The first week of every February is designated as PeriAnesthesia Nurse Awareness Week, a week to raise awareness of and appreciation for the nurse in this specialty.
As with many other areas of nursing, population changes and national health trends are shifting this specialty. Perianesthesia nurses are a patient’s advocate and guardian during any procedure that requires anesthesia. As the largest generation, the baby boomers, continues to swell the population of seniors, the need for perianesthesia nurses who are skilled with older adults is critical. And as some healthcare shifts away from hospital settings, perianesthesia nurses can expect to find more job opportunities in ambulatory surgery sites.
Nurses in this area are with a patient before, during, and after anesthesia, so they provide essential medical care while also using their understanding about personality and the human condition to make the process as easy as possible for patients.
Before anesthesia, a perianesthesia nurse will help a patient prepare for whatever procedure they are having. The nurse is responsible for educating the patient about anesthesia and answering any questions they or their family members might have. As some people are hesitant about anesthesia, may have had a bad reaction to it before, or are nervous about being sedated, nurses need to be able to offer factual advice that addresses the needs of each person. They are also there to let the patient know they will be with them the entire time, even when the patient is under anesthesia and not aware. Sometimes, just letting a patient know they are not alone is a huge relief.
During surgery, perianesthesia nurses shift their focus from a fully awake patient to one that is now under anesthesia and unable to advocate for themselves. This is when the focus shifts to the details that can be almost imperceptible. Nurses watch for any changes in vital signs that could signal a patient is in distress. But one of the biggest skills perianesthesia nurses are well-known for is their ability to watch a human body for small changes. Changes in skin tone, breathing, or muscle movement are of critical importance for the perianesthesia nurse. And because they will care for patients of all ages, knowing what is expected and what is not at each age is essential.
As the patient moves into recovery, the perianesthesia nurse is still at bedside, but this time with a dual focus—on the patient who is adjusting to the anesthesia wearing off and on those same body signals which now change with the patient coming out of a sedated state. People react very differently in this phase of recovery, so again the perianesthesia nurse has to know what to expect and how to help guide a patient through this initial phase.
Minority perianesthesia nurses are especially needed. A nurse who understands a patient’s language, culture, and customs will be much more in-tune with what the patient might be concerned with. If they are frightened, speaking in their first language will be easier, and having a nurse who can communicate easily with them will eliminate stress and confusion. When they are in recovery, the same kind of communication is beneficial to the patient and to the rest of the healthcare team as well.
As an advocate for patients when they are unable to be their own advocate, perianesthesia nurses have a significant role in patient care. This is a great week to honor all they do.
For more than a century, nursing has been thought of as the domain of women. But that has fluctuated over the last few centuries. Men actually dominated nursing through the mid-19th century. During the Industrial Revolution, men began leaving nursing for factory jobs. Florence Nightingale led the advancement of women in nursing, targeting upper and middle class women for nurse training. In fact, men were not allowed to serve in the Army Nurse Corps during World Wars I and II. Today, as workplaces evolve, more men are entering the profession again amidst a nursing shortage.
About 13% of nurses in the U.S. today are men, compared with 2% in 1960, according to the Washington Center for Equitable Growth. However, in the high-paying specialty of nurse anesthetist, there is an equal number of men and women.
The United States is leading the way in the increase in the number of male nurses. While the U.S. rate of men in nursing was not much higher than in Switzerland and Brazil in 1970, it rose rapidly over the next several decades and far surpassed these countries in addition to Portugal and Puerto Rico.
The rise of men in nursing is due in part to a shift in available jobs, especially as traditionally male-dominated jobs in manufacturing jobs like automakers have been taken over by automation or moved overseas for cheaper labor. A recent study published in the journal Social Science Research reviewed eight years of Census data. The study found that of men who had worked in male-dominated industries and then became unemployed, 14% decided to enter industries dominated by women, such as nursing. Eighty-four percent of men who didn’t lose jobs moved onto traditionally female jobs. Unemployed men who got jobs in female industries received a pay increase of 3.80% when making the move.
Where the Jobs Are
Another reason propelling more men into nursing is a shortage of nurses. According to the Bureau of Labor Statistics (BLS), employment for registered nurses will grow 12% between 2018 and 2028, much quicker than the average of other professions. There will be a need for 3.19 million nurses by 2024.
California is expected to have the highest shortage of nurses, and Alaska will have the most job vacancies. Other states that will face shortages of nurses in the next few years include Texas, New Jersey, South Carolina, Georgia, and South Dakota.
One driver of the need for more nurses is the growth of the aging population, who will require more medical care. Job growth is expected in long-term care facilities, especially for the care of stroke and Alzheimer’s patients. The need for nurses treating patients at home or in retirement communities will continue to grow. The rise in chronic conditions such as diabetes and obesity also means more nurses will be needed.
Pay and Training
The median annual wage for registered nurses was $71,730 in 2018, according to the BLS. The lowest 10% earned less than $50,800, and the highest 10% earned more than $106,530. Those working for the government and hospitals earned the most.
But like many other professions, men are outpacing women in pay. Male RNs make an average of $5,000 more per year than their female counterparts, according to a study published in the Journal of the American Medical Association. This salary gap hasn’t improved since the first year the salary survey was done in 1988. The difference in pay ranges from $7,678 per year for ambulatory care to $3,873 for work in hospitals. The largest gap, $17,290 for nurse anesthetists, may explain why so many men enter that specialty.
The researchers note that increasing transparency in how much employees are paid could help narrow the gap. In addition, part of the pay gap may be due to women taking more time out of the workforce for raising their children. FiscalTiger.com suggests that offering adequate leave to both mothers and fathers after the birth of a child could have a role in making pay more equitable.
The Washington Center for Equitable Growth’s report suggests that the amount of formal training required to become a registered nurse may bring men into nursing from other occupations later in their careers. The minimum training for registered nurses is an Associate Degree in Nursing. Increasingly, employers are demanding more education, however. That includes earning a Bachelor of Science in Nursing (BSN) degree. RNs in the U.S. military must have a BSN, and the Veteran’s Administration, which employs the most RNs in the country, requires a BSN for promotion.
While men are still a minority in nursing, various programs offer support and networking. The American Association for Men in Nursing was founded in 1971 but shuttered in a few years. In 1980 it was reformed and now has thousands of members. It encourages men of all ages to become nurses and supports their professional growth.
Some nursing schools also have groups to support male nursing students. New York University, for example, has Men Entering Nursing (MEN), open to all nursing students at the Rory Meyers College of Nursing to discuss the concerns and perceptions that affect men and what it means to be a male in the field of nursing.
Today nurses practice in many arenas, from hospital bedsides to executive office suites to research laboratories to the halls of the United States Congress. Our Code of Ethics charges all of us to be involved in the political process to influence policies affecting the nursing profession and the health and well-being of all people. Our national professional organization, the American Nurses Association (ANA), encourages all nurses to be politically active to ensure safe and effective care for all patients, to elevate the profession, and to work to eliminate health disparities across our country.
Many early nursing leaders were suffragists and some even went to jail for advocating for women’s right to vote. As soon as the 19th Amendment passed in 1920, nurses were elected to local and state offices. Margaret Laird, a New Jersey nurse, was one of the first two women elected to the New Jersey Legislature in 1920. Between 1920 and 1992 nurses served in state legislatures in many states including North Carolina, Virginia, West Virginia, Massachusetts, Maine, and California. Iowa nurse JoAnn Zimmerman served as her state’s Lieutenant Governor from 1987 to 1991. While a nurse has yet to win a governorship, U.S. Senate seat, or Presidential election, eight nurses have served and/or are serving in the United States House of Representatives.
Texas nurse Eddie Bernice Johnson became the first nurse to win a national office in 1993 when she was elected to serve the 30th Congressional District of Texas in the United States House of Representatives. Twenty-six years later, Johnson continues to serve her district. In the intervening years she has been joined by seven other nurses from across the country. The group of Congressional nurses are African American and white, Democrat and Republican. They range in age from 32 to 84. As a group they represent all areas of the country and a cross section of race, age, and political affiliation. They have all brought their professional experiences, ethics, and commitment to caring with them into the political arena. To kick off Minority Nurse’s new Nurses in Congress series, I will share brief biographical sketches of each of the eight Congressional nurses starting with Congresswoman Johnson.
Eddie Bernice Johnson, RN, BSN, MPA
Democratic Representative, 30th Congressional District of Texas, 1993-present
“Whatever discussion I am a part of, I never miss the opportunity to talk about the value of professional nurses, the value of investment in the profession and the value of attempting to look at the full potential of nurse’s abilities.”
—Rep. Eddie Bernice Johnson, Nurse.com
Throughout her life, Congresswoman Eddie Bernice Johnson has been a pioneer. As an African American female growing up in rural Texas during the time of legal segregation, her future may have appeared limited. However, as Mr. James Daniels noted in an interview with Johnson:
Mrs. Johnson, your accomplishments are impressive and even astonishing. Your firsts set you apart as a genuine trailblazer. You are the first woman ever elected to represent Dallas in the U.S. Congress. You are the very first chief psychiatric nurse of Dallas; first African American elected to the Texas House of Representatives from Dallas; first woman in Texas history to lead a major committee of the Texas House of Representatives; first African American appointed regional director of U.S. Department of Health, Education, and Welfare; and the first female African American elected from the Dallas area as a Texas senator since Reconstruction. Your crowning accomplishment, however, is as the first nurse elected to the United States House of Representatives.
—James Daniels, MinorityNurse.com
Johnson was born on December 3, 1935 to Lee Edward and Lillie Mae White Johnson in rural McLennan County, Texas to a family of limited means, but with a reverence for education. Johnson graduated from A.J. Moore High School in Waco, Texas in 1952. She wanted to become a nurse, but no accredited nursing school in Texas would accept African American students, so she enrolled in St. Mary’s College in Notre Dame, Indiana. In 1956, she graduated with her nursing diploma. Johnson continued her education earning her BSN from Texas Christian University in 1967, and in 1976, she was awarded her master’s degree in public administration from Southern Methodist University.
Johnson’s early nursing career was spent as a psychiatric/mental health nurse, psychotherapist, and nursing administrator for the Veteran’s Administration (VA). After ten years working for the VA, she achieved the rank of chief psychiatric nurse at the VA Hospital in Dallas. In 1977, Johnson was promoted and became a regional director of the U.S. Department of Health, Education, and Welfare.
In 1972, while working at the VA, Johnson was elected to the Texas House of Representatives, making her the first African American woman to ever win an election in Dallas. Johnson waged a successful campaign for a seat in the Texas Senate in 1986, which she gave up in 1992 to run for the U.S. Congress. She won in a landslide and became the first nurse to serve in Congress. She has retained her seat for twenty-seven years.
Johnson is widely recognized as one of the most effective legislators in Congress. She is credited with authoring and co-authoring more than 120 bills that were passed by the House and Senate and signed into law. Over the decades Johnson has served on and chaired many committees and subcommittees in Congress, including as a senior member of the Transportation and Infrastructure Committee and Chairwoman of the Science, Space, and Technology Committee. Her subcommittee appointments include: the Subcommittee on Water Resources and Environment, which has jurisdiction over water conservation, pollution control, infrastructure, and hazardous waste cleanup as well as reauthorization of the Clean Water Act; the Subcommittee on Aviation; the Subcommittee on Railroad, Pipelines, and Hazardous Materials; the Subcommittee of Research and Science Education; and the Subcommittee on Energy and the Environment. She has also been a Senior Democratic Deputy Whip and Chair of the Texas Democratic Delegation. As chair of the Congressional Black Caucus from 2001 to 2003, Johnson was praised for her ability to build coalitions with business interest group as well as labor unions and civil rights organizations.
Johnson introduced the National Nurse Act of 2011, which would elevate the importance of the Chief Nurse Officer of the United States Public Health Service and appoint a National Nurse to work with the Surgeon General to promote wellness and health literacy. She is also passionate about improving mental health and increasing federal funding for women pursuing science, technology, engineering, and math education.
The World Health Organization designated 2020 as The Year of the Nurse and the Midwife. What does that mean for nurses everywhere?
The designation was made last year by WHO to help raise awareness of the nursing and midwifery professions and also to call attention to global health. Nurses and midwives, says WHO, are critical components for improving the health of people worldwide. By calling attention to the nurses and midwives who take care of people every day, it’s also shining a light on disparities that exist and that nurses are helping to bridge.
What makes 2020’s Year of the Nurse and the Midwife so special? It happens to be the 200th birthday of Florence Nightingale, the founder of the nursing profession. And 2020 is also the end year for several campaigns around nursing—the Institute of Medicine’s proposed goal for having 80 percent of nurses having earned a bachelor degree and WHO’s own three-year NursingNow! campaign that ends in 2020. NursingNow! focuses on how raising global health will raise the state of nursing and help support essential policies around nursing.
This year also marks the year WHO is developing a State of the World’s Nursing Report to be presented at the 73rd World Health Assembly to be held May 17 to 20 in Geneva. The organization is also contributing to a State of the World’s Midwifery 2020 report that will be released this spring.
As more attention is focused on the nursing profession and the role nurses play in offering primary care around the globe, the more strategic decisions will focus on strengthening the nursing industry and supporting nurses and midwives in their roles. The hope is that focus will bring an influx of funding into more research, career supports, and adding new or strengthening existing policies to protect nurses, midwives, and patients. With these positive and effective changes started, the path is paved for better working conditions, more nurses in the field, a more diverse and inclusive workforce to represent patient populations, and improved patient health.
As a force of global change, nurses will play a pivotal role in helping achieve the WHO goal of universal health coverage and contribute to the global Sustainable Development Goals presented by the United Nations.
As a goal, the Year of the Nurse and the Midwife is on target for what professional nurses need and want to hear and have action taken on. But the designation also speaks to the state of global health and the pivotal role nurses and midwives play in keeping humanity healthy, despite some declining rates of nurses.
Nurses work in all conditions in some of the most remote corners of the world to ensure that no matter where people live and no matter what conditions they live in, that they will be able to achieve the best health possible. That alone is a lofty goal and one that nurses get up every day and just do. At the very least, nurses deserve a year dedicated to the impact they bring. Let’s hope the Year of the Nurse brings the change nurses deserve.
Teaching in the field of nursing is a rewarding experience and an opportunity to give back to nursing. Education in the faculty role allows for providing insight into current practices based on lived experience and present evidence-based guidelines. Overall, Caucasians and Asians are overrepresented in nursing in comparison to African American and Hispanic nurses, according to a study published in the Journal of Cultural Diversity. As a result of this disparity, there are also problems with equal representation of minority nurse faculty. Those considered faculty of color have continued to represent less than 13% of nursing faculty. As a nurse educator, I have a direct impact on one’s future practice when caring for patients. I am concerned about these known truths and have a few questions for one to consider:
- Why is there not an equal representation of minority faculty when compared to the majority?
- Are individuals given a fair chance?
It is a tedious process to complete applications for faculty roles and often discouraging to obtain feedback from an automated email generated message about qualifications not matching. I encourage all minority potential faculty candidates to increase their visibility in becoming part of a nursing faculty and continue to be persistent. There does need to be interest in nursing research to be considered competitive for some positions. There are overwhelming amounts of candidates with clinical experience as registered nurses or nurse practitioners. Students more than ever need to see someone who “looks like me” at some point in their curriculum with whom they identify with. This is important in ensuring self-efficacy is present throughout their program.
Often, the hiring process is screened by human resources and not nursing departments. Specific to nursing may be the change of having administrative involvement with applications submitted for faculty roles. Anyone who knows me both personally and professionally understands my passion for nursing education. A majority of my close friends have been convinced to give back to nursing in becoming professors. As an African American female, I disproportionately represent a minority faculty. I am grateful for my opportunities. However, we have more work to do in the recruitment and retention of minority nurse faculty.
Colleges and universities must consider diversity within the workplace, particularly for nursing. This is an initiative for the American Association of College of Nursing (AACN). Their initiative involved the inclusion of a diversity of both students and faculty in schools of nursing across the country. An inclusive learning environment can be shaped by the active recruitment of minority faculty. Should there be a representation of diversity in the hiring process, such as within a search committee? This endorsement by AACN is a step in the right direction in the solution to improving a diverse workplace and learning environment for students. Recognition is the first step in making strides to consider those who are minorities from diverse backgrounds.
If you have decided to advance your career this year, getting a promotion might be at the top of your to-do list. Or maybe you’re content with your current role, but would appreciate more recognition from your supervisor for bringing 110 percent to the job all day, every day.
Promotions take a lot of effort—few nurses get promoted just because they come to work every day. How can you bring some attention to your work?
Here are five small steps to do this year that may set you on a path to your next promotion.
- Be Valuable
Doing your job is expected; doing more is what gets you noticed. Create value for your organization by always assessing processes to see where you can create more efficiency. When you can do something better, faster, or with less people and the end result is better patient care, you become a really valuable nurse. Keep alert to ways to improve routines.
- Get Extra Training
Making the effort to get an additional nursing degree is almost a fast-track plan for getting a promotion. With a push for having nurses attain a minimum of a bachelor’s degree, extra education is a valuable asset. If an advanced degree isn’t really an option for you, certification is another way of achieving a higher professional level. Certification helps you gain a deeper understanding of complex nursing areas—from cardiac to wound care—and will help you provide better nursing care. Find out about new practices and new technology, Don’t forget about online or in-person seminars that many healthcare organizations offer.
Whatever you do, make sure you keep learning and keep your supervisor in the loop when you learn something especially valuable.
- Become a Networking Pro and Get Involved
Get to know other nurses and healthcare professionals by getting involved in the professional nursing community. Join a professional organization and volunteer to take an active role within that organization. While you are out and about, be an active and positive ambassador for your organization. This activity won’t necessarily get you a promotion, but it will get you noticed for what you bring to your organization.
- Go to Conferences and Share Your Knowledge
Attending conferences is an excellent way to learn more about nursing and to uncover ways you can improve your own nursing care. But don’t go to a conference and then operate in a silo. Share what you have learned when you return. Offer to give a lunchtime talk about a new tactic, a cutting-edge technology, or a vital change in evidence-based practice. Let others know what you learned about how other nursing units are successful.
- Think of Good Publicity
Become a vocal nurse advocate wherever you are. Find a nursing cause you believe in and get involved to change policy. Write letters to the editor championing the valuable care nurses provide. Raise funds for causes devoted to nursing. Becoming a positive force for change elevates your own personal goals and gives your industry and your career a boost in the process.
Being a good nurse is any nurse’s goal, and getting ahead in your career involves that qualification and then a little more. Extend yourself to reach that promotion.