RNs. These individuals mentor others who are just beginning their nursing career. As a nurse educator there is an opportunity to positively influence an entire generation of novice nurses.
A MSN who prefers to advance their clinical practice opportunities will be able to consider becoming a Certified Nurse Midwife or Nurse Anesthetist. In these, and other clinical specialties, the nurse works closely with medical physicians to serve women’s health needs or administer anesthesia for surgical patients. Many MSN programs offer specialized tracks that prepare students to apply their advanced skills to psychiatric nurse practitioner, acute care nurse practitioner, or family nurse practitioner. Job opportunities for master’s educated nurses are expanding rapidly with an expected increase for MSN graduates to exceed 30% by 2026.
A flexible and extended career. RNs who hold MSN degrees rank among the most experienced nurses in their workplace, they can enjoy more flexibility at work than most RNs or LPNs. MSN practice settings might resemble non-traditional settings that operate during regular business hours. The MSN often is able to perform their job remotely, during shifts that are more convenient and with the freedom to determine the workday schedule. With greater flexibility and greater responsibility associated with an MSN, there is also an opportunity to extend the life of the nursing career as RNs perform the less physical tasks without the advanced education who will be charged with less physically demanding job duties.
Professional respect and networks increase. With a graduate degree, more earning power, greater job flexibility, and opportunity comes added respect from colleagues, other health care professionals, and peers. Nurses are among the most trusted of professionals in the nation and that trust and admiration extends and expands as the nurse extends and expands his/her educational and professional career. Master’s programs in nursing help students establish valuable relationships with other nurses and professors. The connections and relationships established during graduate school can lead to a new job, identify an interesting new field, or help to discern a doctoral program.
Lifelong learning. The master’s degree often becomes the gateway to the PhD in nursing or a Doctor of Nursing Practice (DNP) to further expand career opportunities or achieve new personal goals. Returning to school can seem daunting, but there are strategies that can minimize the fear. Typically, the MSN is a two-year program of study, but there are accelerated options to explore. Prospective students might consider online programs, or take advantage of bridge programs that help students go directly from the pre-licensure program into a graduate program. Future graduate students should explore programs with affordable tuition options as well as the employer tuition assistance.
Making a difference. Often nurses enter the profession to make a difference in the lives of others. While financial compensation, flexibility, and job variety are impressive advantages, most nurses find fulfillment in their ability to influence health care and affect the lives of individuals, families, and communities. Expanding knowledge through advanced education will serve as inspiration to others including others in the profession. The personal fulfillment and professional satisfaction that accompanies the MSN is not measured in the salary increase or multiple job choices but rather in the sense of accomplishment and improved self-esteem.
Transitioning from RN to MSN
Principles of Professional Role Development
Written and designed for RN to MSN students, this book focuses on the multitude of Masters' prepared roles available to a transitioning student, from nurse practitioner and beyond. Transitioning from RN to MSN examines both direct care roles (e.g., Clinical Nurse Leader), indirect care roles (e.g., Informaticist), and also covers new emerging areas.
From the time spent waiting for an organ for donation to the post-surgical recovery, transplant nurses play an integral role in the lives of patients involved in transplants. Today, National Transplant Nurses Day, recognizes that work.
The International Transplant Nurses Society started a national recognition day for transplant nurses in 2006. Since then, they have attracted attention to the day and boosted recognition for all these nurses do in their field. The organization even builds pride with an essay contest in which patients may nominate a nurse who has had a particularly important impact in their lives.
But the day also shines a light on the varies responsibilities of nurses who are an integral part of the transplant team.
According to the Health Career Institute, transplant nurses’ duties can range from prepping patients for transplant surgery and assisting in the transplant surgery itself to monitoring post-surgery for organ rejection or complications.
Before deciding on this career path, prospective transplant nurses generally gain experience in the field by working in a transplant unit. Eventually, certification as a clinical transplant nurse will help you provide the best patient care and will also signal to your organization how committed you are to your job. Certification in the field through the American Board for Transplant Certification shows you are willing to go beyond your job requirements and gain additional training and education to remain on the forefront of transplant-related practices.
Nurses who work with transplant patients and their families may be involved in cases of living donors or deceased donors. They must remain sensitive to the complex emotional environment surrounding the origins of the donated organs while remaining a vigilant advocate for the organ recipient’s health first and foremost.
Transplants are becoming more and more complex, with multi-organ transplants a more common surgery than ever before. Transplant nurses on the leading edge of the field will want to be well-educated on all the body systems involved and the varied ways that can present challenges in the human body. Because the transplant team includes many diverse specialists, transplant nurses have to work well on a fast-paced team where situations change in an instant and the clear path isn’t always obvious. They have to have excellent critical thinking and be knowledgeable and confident enough to make excellent decisions based on the patient in front of them.
With the emotional challenges and complexities around transplantation and the patients and families involved, transplant nurses have to be sure to have resources to deal with the emotional extremes–from grief to joy—that will become part of their daily routine. But they are reassured about the impact they are making for the patients they treat. A lifelong connection often develops from playing such an essential role in someone’s journey.
Especially since the #MeToo Movement began, sexual harassment has been in the spotlight. We spoke with nurses who have been harassed, legal experts, and nursing professionals to determine what you should and can do if this happens to you.
Celia,* RN, a longtime hospice nurse, remembers it like it was yesterday. A younger man, at least younger for hospice, had been admitted with terminal cancer. While Celia says she recalls other nurses talking about the patient having made “inappropriate comments,” she had never experienced it herself.
Until she did.
The patient had been angry and struggling with what he deemed the unfairness of dying young and leaving his wife and child—and knowing that he wouldn’t be able to take fun trips or do things with his daughter. Because he had a trach, which requires frequent suctioning and medication, he felt like the staff was treating him like a leper—when actually, they were simply following all safety precautions.
“Once trach care was completed, I sat down, took my gloves off, and offered him a hand to hold—this is standard practice between hospice staff and patients, and it’s not frowned upon,” says Celia. At the time, the patient held her hand, cried, and expressed gratitude for the time to talk. “I felt we had a nice, professional, and therapeutic rapport.”
A few weeks later, a couple of days after Christmas, Celia was caring for the patient, and he asked if she was married. When she responded that she was in a long-distance relationship, he asked how she took care of her sexual needs—and asked using inappropriate, graphic sexual language.
Celia replied, “One—that is none of your business. And two—It’s not appropriate conversation between a patient and a nurse!” Then, Celia calmly informed him that this was harassment and abuse. With one word to her managers, she told him, she would never have to be his nurse again. She says that the patient was contrite and apologized. Celia passed it off as a one-time thing and let it go.
Unfortunately, that wasn’t the end of the harassment. After a couple of weeks, Celia was the patient’s nurse again. While taking care of his trach, she talked with him. When he could speak, they discussed their favorite kinds of music. She recalls, “It was a nice interaction, as I grew up in a musical home, and discussing this was special to me.”
Near the end of the treatment, though, everything changed. The patient told her lots of things that he would like to do with her sexually, in graphic detail.
Celia recalls, “I was horrified. I was angry. I felt nauseated. I felt ashamed about my body, and I wanted to cry. I was shaking, inside and out.”
She told the patient that he was so far out of line. He was shocked that she was so rattled and tried to justify it by saying that it was a compliment. Celia left his room immediately.
The first thing she did was post on the staff’s white board that she would no longer care for this patient. When she calmed down, she emailed her managers and then communicated with them in person the next day.
Celia’s managers were supportive. She never saw the patient again, and he left the facility a few days later.
Harassment is Prevalent
A Medscape.com survey published last year revealed that the majority of nurses—71%—say that they had been sexually harassed by a patient. Of those responding, 90% were female nurses, 10% male.
But male nurses get harassed as well. They may, however, be even less inclined to report it. In the same survey results, it states, “By gender, female nurses…were much more likely to say they had been sexually harassed than their male counterparts (73% for female nurses vs 46% for male nurses).”
No matter the gender of the nurse who experiences it, sexual harassment is wrong. That said, how do you decide if what a patient is doing or saying is sexual harassment?
If it Looks Like a Duck and Quacks Like a Duck
According to Trista Long, RN, DNP, MBA, ON-C, a nurse manager for an inpatient med/surg unit with Blessing Health System, it is easy, most times, for nurses to differentiate between behavior that is appropriate or inappropriate. “The first sign of inappropriate behavior is when patient’s actions or conversation makes the nurse uncomfortable. Patients who are making inappropriate comments will first ‘test the waters’ by making inappropriate jokes or mild comments to gauge the nurse’s response. If the nurse dismisses the comment, the patient will likely continue with the inappropriate conversation or actions.”
If a patient exhibits inappropriate verbal behavior, it’s often easy to recognize, says Long. “Nurses know what crosses a line and what doesn’t,” she says. Because of the physical nature of nursing, however, Long says that inappropriate physical behavior can sometimes be more difficult to recognize.
“I often tell my staff that—again—inappropriate touch is anything that makes them uncomfortable…it’s no different than being in public and having someone touch you inappropriately. Just because you are in a hospital does not give another person the right to touch you,” explains Long. “Most patients will want to hold your hand or touch your arm, but they will not go any further than that. An action or remark could be considered harassment if the nurse directs the patients to stop, but that direction is ignored.”
“A ‘reasonable person standard’ is generally used to determine if conduct is motivated by prurient interests or for a person’s sexual gratification,” says Debra W. Levin, counsel in the health law group at Brach Eichler. She previously served as counsel to the New Jersey State Board of Medical Examiners and was the Assistant Section Chief responsible for legal services provided to more than 50 licensure boards, including the New Jersey Board of Nursing. “If a reasonable person would be offended, then it can be determined to be sexual harassment. Because the standard is subjective, it is often hard to determine.”
“Sexual harassment is generally any unwanted sexual direct or indirect physical contact or comments. Of course, some physical contact may be more overtly ‘sexual’ than other contact, but much of the time, the intent will be evident,” says Jessica T. Ornsby, LL.M., Esq, managing attorney with A+O Law Group. “A good rule of thumb is whether the contact is objectively appropriate under the circumstances. For example, if a nurse is taking a patient’s blood pressure, is it necessary for the patient to place his or her hand on the nurse’s thigh? Probably not. But if a nurse is helping a patient into bed, that patient may need assistance stabilizing himself/herself and may rest his or her hand on the nurse in a way that would otherwise not be necessary.”
She adds, “Sexual harassment is basically a step down from sexual assault. If the action/contact involves force or any kind of penetration, that is most likely assault and should be addressed accordingly.”
What to Do if It Happens to You
Suppose a patient sexually harasses you. What do you do?
“Experts believe that sexual harassment is significantly underreported in health care. For that reason, I believe the best defense for nurses starts with reporting these types of incidents,” says Jennifer Flynn, CPHRM, risk manager at Nurses Service Organization. “No matter who the harasser—whether it be a supervisor, coworker, or a patient—nurses can take steps to address harassment in their workplace.”
“While working in a hospital, the first step is for the nurse to address the behavior. The nurse should tell—not ask—the patient to refrain from the inappropriate comments or actions and to stop immediately. The nurse should then report the behavior to his/her manager so that the leader can be aware. If the behavior stops, it typically will not need to go further,” says Long. “It is imperative that the nurse set boundaries with the patient immediately once s/he recognizes the behavior. If the action is severe or violent, the nurse should report it immediately, and the leader should address it. If the nurse is uncomfortable caring for the patient, the patient can be reassigned to another nurse. There have been times when I have assigned only male nurses to a patient who was harassing the female nurses.”
There may be times in which a patient won’t stop. In this case, Long says that the leader should talk with the patient and stress that the behavior won’t be tolerated and must cease. “If the behavior continues or if the nurse is uncomfortable caring for the patient, the patient should be reassigned to another nurse, and the leader should engage the Risk Management Department and/or the Security Department to assist. Many times, a Security Officer will be asked to speak with the patient and direct them to stop the behavior. Since they are often in uniform, it can be a show of added authority and the behavior will stop. If it does not, the Risk Management Department can speak to the patient and explain any legal consequences to their continued inappropriate behavior,” says Long.
Ornsby says that each work environment, ideally, should have some kind of policy with regard to sexual harassment. “Nurses should make note of these policies and earmark them for future reference,” she says. “If the policy does not specify to whom to report the incidents—ask. If a patient’s behavior…is making you uncomfortable or causing you to feel unsafe, leave the situation immediately. Your personal safety and well-being are the most important. Federal laws on sexual harassment apply regardless of whether the harassment is taking place at a hospital or a doctor’s office.”
Levin agrees that health care organizations should have policies in place. “Larger or licensed facilities may have staff to counsel the patient regarding harassing behavior. Additionally, in regard to patients, the patient can be transferred to another’s care, a chaperone can be provided, and the patient can be counseled. In dramatic situations, the patient can be discharged/terminated from the practice or facility. State-specific laws apply that govern termination of the doctor/patient relationship/discharge so that the patient is not abandoned, and there is a transition of care,” she says.
The American Nurses Association has challenged nursing professionals to end sexual harassment in the workplace by adopting a zero-tolerance policy. “Much has been written lately about the importance of nurses engaging in self-care. Not tolerating sexual harassment is an integral component not only for self-care, but also for self-respect, vital for professional effectiveness. Speak up when sexual harassment occurs and facilitate a civil work environment,” Flynn says.
The Bottom Line
“If the organization is not responsive to the nurse’s claims, s/he should consult legal counsel or their union. No one should be subjected to sexual harassment in the work place,” says Levin.
Long says that harassment, whether physical or verbal, has been perceived in health care as “part of the job.” But it’s not and never should be seen as such. “It is never acceptable to be harassed by anyone at any time. Nurses are an integral part of the health care team and should command the same respect as every other profession,” says Long. “Unfortunately, nurses have been depicted in a sexual manner for ages and that has demeaned the profession. Being a nurse does not negate my rights as a human being to not be verbally or physically assaulted.”
“I took an oath to care for others, but that does not mean that I have to sacrifice my physical or mental well-being,” Long adds.
WOC nurses treat patients who have unhealed wounds, ostomies, or urinary or fecal incontinence issues, so nurses who are in this field or who are considering entering this specialty will have many areas of focus to work in. Some patients receive care for these conditions throughout their lives while others might be going through the process of figuring out the best care for new conditions. Nurses interested in growing professionally as a nurse in education and in patient interaction will find this field particularly satisfying.
Nurses in wound, ostomy, and incontinence care work with patients of all ages and with different health conditions. From infants with gastrointestinal system disorders to patients who have newly presented urinary incontinence to patients with open wounds, WOC nurses know the medical conditions and help patients understand what is happening. They are able to navigate the incredibly complex conditions that bring patients to them and the different stages of understanding and self-care their patients are capable of.
WOC nurses are mindful of the medical care their patients need and also promote education to make their patients engaged in their own care if at all possible. As with any nursing specialist, certification through the Wound, Ostomy, and Continence Nursing Certification Board is encouraged. With varied conditions requiring treatment in this field, nurses can also look into certification for foot care, as so many patients deal with wounds on their feet that won’t heal.
In the efforts of continuing to gain knowledge and education, the Wound, Ostomy, and Continence Nurses Society is hosting a webinar this week. Kathleen Lawrence MSN, RN, CWOCN presents the webinar “Guiding Your Professional Future with the Scope and Standards for the WOC Nurse” on Wednesday, April 17 from 1-2 pm Eastern. If you participate, you may be eligible to earn one credit hour. The webinar is free but you must register to participate.
For fun, the society is also encouraging nurses to send in photos from this week in a photo contest. You can also tag the photos with #WOCNurseWeek2019 and share them on social media. Your team might also want to host a small celebration at work. Take a few minutes to enjoy some goodies and recognize how deeply your work is appreciated by the people you help every day. And recognize your team members for the way you all work as a unit to help you patients and their families achieve the very best health they can.
Let’s rewind back to the summer of 2014. I
was in the midst of my senior year of nursing school taking classes, working,
and doing my best to survive the New York City summertime heat. While working
on an assignment one evening, my mother called me to say that my uncle had been
in a near-fatal motorcycle accident. He was put onto a ventilator and had to
endure an extensive hospital stay. This news was incredibly upsetting and
unexpected. I have always been close with my uncle and couldn’t help but feel
I pushed on through my classes and day-to-day routine, but I noticed that I was suddenly sleeping more, eating less, and often feeling unfocused and unmotivated. I chalked it up to stress from school and work, especially since it was my last year and I was expected to graduate that upcoming spring. Reaching out for help was a fleeting thought, and I firmly decided that I could handle these feelings on my own.
Turns out, I was wrong. Feeling down, unmotivated, and overwhelmed consumed me. I received a C minus in one of my summer classes, which coupled with a C minus that I had received earlier in my nursing school career. For a while everything felt so slow, but suddenly it was as if I were thrown into a time-lapse getting caught up with reality. I frantically reached out to my academic advisor who monotonously told me that if I was struggling with a personal issue I should have spoken up sooner and that two C minuses are not acceptable in the program, but I could speak with my professor directly about the grade. There was hope. Except there wasn’t, because my professor would not budge on the matter. With that being said, I was kicked out of nursing school the fall of my senior year.
My recently furnished dorm room had to be dismantled—clothing back in suitcases, photos taken off the walls. I had to say goodbye to my roommates who were confused and concerned. I had to say goodbye to my friends of four years. The reality that I would not be graduating after years of hard work crushed me.
I experienced panic like never before. I couldn’t breathe, couldn’t move, couldn’t feel anything but my lungs constricting. I felt like I was going to explode. A counselor diagnosed me with both panic disorder and generalized anxiety disorder.
I moved back home and tried to figure out what to do next in a frenzied state. No nursing school would accept someone who was dismissed for poor academic performance. The panic attacks only got worse. I was having them at least three times per day. Most people would have given up at this point and settled for less, but I had always known that nursing is the only career I wanted for myself. I would not settle, no matter how much I was hurting, no matter how impossible things seemed.
I began seeing a regular therapist in an effort to get my life back on track. Things seemed to be improving. During the winter of 2015, about four months after my dismissal, I was driving home from a therapy session down a road I’ve known my whole life. Suddenly, a car pulled out in front of me, taking me off-guard. I slammed on my breaks, but it was too late. I smashed into the car head on. My insides were screaming panic, but I couldn’t move. Bystanders got out of their cars to help, but my doors were locked and could not be opened. People were asking me through my window if I could move my legs and I didn’t know if I could. I heard sirens and thought to myself, “I have to be dreaming.” Paramedics had to cut through the top of my car, hoist me out, and strap me to a board that was put into the ambulance. More panic.
Though I questioned my faith during that time, I thankfully left the hospital banged up and bruised, but not detrimentally damaged. I sustained a treatable back injury. After my recovery, I applied for a job at an urgent care clinic because I wanted to maintain medical practice in my life. I thought it would help, both with my practice as a future medical care provider as well as my emotional state. I was happy to get the position, but that meant having to drive again. During that period of time, my drives to work consisted of multiple instances of having to pull over and having countless panic attacks. But I got there. I kept up with both my therapy sessions for the anxiety and physical therapy for my back.
That spring, I attended the graduation ceremony of the friends I was forced to leave behind. I can’t begin to describe how happy I felt for them. At the same time, I worried that they would end up leaving me behind. I felt that in a way, they already were. I felt awkward being with them in public because I didn’t want people from outer circles asking questions that I was too embarrassed to answer. I didn’t know how to fit in anymore with my best friends. This caused panic that I cannot forget.
Rather than closing in on myself, I mustered up the courage to apply back to the same nursing school that I was dismissed from for entrance the upcoming fall semester. I was asked back for an interview, which I graciously accepted and prepared for rigorously. On the day of my interview, I walked into a familiar building unable to control my shaking body. As I sat across from my old professors, I was asked what will be different this time around, should they allow me back. I told them the truth. I spoke about my journey dealing with anxiety and ways that I am now able to manage it, though it goes without saying that it is challenging. I highlighted my relentless drive to be a nurse, and that if the past year wasn’t enough to stop me, then nothing ever could. I was accepted back into the program; my faith was slowly being restored.
I was taking classes with students who had known each other their entire nursing school careers. I also struggled to grasp the material at first, being that I was rusty from having to take time off. I felt disoriented and like an outsider, but I didn’t let that distract me from achieving greatness. I made the dean’s list at the university that only a year ago had told me that I wasn’t good enough. I eventually made friends with my classmates and strengthened the relationships with my old friends.
That May, I graduated proudly. All my friends and family were there to support me. Panic took the backseat.
After passing the NCLEX, I worked in a couple of different clinics and health systems gaining invaluable experience. Despite my fear of rejection, I applied and was accepted into a master’s program for midwifery. I now happily work at a fertility clinic and am excited to graduate the midwifery program stronger than ever. I have discovered my interests within the nursing field, which include researching the United States’ shockingly high maternal mortality rates and normalizing breastfeeding, especially among women of color.
Now, I have been invited to become a member
of the Sigma Theta Tau International Honor Society of Nursing. Once more, I
have to ask myself whether I’m dreaming, only this time it’s under completely
different circumstances. I won’t lie, a sense of underlying anxiety persists
within me, but I can now recognize that I have valuable coping mechanisms that
I have learned through therapy, a group of friends and family members who are
my rocks, and a sense of proudness and empowerment in what I have accomplished
that cannot be taken away. I am eager to make my mark on the field of nursing.
I can’t wait for what will come next.
Many people feel called into nursing careers. Nurses get the
unique opportunity to directly serve people in achieving better health. But
while nursing offers many rewards, the stress of the job can also lead to
burnout. Left unchecked, career burnout can drive even the most dedicated
nurses to leave the profession altogether.
Anyone considering a nursing career should start by having realistic expectations of what day-to-day life is like as a nurse—especially in acute care settings.
Ingrid Flanders, RN, BSN, MN, FNP-C, a visiting assistant professor at the Linfield-Good Samaritan School of Nursing in Portland, Oregon, says sometimes the job is different from what a nurse might expect. “Maybe they don’t have a full understanding of the role and the responsibilities that go with it,” says Flanders. “Then they’re surprised at the level and intensity of the workload. Maybe they haven’t prepared themselves physically, mentally, and emotionally for the work involved; because a nursing role, regardless of what setting you’re in, is really demanding.”
Flanders notes that patients have high expectations of nurses’ proficiency, which can create pressure. There’s also the pressure that many nurses put on themselves. “Generally, the people who are drawn to be nurses have high expectations of ourselves and so we try to give it all away and we don’t always have enough left for ourselves,” explains Flanders.
What starts out as a passion for helping people can soon lead to chronic job stress or what Vicki S. Good, DNP, RN, CPHQ, CPPS, vice president of quality and safety at Mercy Hospital Springfield Communities in Springfield, Missouri, calls burnout syndrome (BOS)—work-related stress that remains unresolved. “BOS has three elements: exhaustion, depersonalization, and perception of decreased personal and professional accomplishment. BOS is directly related to stress at work and not related to stresses outside of work, although outside stresses may impact the stress at work,” explains Good.
Good says that nurses in high-risk, high-stress work environments (such as critical care nursing) are at especially high risk for developing BOS, where they are asked to care for patients during a vulnerable time in the patient’s life, and often at the end of life, with the accompanying ethical issues.
“Nurses are engaged in high-stakes decision making on a daily basis,” says Good. “The nurse is the clinician who is constantly at the bedside of the patient, giving their entire physical and emotional self to care for their patient and their family. Combine this with one of the most challenging workforce shortages in nursing and nurses have rates of BOS equal and often higher than their physician colleagues.”
“By raising awareness and educating nurses on how to respond and mitigate symptoms of BOS we hope to prevent nurses from leaving the profession. BOS has been called a ‘silent epidemic’ because nurses and other clinicians have been afraid to speak up about their feelings, and instead the nurse ‘votes with their feet’ by leaving the unit and/or profession,” says Good.
Warning Signs of
Because nurses invest vast amounts of time, education, and money into entering the field and growing their careers, it’s important that they practice good self-care and watch out for the warning signs of chronic stress and burnout.
Nursing career burnout can be sneaky, warns Anna Rodriguez, BSN, RN, CCRN, PCCN, a critical care nurse who launched TheBurnoutBook.com to help nurses combat burnout. “It comes on so gradually, one bad shift at a time, and before you know it, you dread clocking in to work,” says Rodriguez. “Early recognition is key. You need to pause and assess yourself frequently for signs of fatigue, depression, or feeling cynical or apathetic toward your work. You might go home feeling emotionally or physically drained more days than not. You might feel anxious and find your mind racing, thinking about work. These are all unhealthy signs that the work is getting to you and, if it continues, will lead to full-blown burnout.”
Good says that unfortunately, most nurses do not realize when they are developing the signs and symptoms of BOS. “This is one reason that raising awareness of this syndrome is so important to our profession. As a professional nurse, it is critical to be able to recognize the warning symptoms so that one can then take action to mitigate the potential outcomes of the syndrome,” says Good.
So, what do nurses need to watch out for as they go about their daily work?
“As a nurse, the first thing to become keenly aware of are any changes in energy levels related to work—both physical and emotional. Exhaustion is one of the key symptoms. If the thought of going to work makes you exhausted, pay attention, ask questions, and seek intervention,” Good advises.
Flanders agrees that nurses should watch out for fatigue. Another common symptom is a lack of resilience or tolerance for challenging situations where you feel more impatient or more irritable than usual.
This lack of resilience may cause nurses to become disengaged in their work and interactions with coworkers and patients. “If a nurse was previously highly engaged in social events and activities on the unit and stops participating, this may be a sign of BOS development,” says Good.
Finally, watch out for the general feeling that you’re not making a difference as a nurse for your patients/community. Good notes that this lack of a personal and professional sense of accomplishment is a warning that burnout has set in.
How to Avoid Burnout—or Nip
it in the Bud
What can a nurse do if they are on the road to burnout or to prevent burnout from developing? Here are some expert tips from seasoned nurses.
Practice Self-Care. Flanders says it all starts with prioritizing
self-care. This includes reading for pleasure for a few minutes every day,
maintaining a healthy diet, getting regular exercise to reduce stress, and
making sure you get adequate rest. “Even if you’re a nurse working on a night
shift, it’s important to make sure your sleep pattern is one that’s
sustainable,” says Flanders.
Develop Resiliency Skills. “Resiliency is the antidote to burnout,” says Rodriguez. “It’s the ability to bounce back after feeling that emotional, physical, and psychological exhaustion that burnout creates. It’s finding a way to balance the energy you give to others and recharging yourself so that you can continue to care for others effectively.”
Rodriguez suggests the following tips to build resiliency as a
Be intentional on your days off to regroup and rest so that you can come back a better nurse on your next shift. Don’t say yes to extra shifts if you need to rest.
Take breaks during your shifts (and practice self-care strategies during your break, such as eating a healthy meal or reading for pleasure).
Plan unit-bonding activities. Getting together with coworkers outside of work is a great way to fight off burnout.
Talk It Out. Having a support network is vital for nurses. Nurses need to ensure they have other nurses to turn to vent about a bad day, a troublesome patient, or frustrations. Having nursing friends at work and/or joining a professional nursing association dedicated to your specialty, such as the American Association of Critical-Care Nurses, can be an excellent outlet.
“We need a way to talk about the things we see every day,”
says Rodriguez. “There’s a lot of doom and gloom. There are morally distressing
moments. There are times when we’ve given so much of our energy to others that
we develop compassion fatigue and go into survival mode, shutting down our
empathetic side as a coping mechanism. The ability to vent in a healthy way
with our peers is essential to dealing with all of that and maintaining our
empathy. No one understands what you go through better than another nurse.”
Explore Your Options
If you feel that you are already in burnout mode, take some time to explore your career options. Some nurses who experience burnout leave the profession altogether. But that may not be necessary.
Start off by exploring ways you can remain in the field by taking some time off, changing units, or finding a new job in a less stressful environment.
“A sabbatical or some time off may help, but it’s generally not a
long-term fix,” says Paula Davis-Laack, JD, MAPP, owner of Davis-Laack Stress
& Resilience Institute. “Remember that burnout is more about work
systems, cultures, and values creating an environment that breeds burnout, so
until the workplace changes, burnout will likely remain a possibility. You may
just be in an environment that’s a disconnect for you. Can you switch teams,
organizations, or practice settings?”
If a change in work environment or position doesn’t help, then
it’s time to look at nontraditional career tracks such as becoming a health
coach, nurse entrepreneur, or nurse educator.
“One of the things I’ve enjoyed about being a
nurse now for almost 35 years is that there’s a variety of nursing roles within
the profession, and it’s important for young nurses to know that if they’re
getting to the point that they feel like they can’t do it anymore, there are other
options and other roles that might be a better fit for them at that point in
their lives,” says Flanders. “It’s important not to feel like you’re stuck in a
corner and that you don’t have the power or ability to make it different if it
needs to be different. Because when you’re in the role of taking care of other
people, if you’re not doing well, then how can we possibly do our jobs as
you agree with the latest trend toward simplicity and reducing the
amount of things you possess, there’s something to be said for the
idea of reassessing.
Marie Kondo’s philosophy of The
the stands, people around the globe took notice. With an eye toward
tidying up and, more importantly, the simple question of “Does this
spark joy?” Kondo has inspired legions to cut back, donate, and
toss everything from clothing to dishes.
the simplicity question also begs a larger examination of the life
you lead, and for nurses, this is especially important. When you
apply Kondo’s question to your career, it might make you stop and
rethink how it is progressing.
a nurse, you likely came to the career because you had a passion for
helping others, for making sure patients were treated respectfully,
and for a meticulous approach to accurate methods. But as a nursing
career progresses, burnout can take a toll on your mental and
physical health as well as your job.
matter what stage of your career you are in, it’s worthwhile to check
in with your hopes, dreams, and expectations every now and then.
Maybe “sparking joy” is a little extravagant when it comes to
career assessment, but it’s not that far off.
put, is what you are doing making you happy?
the answer is yes, that’s great news. It doesn’t mean you are off the
hook, though. If what you are doing is satisfying personally and
professionally, think about what you do that makes it that way. Also
think of ways you can expand your professional goals to include
activities, educational pursuits, or opportunities that will continue
to keep you on the right path. People change and so do careers. If
you know the core reasons you are happy in what you are doing, it’s
worth finding ways to grow from that point.
your answer is more on the negative side, it’s time to take a close
look at the roots of your dissatisfaction. You might find yourself
feeling unhappy in a role that once was perfect for you. But you
might have new colleagues, new standards or expectations, or even a
longer commute. Your shift could be different or you might wish for
more flexibility if your life at home is changed at all. You might
even find your work has become more routine than you like and are
thinking of making a switch.
Kondo’s close examination of the possessions people hold,
scrutinizing your satisfaction with your career might reveal some
tweaks that can make all the difference or it might become perfectly
clear that it’s time for a major career change. Could a new schedule
serve you better? Would you be happier working predictable clinic
hours instead of working on a unit that runs 24/7? Are you thinking
your years of experience are better suited to making changes at an
administrative or policy-making level? Or have you been in an
administrative role and want to get back on the floor?
the time to weigh your options given your basic needs for things like
salary and benefits, patient care options, educational commitments,
and personal lifestyle. Then begin to chart out the steps you need to
take to get back on track.
is a calling for so many, but it’s not perfect. It is, however, a
broad industry, one that offers opportunities for change and growth.
Figuring out how to stay satisfied and nourished in a career you once
felt compelled to become part of can bring you some of that spark you
Over the past half a century, the number of
men in the nursing industry has increased exponentially. In the sixties, only 2% of men were nurses. Today, the percentage has
climbed to 13%. That’s an 85% increase, which is huge!
However, if 13% of nurses are men, that means that 87% of nurses are not. There is an extremely disproportionate number of men in the nursing field, and there’s no real reason for it, other than stigma. But today you’re going to learn just how senseless this stigma is, and why it must be stopped.
Originally, men were nurses. In 250 B.C., the world’s first nursing school opened its doors, for men only. Yes, nurses were originally all male! But times have changed. Nowadays, women make up the bulk of this once male-dominated industry
Why? Because of the stigma. What’s the stigma,
you ask? The stigma is that nursing is a caregiving position, and therefore,
such a job should be reserved for women. Now, here’s the fallacy of such a
statement. Today, women are doctors, accountants, and policewomen, jobs which
were once considered to be for men, and no one thinks twice, because gender
bias deserves no place in a country as morally advanced as the US. But for some
incomprehensible reason, there is a significant amount of gender bias. Pay
attention to the nursing industry, and you’ll notice it there.
But this has to stop. We need male nurses; they’re just as capable, strong, and intelligent as their female counterparts, and add a much-needed balance to the industry.
How Can We Stop the Stigma?
Never belittle the concept of someone becoming a male nurse. Being a nurse is something to be proud of, regardless of gender! It shows you’re a caring, kind person who wants to help others and has the ability to accomplish goals.
Respect men in the nursing industry. These men are people who don’t care what everyone else is doing. They do what should be done, regardless of what others will think. And that is something to look up to.
Spread the word about the benefits of becoming a male nurse. The pay is fabulous, the line to the bathroom door is moot, and promotion is likely (since men are more likely for promotion overall, and there are so few men in the field to begin with). There are many more positives about this career; perhaps we’ll get into the details another time, but even just the aforementioned benefits can be enough to show guys you know that this is a field worthy of their consideration.
Become a nurse! It’s a great career choice for men, and every additional male nurse makes a difference in the percentage.
Tips for Men in the Nursing
Being a male nurse isn’t always easy, but it’s
wonderfully rewarding, both financially and emotionally. Here are a few tips
for you to get the most out of being a guy in scrubs.
The same way men prefer male nurses, women often want to be cared for by a female nurse. This is nothing personal; don’t take it to heart. There will be many a man who will be really happy to find out you’re being his nurse.
There are many organizations, such as AAMN and The Brotherhood of Nursing, which can help you connect with other male nurses.
Does it bother you that most scrub stores are so feminine focused? Then you may prefer to shop at Murse World, which exclusively provides guys with a full selection of male scrubs from all the best nursing uniform brands.
Stay confident and proud. You’re helping so many patients, and simultaneously breaking gender barriers in the nursing industry.
Whether you’re a nursing student, a nurse, a patient, or anyone else, you can have a part in stopping this unnecessary stigma
I remember my last code. You know how it
goes: it was 7:00 a.m., and I was charting as if my own life depended on it.
The gray light of early morning oozed through the curtained windows. All was quiet,
except for the clacking of the keys. My mouth tasted of too strong coffee, yet
my eyelids dropped. It was almost time to go.
That was when I heard the snoring. It was a sound I hadn’t heard before. The sound has a rolling, gagging quality to it. I jumped to my sore feet and listened like a hunting dog for where the sound originated.
There it was. There!
I ran into the patient’s room, took one look from the doorway and knew he was dying. His mouth hung open in a large “O,” and his tongue spilled out of his powdered blue mouth. I yelled for help and plunged into the job of securing the airway.
It was just like any other code, really. I’m not sure when I started to feel uncomfortable. My hands shook, and something deep inside me trembled. I had told myself since my last dance with my mental illness that I wouldn’t get myself into stressful situations—something absolutely impossible for a floor nurse.
The charge nurse was there, and I felt the patient was safe with her. Clearly, he wasn’t safe with me. I told her that I couldn’t be in there anymore, and I left.
My manager approached me not unkindly and told me to go back in. I told her I couldn’t. I honestly would have stood like a statue had I tried.
It was a matter of a few weeks before they fired me, and with good reason considering how I acted. Did I even deserve to be called nurse after all that happened in my struggle to be a good nurse?
In other words, who am I now?
I honestly didn’t grow up wanting to be a nurse. I wanted to be a writer, but I was told that wasn’t a path that would lead to a good life. So, I abandoned it. Instead of facing my passion for writing, I furtively scratched out short stories in the far reaches of my room. All I ever wanted to do was write.
Life twisted. It turned tortuously, and I found myself needing a job. I liked medicine. In fact, that was what my mother wanted me to pursue—and what she had wished she had pursued. Nursing seemed like an obvious path for me. I love helping people. I am fascinated by the human body. I was smart enough for the curriculum. I liked it but didn’t love it like some of my classmates.
I will brag and say I graduated second in my class. Through nursing school, I did develop a love for it. I could help people so much more with the knowledge I had gained. I knew things and had seen things that made me powerful. Medical knowledge is immensely powerful.
I was proud to say
that I was a nurse. I felt a fellowship with the hardworking men and women
around me. I was amazed at how good they were, how it felt to work as a team. I
loved helping out with codes and being on the frontlines. I grew to love being
a nurse, and I took part of my identity from this fact.
what went wrong?
On some deep level, I knew my emotions
were not in my control all the time. I would have racing thoughts about the
simplest things. I would worry that something terrible would happen. Very
often, I could not manage the strength to get out of bed and to be a part of
life. I had known this since I was a teenager, but I didn’t want anyone to call
I still functioned well as a nurse: respected, well liked with a great reputation. My feelings only got worse as I continued to work, though. The stress of nursing weighed down on me, the struggle to get through a shift. I took a leave, and I was finally diagnosed—and treated for—bipolar disorder.
It seemed liked a downward spiral, though. I would get better only when I didn’t work. And I wanted to work! I had worked so hard and given up so much for the privilege to call myself nurse.
It all went away, and that made me incredibly sad. In that state and in that situation, I was not safe for patients. I understand that and thank those who removed me.
I work as a practice administrator in a psychiatrist’s office now. My struggles with mental illness allow me to help those who are suffering or maybe are at a part of the journey that I recognize. I write, too, as you may have noticed. Since I lost my job, I’ve been using my skills in both nursing and writing to make a way for myself and my family.
But I don’t feel like a nurse anymore. I don’t feel a part of that fellowship. I don’t remember drug names, and I can’t tell you what lab values mean. I worked so hard for entry into this club, and I feel on the outs. I feel disconnected with an identity I once held dear.
I told my mother-in-law about missing nursing. She’s a positive woman, always upbeat. Certainly not like me! Her words were simple, though I doubt she understood the complexity of the situation.
“Lynda,” she said, “you are more than a nurse now. Other people are just nurses.”
I will admit that it still stings, despite my mother-in-law’s wisdom. On my journey, I became a nurse, but as that journey continued, I found that I could be so much more, all the parts of me. And maybe, through that journey to becoming a nurse, I can help someone in their journey—whatever it maybe.
Barbara Stilwell, PhD, RN, FRCN, is the Executive Director of Nursing Now, a three-year global campaign seeking to raise the profile of nurses.
Dr. Stilwell recently talked with Minority Nurse about what she hopes Nursing Now will accomplish before the campaign ends next year.
What follows is
an edited version of our interview.
What do you hope to accomplish?
The campaign ends in 2020 and by then we aim to achieve the following:
1. On investment: There is greater investment in the nursing workforce—in education and professional development, standards and regulation, and employment conditions as well as in numbers in training and employment.
Measurement: that there are increases globally in investment in nursing and in the numbers of nurses in training and employment, and that a trajectory has been established and progress is being made towards eliminating the shortfall of nine million nurses and midwives by 2030, tracked through the State of the World’s Nursing report.
2. On policy: The health workforce generally—and nursing and midwifery specifically—are more central to global and national health policies.
Measurement: that all global and national policies on health and health care acknowledge the role of nursing in achieving their goals and include plans for the development of nursing. That national plans for delivering UHC make specific proposals for enhancing and developing the role of nurses as the health professionals most able to deliver patient centred UHC to individuals, families, and communities.
3. On leadership and influence: There are more nurses in leadership positions where they are able to influence policy and decision making and more opportunities for leadership and development for nurses at all levels.
Measurement: at least 75% of countries have a CNO or Chief Government Nurse as part of their most senior management team with the longer term aim of all countries having such posts; there is an increase in the availability of senior leadership programs for nurses; and a global nursing leadership network is established. More young nurses have access to leadership development programs.
4. On evidence: There is more evidence available to policy and decision makers in forms that are understandable about: i) the impact of nursing and where it can have most effect, ii) the barriers that currently prevent nurses from practicing to their full potential, iii) practical methods for addressing these barriers, iv) and that there is more research underway.
Measurement: There are increasing numbers of articles on aspects of nursing in peer reviewed journals that reach an audience broader than nurses; there is a coordinated global network on research on nursing; and there are innovative methods tested of bridging the evidence to policy gap in nursing.
5. On effective practice: There is more dissemination and sharing of effective and innovative practice in nursing and improved methods for doing so.
Measurement: that there is a
coordinated global portal allowing access to examples of effective practice and
innovation that is supported by nursing organizations and available to nurses and
policy makers globally.
What has the campaign accomplished so far?
We now have 170 Nursing Now groups in 77 countries and growth continues. We are a social movement that works through its groups and networks to change the culture of nursing, and feedback so far suggests that the campaign has come at a moment when nurses are ready for change.
What do you hope to have happen in the next year?
WHO has declared 2020 will be the Year of the Nurse and Midwife and is preparing a State of the World’s Nursing Report—the first one ever. While there is support at WHO for nursing and midwifery, the presence of a global campaign has highlighted the significant issues in nursing development if Universal Health Coverage is to be achieved.
Our Nursing Now groups are spearheading initiatives to tackle today’s health issues—for example, how to achieve universal health coverage, the health of homeless people, gender-based violence, men in nursing, the image of nursing and midwifery, and many more.
How can nurses and/or health care providers become involved in it?
We have a great web site which
invites comments and case studies. Please explore it and contact us if you have
ideas. This is a movement that belongs to all nurses.
Dr. Barbara Stilwell, Global Campaign Executive Director for Nursing Now, an initiative to empower nurses worldwide by building grassroots support to demand better investment in nursing and midwifery to tackle 21st-century health challenges, is the author of “#Nursing Now," an article about this campaign, in the most recent issue of Creative Nursing: A Journal of Values, Issues, Experience, and Collaboration.
This issue is currently free to read for a limited time.