Technology in health care is always changing and improving—this means faster, more accurate, and safer ways to do your job. Here’s the scoop on the latest and what’s coming in the not-too-distant future.
Technology has been making our lives easier throughout history. While some people are concerned that more efficient technology prevents nurses from spending time with patients, experts say that this couldn’t be further from the truth.
“There is a fear that technology takes nurses away from the patient to spend time at the computer. As interface capabilities increase, more time can be spent with the patient,” argues Nikkia Whitaker, MSN, RN, CCRN, clinical technology integration manager at Dayton Children’s Hospital. “Having systems work together to decrease multiple workflows and eliminate manual processes is what will help nurses appreciate the emergence of technology.”
Get Ready, ‘Cause Here it Comes
Remember when you were a kid and you wondered if eventually robots would take over the world? That’s not happening exactly, but robots are being implemented in health care. And don’t worry; your job is safe.
Both large and small technologies are revolutionizing the nursing practice in so many ways, says Divina Grossman, PhD, RN, FAAN, president and chief academic officer at University of St. Augustine for Health Sciences. “One example is the deployment of robots, such as those that deliver patient medications from the pharmacy to hospital units, automate the preparation of chemotherapy and other drug admixtures, take patient vital signs, deliver food to patient rooms, or transport linens throughout the hospital,” says Grossman.
Robots, though, are just a small part of what is going on technologically in health care. Grossman says that mobile technologies, used by themselves or with other technologies, can reduce clinical errors, improve quality and safety, and reduce the physical burden of care for bedside nurses. “Hand-held devices like iPhones with different apps can be used for accessing and charting patient information at the point of care; linking barcoded drugs, treatments, and patients accurately; communicating between patients and nurses across different rooms or areas; remotely detecting motion in bed of patients at risk for falls; and obtaining diagnostic test results at the bedside are a few examples,” explains Grossman. “The tasks of lifting, positioning, and moving patients—which historically have caused frequent back strain and physical injuries for nurses—can now be done using smart technology systems and can even be operated remotely.”
Cathy Turner, BSN, MBA, RN-BC, associate vice president of MEDITECH, agrees that the use of smartphones is part of an ongoing trend to help support nurses in their delivery of care. “Nurses do many different things during a shift of care, and they interact with patients in different ways. Sometimes a device such as a Workstation on Wheels is the appropriate vehicle for the workflow, but there may be times where something smaller may be less intrusive,” Turner explains. “Smartphone devices are able to deliver that flexibility. The smaller devices may be something nurses are already using for calls, secure texting, etc. Why not be able to do a quick medication administration using scanning and documentation tools fully integrated into the Electronic Health Record [EHR]? The other advantage to this type of device is that it is similar to a patient’s use of their portal from an app on their phone. This provides a nice opportunity to share what they are doing on their device on behalf of the patient and provides a teachable moment for the patient using the portal.”
But there are even more types of technology that can directly help nurses who are working with patients. “Wearable technology, telephone monitoring, and nanotechnology further expand the ability to monitor patients’ physiologic parameters—not just episodically as snapshots, but continuously for diagnostic, therapeutic, and clinical evaluation purposes,” says Grossman. For example, “with a noncompliant patient, a sensor can detect whether and when a patient took their medication and have the information transmitted electronically to a nurse through an app on a mobile device. Medication dosages can be adjusted commensurate with serum levels throughout the day; these can also be correlated with levels of blood pressure, heart rate, oxygen saturation, stress or anxiety measured by the same wearable devices,
EHR, an Oldie, but a Goodie
While EHRs aren’t exactly from the stone age, they are the most familiar and most widely used technologies in health care today. But they have also come a long way.
“[EHRs] and Point of Care documentation devices are probably among the most adopted technologies,” says Majd Alwan, PhD, senior vice president of technology at LeadingAge, as well as the executive director of the LeadingAge Center for Aging Services Technologies. “What is new: over the past couple of years, many of these technologies have undergone significant improvement through successive upgrades. They are now much more user-friendly, touch- and even voice-enabled, mobile friendly (to provide access through tablets and smart phones), and have better clinical decision support system, information exchange, and analytics capabilities.”
“Nurses typically spend more time with patients and contribute more information to the patient record than any other member on the care team. While this entails a lot of responsibility, there is also a lot of flexibility and freedom that comes from using an integrated EHR solution. An effective EHR gives nurses more meaningful time back with their patients, and results in less time on documentation,” says Turner. “While there is perception that EHRs are too complex and impede the patient/provider relationship, an EHR designed to support nursing workflows improves both the patient experience and the quality of care that the nurse can provide.”
Turner also says that nurses no longer just enter information and observations into their patients’ EHRs. In fact, EHRs actually give back to the nursing field. “[EHRs are] providing actionable data, clinical decision support, and surveillance tools that allow nurses to proactively meet the needs of their patients,” she says.
In addition, says Turner, EHRs can suggest problems to be addressed as well as the actions that can then be taken. “They can ensure that patient safety protocols are in place, allowing the nurse to focus on more of their time and energy on the patient,” she says. “Surveillance tools monitor EHR data and identify patients at risk. Nurses spend a great deal of time documenting the care a patient receives. The surveillance tools analyze that documentation along with lab results and other data, and push notifications and actionable items to the nurses, giving them that time back.”
These surveillance tools are also able to monitor many patients through watchlists and let nurses know who needs immediate attention. “Watchlists can be built around fall risk, sepsis, CLABSI, VTE, or other potential risks that may affect a patient’s health. These lists give back to nurses, saving them time and giving them the most up-to-date information needed to effectively treat their patients,” says Turner. “I remember reading a heartbreaking story of a parent who lost their child to sepsis. The words that stuck with me: the parent implored that clinicians ask: ‘What if it’s sepsis?’ Surveillance will ask. And direct, appropriate care actions can be taken.”
Learning Via Simulation
While nursing students will always work directly with actual patients before they graduate, the use of simulations beforehand enables them to practice different procedures safely and to learn about rare procedures or cases that they may not often see. “Students are able to learn in a safe environment and can pace their learning activities; not all students learn the same way,” says Nadia Sultana, DNP, MBA, RN-BC, clinical assistant professor and nursing informatics program director at NYU Rory Meyers College of Nursing. “Simulation centers have been planned to include technology that is similar to the work environment.”
Grossman gives an example of how simulation can help nurses learn without an increased risk for patients. “Nurse practitioner students can learn complex skills such as suturing or draining wounds, placing central lines, or inserting of chest tubes before they perform these procedures on live patients in real health care environments. Faculty also have the ability to create dynamic computer-based simulation scenarios to enable nursing students to learn how to adapt their clinical treatment decisions to fluctuations in the patient’s condition,” she says. “With simulation, the ‘patient’ can be of any age and racial background since human patient simulators can be infants, children, or adults and come in different skin tones and physical features. Through computer-based scenarios, simulated patients can become hypotensive, tachycardic, or hypoxemic, and nursing students can learn how to tailor or adapt clinical treatment decision accordingly.”
Students can also be acquainted with rare conditions via simulation. “They can learn how to assess those patients using simulators. For example, a student may not be able to encounter a live patient with Tetralogy of Fallot in the clinic during the semester, but he or she can auscultate, palpate, and assess the relevant findings using the Harvey cardiology simulator. This simulator can mimic 50 different cardiac conditions and also simulate any cardiac disease in a realistic way,” Grossman explains. “The ability to learn interprofessional practice and teamwork using simulated case scenarios like a post-disaster situation or an acute stroke patient in the ER with teams of students from multiple programs—nursing, medicine, PA, et cetera—is also possible with simulation. Thus, nursing and other health care students can learn how to communicate with each other and collaborate in the care management of an individual patient or groups of patients through simulation before they are assigned to care for live patients.”
An even more advanced type of simulation is coming—virtual reality—and both student nurses and experienced ones are going to be stunned with how realistic it will be.
“Virtual reality or augmented reality simulation…depart from the conventional treatment simulation with three-dimensional image data and computer software. Implementation of virtual simulation requires the ability to transfer the planned treatment geometry from the computer to the treatment room in a way which is accurate, reproducible, and efficient enough for routine use,” says Grossman. “Haptics are an example of virtual reality technology where the nursing student can do patient assessment and examination and feel the virtual patient’s skin and body, with the ability to perform clinical interventions. Using engaging and immersive technology like Google Glass or HoloLens, the student can feel being in the real-world health environment, move around freely, interact with the patient and others, carry out tests and treatments, and learn from their mistakes while in the lab or simulation center without compromising patient safety.”
Have no Fear
If the thoughts of working with some of this technology scares you, don’t worry. The facility will provide you with the training you need, and the technology will make health care safer and allow you more time with patients.
“It is easy to be afraid of change, but you must always keep in mind what is best for the patient. Put yourself in the patient’s position and imagine how much safer they must feel to know that so many systems are working to support their care,” says Whitaker. “Do not be afraid to advance. A nurse’s touch will always be valued and needed, but technology can help bring nursing care to the highest level.”
Most registered nurses are familiar with the rights of patients under their care and work hard to alleviate suffering and maintain respect for human dignity. They advocate on behalf of patients, their families, the community, and society as a whole. But many nurses do not know their own legal rights and responsibilities as health care professionals.
Nurses with knowledge of whistle-blower laws, for instance, may be more likely to press administrators to end patient-care abuses or fiscal fraud. Standing up for what’s right is tough in any case, but especially for women and minorities, who make up a majority of the profession. Yet, minority nurses have historically demonstrated heroic activism for community health and social justice, during the civil rights era and the AIDS epidemic, for instance.
Nurses face the same legal issues as many other employees, such as sexual harassment in the workplace. But they also must protect against career-specific liabilities, such as being accused of violating the nurse practice act or similar regulations.
“There are three major concerns for nurses,” according to Gerard Brogan, RN, lead nursing practice representative at California Nurses Association and National Nurses United. “I travel and talk to nurses across the country and union or not, I hear the same things. The first concern is nurse-to-patient ratio, two is violence in workplace, and three is scope of practice.”
This article, then, will focus on legal issues that are unique to nurses.
Nurses across the country have expressed overwhelming concerns regarding these roadblocks to patient care and safety: short staffing on overcrowded units, limited ability to take even short breaks due to scheduling gaps, floating nurses without the proper training for certain departments, and so on.
According to Brogan, California is the only state in the country that has nurse-to-patient ratios. “Massachusetts and Arizona have them for the ICU only,” he says. “Nurses are working in understaffed hospitals, which are dangerous for patients and everyone else. We now have two nurse-to-patient bills in Washington. One is a house bill and one is a senate bill. They would require every hospital to adhere to ratios similar to the California bill.”
Brogan says that he often sees on social media the phrase “nurses should not be political.” But he believes that’s a naïve and possibly dangerous position. “Health care employers are heavily involved in politics, so as an organization and profession we have to also be involved in politics ourselves.”
Other aspects of staffing include how hospital plans are created and implemented allowing direct-care nurses to play a role. “The Oregon Hospital Nurse Staffing Law gives power to the hospital staffing committee,” says David Baca, RN, BSN, an emergency room nurse at Asante Rogue Regional Medical Center in Medford, Oregon.
The law is also a legal measure regarding rest-breaks and specialized staffing on specific units and departments. “The phrase ‘A nurse is a nurse is a nurse is a nurse’ is common, but that kind of thought process needs to go away as it becomes clear that appropriate education and training are needed,” says Baca.
The nurses at his hospital also recently won a new contractual right: break-relief nurses on units, when necessary, to allow nurses to schedule earned breaks and meals. Baca estimates that only 30-40% of nurses at his hospital know about the new staffing laws. “A little more education is needed,” including the hospital and individual nurse’s unit. “Standards and practices in the ER should be something we’re aware of. If not, we should be asking: ‘What does the ENA say about staffing and nurse patient ratios?’”
“When it comes to workplace violence, nurses have been in the top five forever,” says Baca. According to an U.S. Bureau of Labor Statistics analysis, 52% of all incidents of workplace violence in 2014 involved workers in the health care and social service industry. “The ER is open to everybody. We serve everyone, including the intoxicated or those with mental issues, so nurses are assaulted. It happens on almost a daily basis.”
“A few years ago, we had a huge problem with psychiatric crisis patients. We couldn’t secure them in appropriate rooms for their own safety and ours. They’d either elope or assault. That’s a huge risk, so the hospital invested a million dollars into ER security for the safety of everybody,” says Baca.
“Most assaults in the ER go unreported. If you regularly see colleagues assaulted, it becomes the norm,” warns Baca. “Maybe we need to prosecute more patients who assault nurses, medics on ambulances, or technicians. There’s a very low prosecution rate and almost no legal ramifications for patients who assault. We need to change the workplace culture that accepts violence.”
In 2014, California enacted a trailblazing law to reduce workplace violence incidents in health care facilities. “Every hospital has to develop a comprehensive workplace violence program to protect the safety of patients and employees,” Brogan explains. “We’re not just interested in working on the welfare of nurses in California or nurses in the union. Our efforts are for nurses across the nation.”
Then there’s the more common, less intense form of violence: bullying…
Brittney Wilson, BSN, RN, a social media influencer also known as The Nerdy Nurse, started blogging as a response to the stress of nurse-on-nurse bullying as a newly graduated floor nurse.
“What I learned from my experience with lateral violence is that in a right-to-work state it is very difficult to make a stand for yourself,” Wilson explains. “I did learn that in order to build a strong case for yourself you should keep notes including dates/times/names of incidences. You should also report incidences as soon as they occur. But if your hospital does not have a union, it is pretty much your word against another employee.”
In Wilson’s case, the nurses who witnessed the bullying weren’t her allies, and neither was management. “My employer didn’t support me and believe me enough to address the work environment, pursuing the issue just made things more difficult for me and lead to me being forced to take a different position and a pay cut until I ultimately left the organization,” she adds.
Though nurses have a right to be treated with dignity, respect, and civility, they sometimes must fight just for an environment that isn’t downright hostile. Wilson advises nurses in that situation to “find new employment and an organization that will support and value them. We are living in an economy where there are more jobs than there are nurses. If you aren’t being treated respectfully, you owe it to yourself to remove yourself from a damaging situation.” That’s just what Wilson did, parlaying her newly accrued digital skills into a well-paying and satisfying career in nurse informatics and technology product development.
It goes without saying, but nurses must themselves also avoid those types of uncivil, hostile, bullying, or intimidating behaviors that show disrespect for patients or colleagues. Otherwise, they put themselves at risk of censure for trampling the rights of others.
Scope of Practice
“There are fifty states and 50 different nurse practice acts,” says Brogan. “Hospitals don’t really educate employees on the legal scope of practice. I’ve been educating nurses for 20 years and find that hospitals see nurses as a unit of labor, not as a professional.”
In today’s fiscally-focused health care landscape, there is always a concern that the scope of professional nursing practice is at risk from understaffing, de-skilling, and other encroachment, warns Brogan.
“The hospital industry is trying to expand the scope of nurse’s aides and medical assistants. Nurses are professionals with independent judgment,” he says. “If they are given too many patients to care for, as is often the case in non-unionized hospitals, they have to take them or they can be fired.”
All nurses need to remain current, competent, and within their scope of practice, or risk losing their license—and their career. Protect yourself by taking continuing education courses in nursing (online or in-class) or enrolling in an advanced degree program. If further formal education is problematic, you can learn informally through a professional nursing association, either for your particular minority group or one in your specific area of
Rachel Seidelman, RN, a direct care nurse at Providence Health & Services in Portland, Oregon, has been a nurse for eight years and continually updates her understanding of the law. She knows her state nurse practice act rules and reviews them regularly to ensure she protects her practice and her license. “The biggest thing that’s helped guide me comes through my union; there’s a branch for practice. I know state and federal law and the overlap. I make sure I know who I can delegate to, because it’s all on me if a colleague messes up under my umbrella.”
“How I was precepted really helped me as a young nurse without much work experience,” Seidelman says. “Part of the onboarding process is to ensure they understand the wage scale, the contract and their rights within it, and a lot of other things, too. I’m a preceptor now and will never stop because I learn so much from doing it.”
One example of how Seidelman expands her knowledge of issues related to nursing practice concerns the opioid epidemic. After reading a series about it in the state’s major newspaper, she wondered what her response should be as an off-duty nurse encountering a stranger overdosing. Should she carry the opioid antidote naloxone as a precaution? “That question led me to the Oregon Nurses Association, my employer, and discussions with pharmacists and mentors.” She couldn’t obtain the antidote without a prescription, but new laws enacted in 47 states make it more freely available. The surgeon general recently urged opioid users, concerned family members, and professionals to keep it on hand.
“In this day and age, it’s important to protect our own license and also protect our patients and colleagues. I advise fellow nurses to ask good questions, be curious, find answers, and then tell others,” says Seidelman.
Advocating for Your Patients, Community, and Profession
Nurses have long participated in the political process and sought to shape health care legislation that supports nurses as well as benefiting patients and communities.
Martese Chism, RN, a Chicago nurse, is inspired by the example of her great-grandmother, Birdia Keglar, a civil rights activist in the 1960s. “She marched in Selma with Rev. Martin Luther King Jr. and lost her life because of it. Dr. King, in his speech, said he would like to have a long life, but that wish didn’t stop him from protesting,” she says.
Chism explains that her first college degree was in accounting, but she discovered “my calling is advocating for patients,” so she went back to school to become a nurse. “We’re supposed to advocate for our patients… I believe my fiduciary duty is to my patients, not the hospital. I advocate for my patients, but in the back of my mind, I worried about job security. I was single and didn’t have a family to support, but if I had, I wouldn’t have been so vocal without my union,” she explains.
One matter that Chism has spoken out about is the closure of public hospitals and other health care facilities in minority communities. “When elderly patients with no insurance need skilled nursing care our hands are tied [because of the closures] so now our uninsured patients have nowhere to go,” she says.
Some of Chism’s patients were retired public employees who aren’t eligible for Medicaid or Medicare. “They’re now turning 70 or 80 and they have no insurance. That’s why I’m fighting for Medicare for all,” she says. “As nurses, we’re supposed to advocate for our patients, but I don’t feel like I can without union protection. If I do, I’m branded a troublemaker. I’ve been speaking out in public for a long time and I could never get a promotion. If it wasn’t for the support of my patients, and union, I wouldn’t have lasted this long on the job.”
According to The Code of Ethics for Nurses (2001), nurses do have the right to advocate for themselves and their patients, and to do so without fear of retribution. Each state’s nurse practice act varies, but Chism was outraged when Illinois tried to remove “advocacy” from its nurse act. “They tried to say that your duty is to your employer, but our union fought to stop that. We don’t know about the future, though, especially with the recent [Supreme Court] Janus decision. The union movement might be weakened even more.”
Finding an Attorney to Explain Your Rights or Represent You
Even though you do your best to learn the laws related to nursing, you can’t always avert legal trouble. There may be a claim of professional negligence, say, and then you’d need to retain a qualified attorney in your area to defend you.
“Generally, look for an employment lawyer, they will understand the federal and local laws on wages, overtime, discrimination,” says Jeffrey M. Edelson, JD, attorney at Markowitz Herbold in Portland, Oregon. “They’re often divided by union and non-union. The tradeoff with collective bargaining is that an agreement could be in conflict with state law.”
If facing disciplinary action with the nurse licensing board, you may require an attorney who specializes in licensure protection.
Or your case may call for an attorney with experience in an entirely different area of practice. “For example, in the case of the Utah nurse [Alex Wubbels refused to draw blood from an unconscious patient], you’d need a criminal lawyer,” he explains. Or, if you work at a state hospital and are fired for expressing an opinion or acting on a matter of conscious, “you may need a constitutional lawyer in that you may have additional first amendment rights, versus if you’d worked at a private clinic,” Edelson adds.
A common way to find an employment lawyer is to checking profiles in listings such as “Best Lawyers in American,” he suggests. Or use your personal network of nurse colleagues, friends, or family to find an attorney. “Call your family lawyer, the one who does wills, and ask ‘do you know an employment lawyer?’” You’ll likely be referred to an appropriate attorney. Plus, “you’ll get that lawyer’s ear because you’ve been referred,” says Edelson, and they’ll each want to protect their professional relationship. Ask about their experience with your type of legal trouble or concern. Then inquire about fee structure. Some will charge for an initial consultation, while others won’t, and most work on a retainer basis, though some will take a case on a contingency basis.
Other resources for finding local attorneys: your professional nursing organization or union, the American Association of Nurse Attorneys (TAANA), and the State Bar Association.
In addition, you may want to purchase malpractice insurance (including license defense coverage) in advance of any need. Some professional nursing associations even offer a discounted rate, making it a prudent and affordable option.
During Spring Break 2018, graduate nursing students from Wagner College travelled to Cap-Haïtien airport where they would begin a six-day mission to provide health care to the men, women, and children of Haiti. Our NP students acquire 50 community hours toward the required practicum hours for their service.
Haiti, a beautiful country with white beaches and clear blue water, is approximately one-third of this tropical island, which it shares with the Dominican Republic. The name actually means “high land,” as much of the island is covered with mountains. The official language is French with most people speaking a dialect known as Creole.
“For Haiti With Love” is located in the northern area of Haiti called Cap-Haïtien. Our team of volunteers brought a large amount of medicine and supplies, as our NP students would be treating as many as 50 people per day during the first days in the clinic. Although exhausted, there were no complaints, as this was a gift to the Haitian people given from the heart.
Interactions with the local people gave the student nurses a great sense of satisfaction and exposure to a new and interesting culture. The group was well received with genuine acceptance and welcoming love. Riding on the back of a pick-up truck and eating fried goat were some of the unique aspects of the culture that contributed to this bonding experience.
Upon arrival, poverty and issues with waste management were noted with trash being seen along the road and in the water. Another major issue was widespread unemployment. It was also noted that there was no access to running water or electricity inside their homes.
Although the nursing students were anxious initially, the people made the volunteers feel comfortable and safe. The group was warmly embraced and received three home cooked meals per day and were treated like family.
Children were well dressed and smiling. Although underprivileged on many levels, education was extremely valued among the Haitian people.
The volunteer work at the clinic involved a lot of wound care, such as venous stasis ulcer care. Although volunteers were working in the burn clinic, no one was turned away if they had other health issues that needed to be addressed. Many children received burn injuries from spilling hot water upon themselves. Education related to prevention of burn injuries was badly needed. Most of these children went directly to school after having a debridement and dressing change with little pain management. Privacy was another concern since many patients were treated in one room at the same time.
The volunteers used their clinical skills in a place outside of their comfort zone. Knowing that most of their patients would return to very poor living conditions was difficult for the volunteers. Many reported that this changed their perceptions and their lives. It helped them appreciate their own good fortune, the value of good health, and accessibility to health care. Similarly, the people of Haiti were filled with love, trust, and appreciation for everything the volunteers were able to provide.
Upon the return of the volunteers to campus, they were given the opportunity to present their experiences to other graduate nursing students in their Health Policy, Organization, and Finance class. A lively discussion and exchange recapped the entire experience for our volunteers and left our other students in awe.
Making a difference in the lives of those who may not have the means necessary to help themselves was a good feeling. Most volunteers said they would do it all again if given the opportunity because it was an experience of a lifetime.
According to the American Association of Colleges of Nursing, only 2.1% of deans and directors are 45 years of age or younger. Further, according to the Robert Wood Johnson Foundation, a large percentage of senior nursing faculty members and Academic Nurse Administrators (ANAs) will retire over the next decade, and half are likely to retire by 2020. While experienced ANAs are retiring or resigning, formal mentoring for incoming Novice Academic Nurse Administrators (NANAs) remains relatively absent. Few nurses or nursing faculty fully grasp the complex responsibilities of this position. Typically, ANAs preside over the perpetual cycle of nursing student admission, academic progression, student attrition, and graduations. The specific roles and legal responsibilities of ANAs are outlined by each state in their state nurse practice act. Most programs are offered in community colleges or universities.
Regardless of the location or type of nursing educational program, ANAs are responsible for the majority of decisions made regarding the legal operations of these programs. Ultimately, ANAs are critical to the delivery, operations, and sustainability of nursing education and ultimately to the perseverance of the nursing profession. Unfortunately, formal nursing educational programs seldom address the daunting operational challenges that ANAs—and particularly NANAs—face when attempting to meet the expectations of this role transition. Consequently, vacancies loom across the nation, creating an urgent need for retention through formal mentoring.
Significant Challenges for ANAs
Experienced and novice ANAs are responsible for their nursing program’s state approval through accreditation. This lengthy endeavor requires at least one year of advanced preparation. State accreditation for pre-licensure nursing programs includes a program self-study and program evaluation, generally under severe time constraints. Accreditation topics under review include a total program evaluation plan, sufficiency of resources, appropriate administration, nursing faculty, nursing content experts, curriculum assessment, adequate clinical facilities, demonstration of student engagement, and a self-study summary. Additional responsibilities include monitoring the program’s National Council of Licensure Examination for Registered Nursing (NCLEX-RN) pass rates, sustaining student enrollment, maintaining nursing faculty stability, retaining program accreditation, and remaining fiscally sound despite varying degrees of institutional rigidity. Seasoned ANAs recognize that the terminal goal for each nurse graduate is to successfully pass the NCLEX-RN exam and thus earn state registered nursing licensure.
For ANAs, policymaking occurs continuously. Issues are brought to administration and faculty for exploration of the necessity to make or change policies to ensure that educational and nursing practice standards are current, and to change policies when they are not. Changes are also generated by requirements of affiliating health care agencies, university, college, and statewide policy recommendations that require extensive institutional buy-in and support. Many ANAs exert great efforts to receive institutional and faculty support in the operations of their nursing programs. A 2014 study in Nursing Education Perspectives found that among 242 ANAs, factors associated with job dissatisfaction included a lack of institutional support, mentorship, recognition, and respect. Furthermore, over a decade ago, it was reported that aging, bullying, and stress correlated with increased vacancies among all ANAs. In a current online survey of nursing faculty from 12 of the 15 highest-ranked universities, 22.5% reported not having a mentor, most (61.2%) found mentors on their own, and only 16.3% had formally assigned mentors. Overall, studies have revealed that the most helpful role transition experiences came from mentoring (53.5%), while (30.2%) came from work experiences, strongly indicating the need for formal mentoring.
Formal Mentoring Praxis
In Integrated Theory & Knowledge Development in Nursing, authors Peggy Chinn and Maeona Kramer define praxis as the integration of knowing: empirical, ethical, aesthetic, personal, and emancipatory concepts. In formal mentoring, experienced ANA mentors will apply their integration of knowing through mentorship of NANAs with the following conceptual guidelines:
- Empirical: Use of a practical and pragmatic approach to mentoring
- Ethical: Addresses the legal issues affecting nursing education
- Aesthetic: Sharing of creative artistic diagrams, charts, and visual aids
- Personal: Storytelling of lessons learned as an experienced ANA
- Emancipatory: Supporting the independence and growth of the mentee
Critical Social Theory (CST) and NANA Mentoring
Critical social theorists aim to aid in the process of progressive social change by identifying not only what is, but also identifying the existing (explicit and implicit) ideals of any given situation and analyzing the gap between what is and what might and ought to be. In Advances in Nursing Science, P.E. Stevens identified six tenets of CST. Three of the six tenets of CST have important underpinnings to the praxis of leadership mentoring for NANAs. The first tenet examines the academic institutions’ social, political, and economic influence on the development of a formal NANAs mentoring program. The second seeks to reduce invisible oppressive institutional rigidity found in an academic environment while the third seeks to provide formal mentoring that emancipates and liberates the NANAs leadership potential.
Strategy and Implementation
Following the attendance of a formal mentoring workshop, ANAs would be assigned to mentor NANAs for one year. The three tenets of CST would serve as guides for the ANAs mentoring endeavors. Informed by CST and the praxis (integration of knowing), ANAs will share knowledge beyond empirics to more aesthetic, ethical, personal, and emancipatory patterns. The ANA mentor and NANA mentee would agree upon a formal mentoring schedule of two-hour weekly meetings to address specific nursing program director related topics, such as:
- Faculty to Director Role Transition
- Compliance with the State Nurse Practice Act
- Program Directors Manuals/Handbooks
- Maintaining State Program Accreditation
- Writing of Policies and Procedures
- Seeking Institutional Support
- Handbooks (Student & Faculty)
- Ethical and Legal Issues
- Essential Documentation
- Hiring and Orientation of New Staff and faculty
- Collegiality Among Stakeholders
- New Student Orientations
- New Student Admissions
- Academic Progression
- Student Advisement
- Student Attrition/Retention
- Student Essential Behaviors
- NANAs Scholarly Expectations
- Grant Writing
- Promotions, Tenure
- Director & Faculty Professional Development
This formal mentoring program design aims to report positive post survey responses in job satisfaction and retention among NANAs. It is intended to create scholarly academic dialogue to explore the implementation of this mentoring model for NANAs. Future research and discussion will focus on the qualitative experiences of the ANAs mentors’ roles and NANAs mentees as participants. The provision of the CST as a framework for the praxis of formal mentoring guides ANAs in their mentoring endeavors. The success of a praxis leadership mentoring model can facilitate enhanced role transition and increased retention among NANAs.
Students across the country say they have been shamed by for-profit colleges promising a great education and career prospects. Here’s what nursing students should know before enrolling in any degree program to ensure it is a wise investment.
Imagine spending years in nursing school only to learn that a degree from the college you’re attending won’t actually qualify you for the nursing job of your dreams. Unfortunately, this can be a devastating reality for many students across the United States who attend for-profit colleges.
For-profit colleges have received a lot of negative headlines in recent years. There have been several cases of for-profit colleges shutting down without notice to enrolled students—leaving them without options for continuing their education. Others have faced lawsuits by students claiming they were shamed and their degrees are worthless in the job market.
Many for-profit college programs advertise flexible class schedules, accelerated learning, and high job placement. However, with so much controversy surrounding these colleges, it’s smart to thoroughly investigate if the college you are considering will provide you with the education and job prospects you seek.
A growing number of nursing students have found out the hard way the true cost of some for-profit colleges. They are left with massive student loan debt and useless degrees that won’t get them a job. And to make matters worse, traditional colleges and universities won’t accept their transfer credits.
A November 2017 study published by The Century Foundation found that for-profit college students accounted for a staggering 99% of applications for student “loan relief from students who maintain that they have been defrauded or misled by federally approved colleges and universities.”
Like many students, you may be enticed by what some for-profit colleges offer in terms of flexible class schedules, online learning options, accelerated degree programs, and less competitive admissions requirements. Public colleges and universities are more competitive, and a for-profit program can seem like an easier path.
For-profit colleges are known for targeting nontraditional students who desire more flexible education programs and want to enter into a certain field or industry such as nursing. But some college advisors steer students away from such colleges.
“Our general advice about for-profit colleges is to avoid them if at all possible,” says Evelyn Alexander, founder/owner of Magellan College Counseling, an independent service that helps students with the college admissions process.
The first step to a successful nursing career is to do your research for any degree program you are considering prior to enrolling. It’s smart to do due diligence to ensure you are making a wise investment of time and money in your education.
Here are some tips to help you determine if the college you’re considering is a good choice for a successful nursing career.
Know the Status
You should always know upfront the status of the college you’re considering. Colleges and universities can be state, nonprofit, or for-profit. This is the first thing to know when deciding on a nursing program.
“I started poking around several college websites, and it’s very difficult to determine if a college is for-profit, because they generally don’t announce it,” Alexander says. “I think the best way to deal with this is to ask, upfront, immediately, if the college is nonprofit. Just come out and ask, and if it is not nonprofit, see if there are other options available to you.”
Alexander notes that a private college can be either for-profit or nonprofit, while public colleges/universities are publicly owned and always nonprofit. Alexander almost exclusively guides her clients toward nonprofit colleges and universities.
Seek Out Accredited Programs
One of the major problems that many for-profit students encounter is that their college program doesn’t have the industry-recognized accreditation that employers want. Many students find this out only after they have spent time and money on a degree and begin job hunting.
While most for-profit colleges do have accreditations, they may not be the specific accreditations employers look for in nursing job candidates. In addition, without the right accreditations, your credits won’t transfer to another school.
For nursing programs, look specifically for schools with Accreditation Commission for Education in Nursing (ACEN) accreditation. Also, look for nursing school programs that are regionally accredited (e.g., accredited by a state board of nursing), as this is an indication that other colleges/universities are more likely to accept transfer credits. Beware of nursing programs that don’t meet these criteria.
You can also contact other nonprofit/state colleges/universities in your area and ask if they accept transfer credits from the college in question. You want to keep your options open for transferring to another college in case it is necessary. So, it’s best to know from the start if your credits will transfer.
Don’t Fall for Pressure Tactics
One common complaint about for-profit colleges is that admissions staff pressure potential students into enrolling or don’t offer sound admissions and financial aid guidance. If the admissions reps are using pressure tactics or making big promises about job prospects, beware. Admissions reps should be enthusiastic about what their school has to offer, but they shouldn’t be like a pushy car salesman.
For-profit colleges usually have an easier admissions process than nonprofit/state colleges and often do not require test scores such as the SAT/ACT, a certain GPA, or the like. This makes enrollment easy; especially for nontraditional students or those working full-time. However, nursing programs with the proper accreditation will likely have a more competitive admissions process—and that’s a good thing.
Do graduates of the nursing program you’re considering actually get nursing jobs in your area? An easy way to start researching actual job placement success for a college is to utilize online resources such as LinkedIn to search for graduates of the program you’re considering and take note of their job history. Are graduates working for reputable health care organizations in your area? Or do they have non-nursing jobs? While this is anecdotal research, it’s a good way to get an idea of job prospects.
While you’re online, do a Google search for the school and read student reviews and ratings. Are there a lot of complaints or low ratings? Your online search may also bring up news articles that mention the college, which could provide information about pending lawsuits filed by previous students. You don’t want to enroll in a college in legal or financial jeopardy.
If there are no red flags from your online research, pick up the phone and call large employers, such as hospitals and clinics in your area, to speak with an HR representative to see if they consider graduates from the college for job openings. Or attend a local job fair and make a point to speak directly with health care recruiters to ask if they regularly recruit or hire graduates from the college you’re considering. Don’t just take the college admissions advisor’s word that employers hire their graduates.
Already Enrolled in a For-Profit Nursing Program?
What if you are already enrolled in a for-profit program? If you’ve already started a program it’s not too late to check on the school’s accreditation and reputation among employers. You may discover that your school meets the industry-recognized criteria for nursing education such as ACEN and has solid regional accreditations.
If you do find some red flags with your current college, first assess what exactly is causing you alarm. For instance, is the only red flag some negative student reviews online? That in itself should not be cause for much concern. However, if you find your college isn’t ACEN and regionally accredited or there are rumors about the school closing or facing legal action, you should reconsider what your realistic job prospects are going to be if you continue with the
Alexander says if one of her clients was enrolled in for-profit institution she would likely advise them to start looking for another program. “They may run into a problem ensuring that all of their credits transfer to another institution; but I would say it’s probably better to get out in the middle than to wait until they finish, when they may hit a barrier in finding a job.”
Choosing a good nursing school is vitally important to your nursing career. All students should be knowledgeable about industry education standards and not rely on admissions representatives who have enrollment quotas to meet and don’t always have your best interest at heart. And if a program sounds too good to be true, it may lead to major disappointment down the
“What seems like a good idea for certain reasons may be overshadowed by much larger drawbacks,” Alexander warns. “This is why we advise against for-profits. It’s not really a good investment if your degree doesn’t get you a job or if you end up owing money on student loans, you haven’t finished your degree, and the next school you attend doesn’t recognize your credits.”
I waited five years for this day: my first day as a psychiatric-mental health nurse practitioner. Mental health is a specialty with the highest demand and lowest supply in the United States. I filled one of seven vacancies, so the staff welcome was warm and inviting to say the least. The outpatient setting was grandeur. It was a far cry from what I am accustomed to. The air was fresh, the bathrooms were clean, and I even scored a corner office! It is a shared space, but who cares? The office has a large window showcasing the mountains and orange trees. The desks are height-adjustable, giving the option to sit or stand. I was excited and prepared for whatever came my way. There was just one problem: It does not seem like they were prepared for me.
After a week and a half of hospital orientation, a nursing mental health supervisor invited me on a tour of my work area. It was my first day actually seeing the clinic and meeting my coworkers. After copious introductions, he invited me to his office. He began the conversation with an oh-so-familiar precursor in nursing: “I have to be honest with you.” I knew I was in for some hardcore truth. Here are the highlights of his honesty about orientation: (a) This is not the nursing you know; (b) there are no checklists or competency fairs for you; (c) you will shadow people who do not have your experience; (d) be a skeptical sponge; and (e) you will only get out of it what you put in to it.
I want to assure you everything the mental health supervisor said rings true. The following weeks were an emotional rollercoaster. There were times I would feel challenged, confused, frustrated, bored, excited, and disappointed all before lunch hour. If you feel this way, this is normal. Experiencing a barrage of emotions is not unusual in your quest to function at the advanced practice level, learn the workflow and learn the system, all while maintaining your nurse identity. Work through it. Do not give up.
Here are some tips that will help you transition successfully from the RN to NP role.
Find a Mentor
Many new graduate nurse practitioners identify mentorship and structured orientations (i.e., residencies and fellowships) as most important in considering job prospects. If your employer is one-in-a-million and offers a nurse practitioner residency/fellowship program, I encourage you to apply. However, the truth is many employers do not offer nurse practitioner training programs. Do not be discouraged. Consider investing your time in a mentorship instead. Mentorship is a powerful tool to ease your transition. Mentors are reliable resources, safety nets, so to speak. They will assist in developing your knowledge base, clinical skills, and overall confidence. If you do not feel comfortable searching for a mentor. Do not worry. It is likely your supervisor will assign a mentor to you being that you are a new graduate. Be advised: Mentorship is a partnership in which both you and the mentor are responsible for your professional growth. Remember, you get out of it what you put into it.
Mentoring is a skill not everyone is able or willing to do. Poor mentorship is detrimental to your professional growth and work environment. It often results in disappointment, isolation, and poor job satisfaction. To avoid a bad experience, try to find a mentor whose experience resembles your own. If there is discord between you and an assigned mentor, or if you feel the mentorship hit a glass ceiling, request another mentor. There is no rule against it, and you do not want to stifle your growth.
Don’t Have a Plan? Develop One
If your employer does not have a program or plan for you, create your own. It is important to set deadlines and expectations for yourself and communicate those with your mentor and supervisor. If you fail to do so, you may find yourself practicing independently too soon. Orient yourself by reading standard operating procedures of your work area and shadowing different providers. Pay attention to the workflow, the workload, and interdisciplinary interactions. Once you are familiar with the system and feel comfortable, I recommend the sink or swim approach. It builds confidence from the start, and you will gradually become more independent.
Ease into first-time assessments and interviews by seeing patients with a clinician shadowing you. Invite constructive criticism and feedback. It can only benefit you. Invest in an updated prescriber’s guide, and search online for local and national organizations relative to your specialty. If you do not want to go bankrupt joining organizations, look at their event calendar. From there, you can attend meetings that would be most beneficial to you for a nominal fee.
As the mental health supervisor mentioned, your training and experience may differ from that of your mentor. You will find a surprising number of nurse practitioners are oriented to their role by physicians. In addition, consider the variation of training and clinical experience within our own profession. There are nurse practitioner programs that require years of experience working as a registered nurse. Conversely, there are other programs that require little to no experience at all. You will see these variations in your workplace. Research suggests that RN experience neither promotes nor inhibits transitioning to the nurse practitioner role. Avoid the trap of drawing baseless conclusions. One graduate is not better than the other; however, experience shapes perspective. You will notice differences in perspective.
My background includes five years in a medical-stepdown unit and the emergency department as a registered nurse, so, naturally, not getting a set of vital signs because “they need to do that” is strange and disconcerting. I remember hearing a nurse practitioner say, “You are doing well. Do you see the difference? You are a nurse practitioner now. Nurses do not critically think. Nurses just take orders. Real thinking is not involved in that. Now, you have to think critically.”
Now, I have to be honest with you. You may hear similar comments in the office, the breakroom, or a meeting. Remember, some nurse practitioner programs are a fast-track to terminal degrees with little to no experience working as a registered nurse. Furthermore, physicians orient nurse practitioners to their role, not the other way around. These comments are not personal affronts. They are knowledge deficits. People do not know what they do not know, so know yourself. You critically think in your sleep. Be self-aware.
Know Your Place
Find your job description and read it thoroughly. Inquire about your role in your area. By role, I am not talking about the mechanics of advanced practice. I am talking about your position on your team. Nurse practitioners are utilized so many different ways. For instance, psychiatric mental-health nurse practitioners in my facility can admit and discharge patients, round on inpatient units, treat patients in the psych holding area of the emergency department, and see patients in an ambulatory care setting. It is important to know what role you play in your area.
Discuss performance measures and standards of care with your supervisor. “What are your expectations? How are you evaluating my performance? What is the standard of care?” Add their expectations to the list of expectation you should have for yourself. Use them to set your short and long term professional goals.
Knowing your place also has to do with knowing the culture. Every work environment has a culture. For me, transitioning from bedside nursing to an office setting was like waking up in the twilight zone. I went from sharing everything (i.e., computers, lunch, dreams, scrubs, pens) to boundaries and territories. Once, I was politely and abruptly escorted out of my office, a shared space, for taking a call while the other provider was charting on one patient. The first and only patient seen all day. This was yet another ride on the emotional roller coaster. Again, I am accustomed to sharing everything. I have seen three nurse practitioners share one office. I could not fathom the “No Talk While Typing” rule going over so well. Again, I did not consider it a personal affront. It was another opportunity for me to learn. Office culture is not at all like bedside culture. Read about office etiquette in shared spaces and be prepared. I most certainly was not.
I do not embarrass easily, so I am comfortable sharing my experiences. I hope my sharing will help make your transition smoother and less intimidating. The nurse practitioner role is indebted to the art of caring and compassion that is nursing. You are a member of the most ethical profession in the world, and nursing is at the heart of everything you accomplished. It is what distinguishes nurse practitioners from other clinicians. Remember, role change does not imply change of character or professional identity. You are a nurse, so this is not your first role transition. You have done this before, and you can do it again.