Certified Registered Nurse Anesthetists (CRNA) Week kicked off on January 19th and recognizes this specialized area of nursing. Sponsored by the American Association of Nurse Anesthetists (AANA), the week honors all these nurses do.
CRNAs recently received a public recognition of their career path when U.S. News and World Report published a Best 25 Jobs of 2020 and nurse anesthetist came in at the number 21 slot.
This nursing career has a lot going for it. It pays well, is constantly changing, and has lots of patient interaction. Nurse anesthetists often assist during surgery or may be in charge of the patient’s entire anesthesia plan and process. In fact, in some places, including rural areas or on the frontlines of the military, nurse anesthetists are often the main providers of anesthesia care to a patient.
Nurse anesthetists bring home a large paycheck. Although the U.S Bureau of Labor Statistics reports the amount will vary based on location, an average annual salary comes in at $167,950. Nurses interested in this path will complete a rigorous educational training. After your early nursing career, a typical path starts out in a critical care role, such as the intensive care unit, where they gain valuable training on evaluating and caring for patients with life-threatening injuring or illnesses. These nurses often have a masters’ degree, but more and more nurse anesthetists earn doctoral degrees. Beginning in 2022, all nurses entering accredited anesthesia programs will be required to earn a doctorate in the specialty.
This role requires initial certification and continued professional certification as the field changes rapidly. Lifelong learning in this specialty is essential for providing the best nursing care and ensuring the best patient safety.
Because of their role in providing essential care, nurse anesthetists routinely work in many areas, so finding a role that suits your career plans and your lifestyle is possible. Flexibility within this role isn’t as common as within other nursing roles, but because there is such a high demand for this role, the job variety is excellent.
According to the AANA, nurse anesthetists provide care to patients in varied locations and settings. From a chaotic battlefield to an organized dental office, nurse anesthetists are required to provide focused, deliberate, and incredibly precise anesthesia care. This role is also essential in pain management clinics and in surgical settings.
CRNAs also play an active and important role in the policies and regulations surrounding the patient care and the professional standards of this specialty. The CRNA Political Action Committee represents the interests of CRNAs and their patients in Washington and in the political establishment of each state.
Nursing leaders and those who take an active role in political decisions can offer a perspective that speaks to ensuring patients have equal access to the best care possible, no matter where they live or their income. These nurses are also proficient in speaking about veterans’ affairs, the opioid crisis, and patient safety.
CRNAs are a vital part of patient care. This week is acknowledgement of all they do.
Though well into her final trimester, Kate Middleton hasn’t let the impending birth of her third child stop her from attending royal engagements. At the very end of February 2018, the Duchess of Cambridge visited the Royal College of Obstetricians and Gynaecologists (RCOG) and St. Thomas’s Hospital in London. While there, Kate Middleton ran into the midwife who helped deliver her daughter Princess Charlotte, Professor Jacqueline Dunkley-Bent, and the two shared a warm embrace.
But Middleton didn’t make the visit just to be reunited with her former midwife: She was there to become the second patron of the Royal College and to officially announce the Nursing Now 2020 campaign, which aims to raise the profile and status of nursing worldwide. As the name suggests, the three-year campaign is scheduled to last until 2020, the 200th anniversary of the birth of Florence Nightingale, the founder of modern nursing.
“This campaign means a lot to me personally. My great-grandmother and grandmother were both volunteer nurses,” Middleton said in a speech she gave the campaign launch. “They would have learned first-hand from working with the Voluntary Aid Detachment and the Red Cross about the care and compassion that sometimes only nurses can provide.”
Find out everything you need to know about the Nursing Now 2020 campaign below.
Critical Roles Played by Nurses
Nurses are the heart of most health care teams, caring for patients from their first breaths to their last, helping with everything from checking blood pressure to offering diagnoses to administering shots and painkillers. “Nurses are always there. You care for us from the earliest years. You look after us in our happiest and saddest times. And for many, you look after us and our families at the end of our lives,” Middleton said. “Your dedication and professionalism are awe-inspiring.”
As the Duchess of Cambridge went on to point out in her speech, sometimes nurses may be the only health care provider readily accessible in certain areas of the world, which is why it’s extremely important that enough nurses be trained and placed in the coming years. “In some parts of the world, nurses are perhaps the only qualified health care professionals in their communities, so your work is all the more vital,” she said.
Coming Shortage of Nurses
According to Middleton’s speech, 9 million more nurses will need to be trained by 2030 to meet the rising demands worldwide, which works out to about 2,000 more nurses each day for the next 12 years. Nursing Now 2020 hopes to start filling that gap by increasing the profile of nursing roles and raising awareness about becoming a nurse. Indeed, the nursing shortage has been deemed a global crisis since 2002, but the recruiting and retention of nurses hasn’t been able to keep up with the health care demands of a growing population.
Five Campaign Goals
To help increase the number of nurses, and to support nurses already working in the field, the Nursing Now website lists five main goals that the initiative hopes to achieve by 2020. They are:
- Greater investment in improving education, professional development, standards, regulation and employment conditions for nurses.
- Increased and improved dissemination of effective and innovative practice in nursing.
- Greater influence for nurses and midwives on global and national health policy, as part of broader efforts to ensure health workforces are more involved in decision-making.
- More nurses in leadership positions and more opportunities for development at all levels.
- More evidence for policy and decision makers about: where nursing can have the greatest impact, what is stopping nurses from reaching their full potential and how to address these obstacles.
Basis for the Initiative
The goals and methods of the Nursing Now movement are based on a Triple Impact report, which was released by the All-Party Parliamentary Group on Global Health in October 2016. The report found that empowering nurses would not just improve health globally, but also build strong economies and promote gender equality (as the vast majority of nurses are still women). These three results combine to form the triple impact that nurses could potentially have. “The nursing contribution is unique because of its scale and the range of roles nurses play,” the report said.
Organizations Behind the Movement
Kate Middleton may be the most recognizable public face of the Nursing Now campaign, but two major health organizations are behind the campaigns: the International Council of Nurses and the World Health Organization. The International Council of Nurses represents millions of nurses worldwide, and seeks to represent them, advance the profession, and influence health policy. The World Health Organization is a specialized agency of the United Nations that seeks to address international health policy. The campaign is also supported by the Burdett Trust for Nursing, an independent charitable trust that helps fund nurse-led projects.
A Global Campaign
The Nursing Now Campaign Board includes both nurses and non-nurses from 16 different countries to represent a truly international group. Official launch events were held in London (where Middleton spoke) as well as Geneva. Various international nursing associations also hosted their own launch events, with locations including Canada, China, Jordan, South Africa, Taiwan, and Macao.
Ways to Get Involved
Beyond advocating for nurses and nursing, individuals who wish to support the campaign can sign the Nursing Now pledge and share the social media kit on various platforms. If there is no existing Nursing Now group in their area, nurses and non-nurses may band together to form their own group, though the process is lengthy to ensure participants are committed.
Whether you live in a developing country or an advanced health care economy, the coming nursing shortage will affect the entire globe, and is being felt in some places already. Through its five goals, Nursing Now hopes to help meet that need by recruiting new nurses and empowering existing ones through greater leadership opportunities and better policy decisions. To learn more about Nursing Now 2020, visit the campaign website.
Geriatrics is the medical specialty serving patients 65 and older. Usually multidisciplinary, the geriatric team may consist of primary care providers specializing in geriatrics, diabetes educators, psychologists, medical social workers, pharmacists, and support staff. The goal is to keep patients functional at their highest level throughout their elder years. This might mean the difference between a patient living independently, semi-independently, or in a skilled nursing facility.
Let’s say your next patient is a 75-year-old female admitted to the ER for confusion. Vitals are HR 98, BP 102/60, RR 20, SpO2 96, T 98 oral. The patient arrives by ambulance from home. Her clothing is wet with foul smelling urine. She is not oriented to person or place. Her affect is flat. Tenting is elicited on her hands. Skin is warm. You note she has lately been to the ER several times for falls and failure to thrive.
What to do for your patient? After the work up, the patient is diagnosed with a UTI and dehydration. Confusion is often seen in the elderly as the first sign of a UTI. Of course the foul smelling urine and new incontinence were the giveaway. This patient is going to need more than a course of antibiotics and fluid. Although she lives with family, the recent visits to the ER make it clear that the family is overwhelmed. A quick conversation with the daughter confirms this fact. You suggest a geriatric consult to the ER provider and she agrees.
Some inclusionary factors for a geriatric referral are age 65 and older, increased utilization of services, changing/increasing needs, decreased functioning, confusion or dementia, failure to thrive/weight loss, falls, and age related health problems. Our ER patient meets several of these criteria. If the patient has a PCP, coordination with that provider would be necessary. Geriatrics will often do a consult to see if the patient is the right fit. It looks like our patient and her family could use the services of a multidisciplinary team.
Active addiction/alcoholism, recent suicide attempt, acute psychosis, or untreated mental health issues would require different referrals. Substance abuse problems, active mental health issues, or suicide attempts would need to be addressed by addiction services and/or mental health services and the patient stabilized before geriatrics could assess age related changes to memory or dementia. These issues would cloud the clinical picture and make diagnosis of cognitive impairment impossible.
The geriatric primary care provider is part of an interdisciplinary team. Because of this, our patient will have access to a range of services that are can be outside of the ability of the primary care provider to manage. Having everyone under the same roof, steps away, using the same electronic record system, allows for an integration of care that would be impossible using outside specialists. Our patient will get a referral from the ER after the ER provider consults with the patient’s primary doctor if she has one.
The patient will be scheduled for a geriatric consult as soon as her condition has stabilized.
Meet the Geriatric Team
Dr. Nirmala Gopalan, MD, is the site manager for the Santa Clara Valley Medical Center Downtown Geriatric Clinic in San Jose, CA.
“On the patient’s initial visit, I’m looking for inclusionary factors. Does this patient need us? There are a lot of elderly patients whose health care needs are well met by their PCP. The ideal patient to come aboard our service meets the inclusionary factors, has a desire to onboard to our services, and is looking for quality of life, not just disease care.”
Ginny Estupian, PhD, is the geriatric clinic psychologist at Santa Clara Valley Medical Center and works closely with Dr. Gopalan. “My role on the team can be divided into two parts; providing individual therapy and neuropsychological evaluations.”
“When I conduct individual therapy, I focus on reducing troublesome mood symptoms such as depression and anxiety. I may focus on helping the patient cope with chronic health conditions that exacerbate their mood such as COPD, chronic pain, diabetes, and cognitive changes. I help the client understand the relationship between the sleep, pain, mood triad, and we focus on improving one or more of those areas. Mood symptoms can improve by learning coping skills, engaging in age-appropriate exercise, or simply processing how they feel about their overall health.”
“The second part of my role is conducting neuropsychological evaluations. I assess for changes in cognition that may occur due to Alzheimer’s disease, vascular disease, or other age-related conditions. Findings from neuropsychological testing are discussed with the multidisciplinary team, then discussed with the patient and family in order to coordinate ongoing care that meets the specific needs of each client.”
Carol Lee, PharmD, is a pharmacist for Santa Clara Valley Geriatrics Clinic. “The first thing I do with the new patient is go over the medication. I’m looking for appropriateness, contraindications, drug interactions, compliance…”
“I look at the patient in terms of the 5 Ms of geriatrics: Mind, Mobility, Medications, Multi-complexity, and Matters Most. Does the patient have dementia, cognitive decline, delirium, or depression? Can the patient tell me why he or she is on this medication? Is the patient an active participant in care or is someone else managing it? Age is just a number. Patients have a wide variability in ability. We don’t prejudge, we assess.”
“Can the patient navigate the pharmacy system? Are they having difficulty with refills or medication timing? Our pharmacy can set up automatic refills, home delivery, blister packs, and other services to assist our patients.”
“Another thing I asses for our patient population is herbal supplements. I educate them on the pros and cons of taking supplements and over the counter medications. The patient needs to weigh if they are getting benefit or detriment from them. I go over each one with them, looking for interactions.”
“Finally, polypharmacy has to be addressed. Some patients have been to many doctors over the years or have seen multiple specialties and they can have a lot of medication burden. Having the patient’s care totally within our system, on the same electronic charting system, and doing a medication reconciliation with each visit helps me to drill down to exactly what the patient is taking, what we can toss, and what we can keep. The patient has health goals, that’s what ‘matters most.’ The proper medicine, and nothing extra, is my job with the geriatric patient.”
Danette Flippin, MSW, MSG, also at Santa Clara Valley Medical Center Geriatric Clinic, looks at not just the whole patient, but at the patient’s support system.
“When assessing the new patient I always think in terms of biopsychosocial and spiritual assessment. Starting with the patient, I ask what is this patient’s level of functioning in the world? What are the physical, cognitive, emotional, and psychological abilities that allow this patient to address needs or to cope with challenges? What deficits are preventing healthy coping or access to health care, or engagement with community support?
“Simultaneously, as a medical social worker, I am looking at the patient’s environment and support systems such as family, friends, social/senior networks, church communities, etc. What is important to this person as they navigate the later stages of their life cycle, place meaning and address the existential questions and factors in their lives?
“When we look at an older adult, we are assessing the well-being of the caregiver as well. The patient and family centered approach is key to assessing, identifying problems, and integrating helpful, successful interventions. When all the information is in place I form a plan on how best to serve this person, not this person’s diseases.”
As we each progress through the stages of life, it’s good to know there are resources available. Not every elder patient needs the services of a geriatric specialty clinic, but the ones that do definitely get value. Don’t forget to evaluate your geriatric patients for specialized care.
Many organizations are moving towards an annual mandatory Personal Development Plan (PDP), also referred to as an Individual Development Plan, as a way of not only identifying avenues of interest for employees, but as a succession planning tool. No matter the agenda for the organization’s necessity for this document, nurses, and especially nurse leaders, should be using this tool to identify and track both career and personal aspirations. Thoughtful and intentional time spent on your PDP can make the difference between a career that happens to you and a career that happens for you.
A typical personal development plan asks the participant to identify numerous career and personal goals to achieve over a set time period. Many organizations, such as Kaiser Permanente, also require that the goals be aligned to the strategic initiatives of the company such as patient care, safety, or financial acumen. It is also not unusual for establishments to require the employee to record a set number of goals in the PDP document. If there is no requirement from the organization, nurses should choose at least three goals for their PDP tool; one short-term professional, one long-term professional, and one personal.
All goals should be written in the S.M.A.R.T. format: Specific, Measurable, Achievable, Relevant and Time-bound. For example, using this format, a goal for completing a master’s of science in nursing (MSN) degree would read, “Complete MSN at Emory University by June 2020.” The relevancy need not be described in the goal as most PDP tools will ask the writer to describe how the goal will relate to or affect the organization. These sections are included in many PDP tools:
- Goal/learning/development to achieve
- Action required to achieve the goal
- Relevance to the organization
- Evidence of completion
- Target date of completion
Nurses are expected to engage in professional development not only as a means to stay current in nursing practice, but as a commitment to nursing as a profession. The PDP is an excellent tool to capture and record these developmental goals and can be used as an atlas to guide your career. Many people underachieve in their career aspirations by simply failing to plan their path. A well-crafted PDP provides the blueprint for how to build your ideal career, clarifies resources needed to meet your goals, and enlists the support of your leaders.
The professional development plan is not a one-and-done task to be completed each year. A strong PDP should be a living document that is updated at least every quarter to keep you accountable to your desired career trajectory. Ways in which a PDP is useful include:
- Clarity – The document should be able to keep you accountable to what you have achieved so far and where you want to take your career.
- Motivation – By updating and streamlining your PDP several times a year you will be able to answer the “why am I doing this?” question in order to stay focused and aligned to your goals.
- Action – By setting written goals in the PDP for both short and long-term accomplishments, you can move backwards from the goal to create monthly, weekly, and daily actionable items that will move you towards your end game.
- Performance – Keeping your PDP current will also allow you to track your performance in any given focus area, which is another good reason to have multiple goals of varying timelines. This also allows you to “toot your own horn” when the time comes for the annual self-evaluation.
Nurses with intentions to move into a leadership role or another specialty area should have this conversation with their manager, unit leader, and mentor. There are many ways in which the manager can assist the aspiring nurse, such as selecting them for committees that provide exposure to other departments and other managers, providing direct coaching on communication styles, and/or sponsoring the nurse for introductory leadership roles within the organization. By setting intentional goals in the PDP tool, nurses can ask managers and leaders for support in meeting these professional targets. To put it in more simplified terms, leaders cannot help you if they are unaware of your intentions.
By sharing your professional goals with your leader, you are also assisting the organization with succession planning as the need for replacing retired RNs will be at a critical state by the year 2022. Whatever your professional goal is as it relates to the company should be of great interest to them as they plan for the mass exodus of the baby boomers over the next decade, given that all areas of nursing will need to be covered. From leadership roles in specialty areas such as intensive care, labor and delivery, emergency services, recovery, cath lab, GI, or neonatal intensive care to advanced practice nursing roles including NPs and clinical nurse leaders, your institute can plan accordingly by knowing where you intend to take your career.
Personal goals are also important to include in your PDP. This not only helps you stay accountable and provides all the benefits listed above, but it also allows your direct leader and administration to see you as a whole person and not just as the career employee. Are you planning to run a marathon? Do you have a goal to serve on an overseas charity project utilizing your nursing skills? Starting a blog or podcast about your nursing specialty? If it is important to you, it should be important to your leader to support. You never know when opportunities or networking can arise from allowing people a glimpse into your personal aspirations.
The personal development plan is a dynamic tool that is created to provide a roadmap for your career and personal goals. Thoughtful, intentional, and frequent time spent on the creation and maintenance of this document should be viewed as an opportunity to take purposeful control over your future.
Nursing is a career that offers incredible personal satisfaction and consistent job growth. People generally go into a nursing career because they know the job is a good match for their goals and capabilities. But the field also offers a job security seen in few other fields.
A recent 25 Best Jobs of 2020 report by U.S. News and World Report rated some of the top jobs in the United States and three nursing jobs made the list. Although many nurses know how valuable their skills are in the job market, seeing three distinct nursing paths represented shows the breadth of the nursing industry.
Of the three nursing positions, a job as a nurse anesthetist came in at number 21 based in part on the high salary (an average of $167,950) and the high demand for nurses in this specialty. Nurse anesthetists also may see a 17 percent increase in employment openings between now and 2028.
Registered nurses come in at number 13 on the list. This career will see an estimated 12 percent increase in jobs by 2028, with nearly 372,000 possible job openings. The sheer number of job openings reflects a need for RNs across the country. RNs will be able to find opportunities in all areas, with rural nurses in particular need. Those in gerontological nursing are also in increasing demand to meet the growing senior population as Baby Boomers reach milestone birthdays over 65.
Nurse practitioners (NPs) will also be in high demand over the next decade, says U.S. News. Nurse practitioners can expect incredibly robust job growth in the next eight years, with a 28 percent jump predicted. That amounts to just over 53,000 estimated additional job openings. Nurse practitioners are needed across the nursing spectrum, and their salary reflects the additional demand and educational preparation required for this role. NPs command an average annual salary of $107,030, landing this career on another list of jobs paying more than $100,000 per year.
With three diverse nursing positions making the top 25 job list for the year, a nursing career path offers job security, excellent salaries, career growth, and personal satisfaction. The three positions on the list all require different academic paths and responsibilities, meaning that the nursing industry has a place for those who are devoted to caring for others and helping to improve the health of the public and who may not take the same steps to get there.
Across the board, nurses can take pride in the recognition of an industry in demand. Nurses save lives, educate patients and families, support their healthcare teams, encourage community health, and provide a village for other nurses. Seeing so much potential for job growth is exciting and reaffirming for those in the nursing industry.
Nurses need to be prepared for every eventuality in patient care: they welcome life into the world, and hold patients’ hands as their lives come to an end. The core job duties are physically, emotionally, and spiritually taxing — and sometimes dangerous — so it’s no surprise that nurses experience burnout at an alarming rate.
In fact, the National Nursing Engagement Report for 2019 found that 15.6% of all nurses were feeling burned out at the time of reporting, with 41% of nurses who reported themselves as feeling unengaged also reporting feeling burned out. But many nurses also know they can’t leave — or even take time off — because the nursing shortage is so critical that every hour counts.
We’ve written before about how to combat nurse burnout, but it’s just as important to recognize the dangerous signs of burnout when it starts.
What Are the Signs of Burnout?
Between the long hours, the demands of the job, and just being human, most nurses will experience either the signs of burnout or full Burnout Syndrome (BOS) at some point during their careers. As the National Nursing Engagement Report showed, even fully-engaged nurses report these symptoms. The first step to combating BOS is to recognize the symptoms.
Perhaps the first sign and highest predictor of burnout is emotional exhaustion. Nurses know what it’s like to be tired, but emotional exhaustion leaves you feeling completely drained as a result of the stress of your job. In addition to feeling fatigued in every way, people who are emotionally exhausted often feel like they’ve lost control of their lives — they often report feeling trapped in their situation, whether it’s at work or in an outside relationship.
Another sign of burnout is depersonalization. When you become so exhausted that you have to detach from your surroundings to survive, then you are burnt out. Your outlook may be negative or even calloused, and it can express itself in unprofessional comments directed at colleagues, feeling nothing when a patient dies, or even blaming patients for their problems.
The final major predictor of burnout is a reduced feeling of personal accomplishment. You may not feel that you’re a good nurse or that you make any difference at all in patients’ lives. Nurses working in high-intensity settings, like the ICU or emergency room, may experience this more often as they receive a greater proportion of cases where little can be done for the patient.
Why Burnout is Dangerous for Nurses and Patients
Burnout is more than having a bad day; it’s an impaired outlook on nursing and life in general. Experiencing burnout doesn’t mean you don’t love your job, nor does it mean that you aren’t good at what you do. In fact, this reality makes it even more difficult for nurses who experience burnout because leaving is just another impossible choice.
At the same time, burnout is as dangerous for nurses as it is for their patients. A nurse in the throes of BOS is both less likely to have life satisfaction and more likely to provide a poorer standard of patient care. In a study published in Research in Nursing & Health, researchers explored the correlation between the quality of care and nurse burnout among 53,846 nurses from six countries. They found a strong correlation between higher levels of burnout and nurse-rated quality of care.
In other words, burnout can become a self-fulfilling prophecy. Burnout can result in lower standards of patient care, which further informs the reduced feelings of personal accomplishment. As nurses make mistakes, they feel even lower job satisfaction and an even greater intensity of burnout, which goes around again to manifest itself once again in patient care.
How Nurses and Nursing Leaders Can Combat Burnout
Nurses are caught between a rock and a hard place — the nature of the job is stressful, but if you love what you do, you can’t quit. Although almost all nurses will go through burnout at some point, there are things that both practitioners and health care organizations can do to stave it off and help re-engage burned-out nurses.
Education is one of the critical ways that nurses can empower themselves and avoid burnout. Pursuing further education can renew your passion for what you do and help you overcome roadblocks. It also puts you in a better position to provide the latest evidence-based care to patients, which correlates to better patient outcomes and increased job satisfaction.
Nursing leaders and administrators also have a strategic role to play, as the environment in which nurses practice needs to be a supportive one. Creating a positive work environment that limits unnecessary stress and allows nurses to care for themselves and recharge can do wonders in both reducing burnout and igniting engagement.
Those same leaders and administrators can also take notes from other industries’ workplace safety practices. You can’t just say you have a safety culture, you need to commit to it by formalizing the ways in which you intend to create and maintain the culture and creating avenues to accept employee input.
There’s Always More Work to Do to Prevent Burnout
Nurses can’t get rid of the high-stress, high-stakes environments they work in. They can’t wave a magic wand and save every patient no matter how severe their condition, and they can’t stop feeling to cope.
In other words, burnout is a given part of being a nurse. While these feelings are normal, nurses also need support in preventing the bad (and downright dangerous) days from outweighing the good ones. Nurses and administrators can and must work together to prevent burnout — and while the challenge is a significant one, it is achievable if we all listen to each other.