Many nurses have answered the call to entrepreneurship, starting successful part-time endeavors or profitable full-time enterprises. The nurses profiled here started interesting businesses that are unusual, creative, or outright quirky.
Learn from these nurses as they describe their start-up experiences, and from some business development experts who advise nurses. They will likely spark ideas for your own entrepreneurial adventure.
Michelle Podlesni, RN
What do you advise nurses who want to start a business?
I always ask them: What makes you happy? What makes your heart sing? Nurses are creative, and there are always ways to express more of who they are. You can design a workstyle around your lifestyle. We’re more than one thing—we may be moms, sisters, executives, fundraisers. Don’t limit yourself, and your potential. There’s no secret to business—it’s simple but, it’s not easy.
To make anything a business you need to make sure you have three things: Somebody who wants, needs, and desires it—and who is willing to pay for it. You have to be able to produce your widget, content, or product. You also have to administer money effectively and profitably. I always advise nurses to identify the fastest path to cash. Bigger than your money investment, even, is your time commitment.
If a nurse doesn’t have a strong interest or passion, then what?
Some nurses don’t want to do their own thing, they want a business in a box. Franchises are well-suited to nurses. And there are all kinds of opportunities out there. I do have one big caveat —always test your assumptions before investing. Nurses don’t do enough due diligence. Do proper investigation before putting money in anything, whether an MLM, franchise, or a website design service.
What does the NNBA offer someone new to that path?
About 50% of our members are nurses who are aspiring entrepreneurs. We have many resources and tools on our website and Facebook page. Nurses interested in more freedom, flexibility and financial rewards can also attend our Nurse Entrepreneurship & Career Alternatives Conference. It will be held September 27-29, 2019, in Las Vegas, Nevada.
Lolita Korneagay, RN, BSN, MBA, LNC
Nurse Medical Cannabis Consultant and Founder of Cansoom
Tell us about your unusual new venture.
I started Cansoom in 2017, and my business is all about teaching people to use cannabis in a healthier way. There are two types of people that I teach: Regular people and medical professionals—that’s the train-the-trainer portion of my business.
Cannabis is important because there are 40 million people in the U.S. who use it. (It’s legal in over 30 states for medicinal use, and for recreational use in 10 or 11 states right now.) Year by year, the users are increasing, and medical professionals need to be prepared. But there are not a lot of opportunities for them to learn.
What was the genesis of your business?
It grew out of a personal need. I was diagnosed with a condition and was in a lot of pain. I had surgery, but the pain continued. I thought: If medical marijuana can help cancer patients, maybe it can help me. It took 22 months to come up with a treatment plan. There were no authoritative books, so I tested everything on myself. Then I put it in a handbook, and later I put together classes.
What’s your advice for a nurse who wants to become a medical cannabis consultant?
If you don’t have a passion for a certain business, you won’t be able to keep going. We need nurses to be patient advocates and to dispel myths. Within the African American community, for instance, marijuana has negatively affected it because people were imprisoned for just possession. But that’s not the case anymore.
Gwen Jewell, RN, BSN, CWS
How did you come up with the idea for your wound care pillows?
I worked on a med-surg unit and started asking: Isn’t there anything better for bed sores? Most professionals say to turn patients and reposition them every two hours. But there is so much more to it than that. It’s not easy. No wonder we get more and more pressure ulcers.
I know a nurse who has been a nurse for her whole life and she’s in her 80s. The whole time she never saw a pressure ulcer. At least 50% of what I see now as a wound care nurse is preventable. A nurse’s day is getting more and more crowded with technology. There is less time to do the simple, basic stuff like turning a patient.
My side hustle has been trying to figure out how to make a support cushion that honestly works, as comfortable as possible, without touching the bedsore.
How did you design and develop your invention?
I called up a foam manufacturer and they gave me chunks of foam. I bought a knife to cut the foam and sew the cover. I tested it on myself and others like my brother who is paralyzed from a spinal cord injury.
It’s hard to get this information to the people who need it. There’s a long learning curve. I finally bought Google ads and sell them, mostly to patients at home. I work on it whenever I can before going to work. (I work swing.) It’s become a passion to put it out in the world. I want to leave a legacy and make a real impact toward creating a world where pressure wounds are a thing of the past.
What’s your advice to nurses with a product idea?
Just do it! We have a whole industry around nursing innovation. Like the woman who developed the colostomy bag, way back near WWI time. She did it for her sister, a young woman with chronic Crohn’s who fell into a depression after surgery. She struggled for 10 years to get anyone to listen.
If you have a good idea, then lean into it. Don’t quit your day job. Test it out first. Fear is the biggest deterrent. We’re in a nursing shortage, so we are always needed and can always get work. So, don’t be afraid.
Clifton Joullian, RN, BSN
How did you come to start this venture?
In studying for my bachelor’s and gathering data, I found some research related to the health benefits of gardening. I was a backyard farmer, so I asked myself: What if I could teach people how to grow their own food organically and how that could help promote health? I had a conversation with Michelle [Podlesni] at the NNBA and she told me it was a great concept, to go to Facebook, create a page, and see where it goes.
How do you fit it in with your nursing job and family life?
My husband and I both grew up in Mobile, Alabama—when I took a job as a travel nurse, we went to Vallejo where we had a large—by California standards—farm and grew citrus, vegetables, and kept hens. That’s where our two sons were raised. We adopted them when they were 4 and 6—and they’re now 18 and 20. For them, gardening was more of a chore. But children will eat more fruits and vegetables if they raise them and those habits go with them into adulthood. It’s like a piece of art: if you raise it, you’re going to share it with others and eat it.
What’s next for you as The Nurse Farmer?
I’m not making money yet, but I plan to kick it up a notch. After both our sons graduated, we moved back to Alabama last year, onto a 10-acre farm. The climate is different, and I made some poor choices, but I’m getting back into Alabama mode. We’ve already got some vegetables; next is herbs and flowers to attract pollinators.
I’m working on a collaboration with The Nature Nurse, Susan Allison, that we hope to launch next year. I’m working with a new local farmers market doing free BP checks. I’m hoping to do cooking demonstrations, like showing people how to process tomatoes, turn them to Creole sauce, but without the salt.
Nancy Joyner, RN, MS, APRN-CNS, ACHPN
Owner of Mya & Me therapy dog team and author of Through Mya’s Eyes
How did you start your entrepreneurial journey?
I’ve worked for 40 years as a nurse—I tell people I’m seasoned, not old! I also work as a nurse mentor for a group of diverse nurses. I’ve done everything in nursing—from NICU to hospice—but my specialty is palliative care. When I incorporated Mya as a therapy dog in my practice, she brought so much comfort and joy. I’m retirement age and was having physical and other medical issues so I wanted to try something less demanding.
What was helpful to you in launching your book?
I found the [NNBA] and started a five-year plan there. A booklet was the easiest thing to publish, so I wrote What If the Doctor Asks Me About CPR? My second book was a “real book,” Through Mya’s Eyes, which is told from her point of view. The unique thing about my book is that includes color artwork, drawings, and paintings from students ages 14 to 18. The book is for a younger, family-oriented audience.
You have a multidimensional enterprise—what else do you do?
I own Njoy Publishing, Nancy Joyner Consulting [palliative care consulting service], and a pet sitting business, too. Mya, my therapy dog, is part of my practice. A therapy dog has to go through a lot of training so she can go to the scene of an accident or she can be around during an assisted activity. A therapy dog has to be invited, and there can only be one dog at a time. Mya is a favorite with patients with dementia: They can be mute, and then all of a sudden, with her, they will talk.
Brittney Wilson, BSN, RN
What’s the best way for a nurse to explore entrepreneurship?
I always recommend nurses start a business as a side hustle, because it’s too stressful otherwise. If you start off full-time, it’s too hard, especially if you’re the primary breadwinner, which many nurses are. Figure out something you can do part-time on the side and do that. As a nurse, you can work three days a week on the floor and one on your business, and the rest can be for your family. You have to make time for your family—if not, your family will resent it and you really need their support to succeed.
How do you get so much done, with a corporate job, a blog, and now the Academy?
You have to be focused. A lot of people aren’t strategic; they fly by the seat of their pants. That little bit of time that you’ve devoted to your business, you have to be 100% focused to write that blog post. Ask: Is it a task that will produce revenue? However, sometimes a business just finds you. I didn’t start blogging with the intent to produce revenue. I started my blog because it was fun, it was my hobby, like other people crochet. At first, my blog didn’t make money. If it’s not fun, you might as well work more hours at your job.
With so many business options, how does a nurse decide what to pursue?
Don’t begin with deciding if you’ll be selling essential oils or CBD oils. I started my business by focusing on making connections. It’s better to build a personal brand first and cast a net that’s a little wider before niching down. Focus on general wellness, healthy eating, and healthy living; get known for that, then after you’re trusted, later you can sell oils. Build your brand first and your revenue later. Know that it’s a long game, and you may not earn income for six to nine months. It’s been said that “there are riches in niches,” but you don’t want to start out so hyper- focused that you have no ability to pivot if you see a business model isn’t right for you.
What part of the entrepreneurial journey is hardest for nurses?
Nurses are used to hard work, but business is marketing and sales and they’re not comfortable with that. But think about it: everything you do in nursing is a sales pitch—time to ambulate after surgery—that’s a sales pitch. Nurses are masters of persuasion and educating patients on the benefits of completing a task. They just don’t realize that’s what sales is and that they already know how to make a sales pitch; they just call it education.
Jon Haws, RN, BSN
Founder and CEO of NRSNG
Do you find that any particular skillset or mindset is crucial for entrepreneurs?
One of my favorite quotes is “you are only as successful as the level of problem you are able to solve.” I have no idea who said that, but it has had a profound impact on growing NRSNG. To me, it means you have to be able to take on greater and greater challenges as you grow your business. So, to answer the question, I believe that one of the most important skills a business owner can possess would be the ability to manage chaos and roll with the problems and punches. Just like in nursing, there are 1,000,000 things you can focus on, but only a few matter. Being able to identify those few problems that matter and solve them will help you and your business grow.
What tips do you have for nurses employed full-time who want to make a total transition?
Patience. Many people think they have to “win” today. This mindset will lead them into doing things that simply make money versus doing things that benefit their customers. It’s all about building something that brings real value to the world . . . not about just quitting your job. I think when the customer really becomes your focus versus just trying to make enough to quit a job, this will reflect in your business. Customers will notice that you really do care and you are fighting to solve their problem.
Any other advice for our minority nurse readers about entrepreneurial life?
At NRSNG our mission is to end the nursing shortage. This is a global problem with a huge scale. We respect the enormity of what we are trying to do and that drives our decisions. If we had small goals, we would make small decisions. Instead, we adopt a world-changing goal and make all of our decisions from that vantage point.
There really isn’t anything “easy” about the entrepreneur life, but it truly is the most fulfilling journey in the world. Watching users find success with your product, watching employees buy into the mission, watching your kids find love for the company. It’s incredible. Find a big mission and chase it like hell!
Donna Maheady, EdD, ARNP
How did you come to start Exceptional Nurse?
Lauren, my daughter, was born in 1986 and later diagnosed with autism, OCD, epilepsy, and a host of other autism-related challenges. I quickly became an advocate for her, and overtime expanded my advocacy efforts to include nurses and nursing students with disabilities.
Is it a business, or a nonprofit, or a passion project?
Exceptional Nurse is a nonprofit resource network for nurses and nursing students with disabilities. The nonprofit provides information, support, mentors, employment opportunities, social media, and related articles. It also awards scholarships to nursing students with disabilities.
What entrepreneurial lessons have you learned?
Do what you love! Being a risk taker is important along with being resilient… moving past setbacks and criticism. A strong work ethic is also important—being an entrepreneur isn’t a 9-5 job! It takes hard work and perseverance to succeed. Continue to learn new skills, network with others, and ask for help when needed. Give as much as you take. Surround yourself with positive, like-minded people. Manage money wisely.
What advice do you have for our readers?
To my fellow nurses and nursing educators, I would stress the importance of recognizing that disability is part of life…for everyone! Nurses with disabilities have knowledge, experience, and skills to share. They have walked the walk and gained insight into patient care. Their experiences inform and benefit their practice. Many have a passionate desire to care for others. Nurses with disabilities can be the best role models for patients.
What productivity tips do you have for nurses who are employed full-time but want to launch a side hustle?
It’s tough. Mentally, the idea of making it all work is easy, but the execution is really hard. Usually it isn’t because of time. You can always make time. The biggest problem is willpower. At the end of the day, after working your tail off, you usually don’t [have] the willpower to get more things done.
The best thing you can do is come up with a long-term gameplan and lay out the tasks that you need to get done. Then break those tasks down as much as possible into smaller chunks. Now that you have these small chunks, take a look at your schedule.
For about a week, keep a journal with you at all times and every hour that you’re up, write down what you did for that hour. What you’ll usually notice is that the times you aren’t working or sleeping, there are lots of gaps where you’re not really doing anything.
Fill those gaps with bursts of effort where you get your tasks done. If you find that at the end of the day you mentally can’t do more things, then wake up earlier and get them done. Diet and exercise also go a long way.
Are you saving for retirement? Here’s your guide to getting on track with securing your financial future.
Saving for retirement can often feel so daunting that you push it to the back of your mind. When trying to manage your career and other personal finance goals such as buying a house and paying down debt, retirement planning and investing often takes a back seat. You know you should ask your HR department about the 401(k) plan your company offers, but you never get around to it. But it’s worth the effort now so that you are well-prepared for the future.
The truth is many Americans are not saving for their golden years. According to a 2018 survey by Northwestern Mutual, one in five Americans has nothing saved for retirement. And 78% of Americans are “extremely” or “somewhat” concerned about affording a comfortable retirement. One in three Baby Boomers (33%), the generation closest to retirement age, have between $0-$25,000 in retirement savings.
Generations X and Y are often saddled with student loan debt and stagnant wages, making it a struggle to save.
While these are scary facts, the good news is that once you take the time to educate yourself on the basics of retirement planning and you take a few smart steps to invest, you can largely put retirement investing in the back of your mind and not feel guilty that you aren’t taking necessary action.
Jane Bryant Quinn, author of How to Make Your Money Last: The Indispensable Retirement Guide, says many people don’t want to think about retirement planning. She also says that making projections and calculating retirement budgets can be a pain but is important to do.
“You have to add up your savings, estimate what you’ll get from Social Security, make an investment plan, estimate how much income your investments will provide, and estimate your retirement expenses,” says Bryant Quinn.
To help figure all of this out, Bryant Quinn says to create budgets. “If you’re married, make three estimated budgets—one for you as a couple, one for you if your mate dies first, one for your mate if you die first. For example, married couples get two Social Security checks (one for each). When one of you dies, the survivor will get the larger check but lose the other one. So, you have to plan for all circumstances,” she says.
Daniel Burke, CFP, ChFC, president of Burke Financial Group, LLC, says nurses spend their entire working careers caring for the needs of others, but often by doing this, they tend to neglect important planning components for themselves.
Are you ready to take action? Below are answers to the most common questions about retirement planning and investing to get you started on the road to a secure future.
What Are My Retirement Dreams?
Start with finding your why. What motivates you when you dream about your retirement? Do you want to spend a year traveling around the country in an RV? Do you want to move to a new city? Do you want to spend more time on hobbies such as gardening, crafts, or learning to speak Spanish? Or perhaps you want more time to devote to friends and family or a cause close to your heart.
Identifying the life you’d like to retire to can serve as a strong motivator as you start down the path of savings. It’s much easier to devote 15% of your income to your retirement account versus spending that money on something fleeting when you can envision the life you’re saving for.
How Do I Get Started?
“Benefits through the employer are a great place to start as nurses begin planning for themselves and their families,” says Burke.
Educate yourself on the retirement benefits offered by your employer. If your employer offers a 401(k) or 403(b) option with a matching benefit, sign up for the match immediately. If you are not taking advantage of your employer’s match, you are literally leaving free money on the table.
If your employer doesn’t offer a 401(k) option, then open a Roth IRA through a brokerage such as Fidelity or Vanguard. Contributions made to a Roth are after-tax contributions, but your money and earnings grow tax-free (meaning you will not pay taxes on any returns you earn from your investments).
What If I Haven’t Been Saving?
If you haven’t been saving anything for retirement, it’s important not to beat yourself up. You can’t go back and change the past, but you can commit to saving going forward.
Bryant Quinn offers the following advice, depending on your age.
New Grads: “Start a savings account, to have a little cash on hand. Put a little into your employer’s retirement plan, despite your student loan. If you change jobs, don’t cash out the amount you saved, take it with you to a new job,” says Bryant Quinn.
Mid-Career: Higher earning years means higher savings. “In your retirement plan, chose funds that lean heavily to stock market investments. It doesn’t matter if stocks go down. Throughout history, they have always come back,” says Bryant Quinn. “You have the time to wait. It’s your best shot at a nest egg. Keep contributing to your plan, even if your kids are in college (or at least try to).”
Near Retirement: Time to plan. “Keep investing in stock-owning mutual funds,” says Bryant Quinn. “You will probably live another 30 years (or more—my mom made it to 103). Over such a long period of time, stocks always go up.”
How Much Should I Save?
If you’re starting from scratch, a good starting point is to invest enough to get any company match offered by your employer. This is essentially free money and everyone should take advantage of it. For instance, if your company offers a 5% 401(k) match, you should invest no less than 5%. But that’s just a starting point.
Another strategy that Bryant Quinn suggests is to simply start by taking at least 5% out of every paycheck and putting it into your 401(k) or 403(b). “If you’re already contributing, increase the amount. What will happen when you get a slightly smaller net paycheck? Nothing will happen. We all tend to spend whatever money we have in our checking accounts. If there’s less in your account, you’ll spend less—even without a budget,” she says. “You’ll make small adjustments without realizing it. It’s the only magic I know in personal finance.”
If your company does not offer a 401(k) program or a match, you can open a Roth IRA through a brokerage service on your own.
“If you have no plan [at work], Individual Retirement Accounts (IRAs) can be purchased at low-cost no-load mutual fund groups such as Vanguard. They’re available at banks, too, but usually with higher fees. Always choose low-cost investments,” says Bryant Quinn.
Once you start gaining some confidence in your knowledge and are eager to save more Bryant Quinn suggests utilizing financial resources, such as online retirement calculators and budgeting tools to estimate retirement living expenses.
Overall, determine a percentage goal that works for you and challenge yourself to increase it incrementally (e.g., every six months or annually). You can also boost your savings effortlessly by automatically investing any annual or performance raises you receive. If you were living on what you made before you got a raise, just keep living off of that amount and invest the extra income.
Do I Need A Financial Planner?
If all of this sounds complicated and you would like a helping hand, consider working with a financial advisor. But choose wisely as many financial advisors get paid by selling you on specific mutual funds, often with high fees. These fees will eat away at your nest egg.
Your best bet is to hire an independent advisor who is fee-only or paid directly by you by the hour. Your company may provide consultations with an advisor from the administrator of your 401(k)/403(b) plan, but it’s important to remember that their loyalty is first and foremost with their employer, not you.
What Is the Biggest Mistake I Could Make?
“Not saving enough,” says Bryant Quinn. “You can save money, even if you’re living paycheck to paycheck.”
If you are a nursing student, I would like to welcome you to the fabulous field of nursing! There is nothing more rewarding than serving in this meaningful profession. I anticipate you plan to practice in this arena upon graduating and passing the state board exam. However, be cognizant that one of the most challenging transformations your nurse educator will be responsible for will be in assisting you to become a professional in the medical field.
I know that you think that your instructors are always nagging you about your appearance, but at the end of this process, you will understand how important this transition is in order to socialize you. You have certainly heard educators discussing first impressions and how important they are in establishing credibility and rapport with your patients and with the health care team. As health care professionals, our demeanor affects everyone around us while we are on duty. Since I am a nurse educator, I would like to disclose some of the dos and don’ts of your daily conduct that you should be aware of as a student entering the nursing profession.
Let us start with the basics: punctuality. Have you ever heard the statement that when you are on time, you are late and when you are early you are on time? This applies to both the classroom and clinical setting. It is disturbing and disruptive as latecomers arrive to the classroom once lecture or testing has begun. As you enter the room tardy, open and close the door, remove extraneous clothing (coats, scarves, etc.), retrieve necessary items from your book bag… Well, you get the idea. While you catch up with the rest of the class, your colleagues have preceded you in doing so. Consequently, the energy in the room shifts as you now settle in for a long day of studies. Have you considered how your lack of punctuality affects those around you? Maybe it is time you do so.
You may ask, “How about makeup? How much is too much?” My answer for this is that if you are putting false eyelashes on before attending class and clinical, you clearly have too much time on your hands. Why not spend those extra 10 minutes reviewing notes taken during lecture or take a quick peek at those index cards? Why not work on those intravenous drip calculations you have been struggling with? It only takes a few minutes out of your day to commit to tackling the less desirable tasks. Facial makeup now takes second place once you realize that the extra minutes you use to embellish your outward appearance would be better spent on nurturing critical thinking skills.
Do you ever have downtime? By this I mean the time you have during breaks and lunch. How do you spend this time? Watching kitten videos, catching up with the celebrities, or perhaps finishing a movie or television show? I tire of overhearing the latest on the pop stars—the Kardashians, etc. You must know that your instructors are observing you and that we are very much aware of what occupies your time. No, we are not telepathic. We know by the incomplete homework you turn in (or not) and by the multitude of excuses you have for late assignment submissions. We know by the test scores that you feel are acceptable, even when we, as instructors, know you can perform academically better. I implore you to spend all the time that you have honing your skills for nursing. There is plenty of curriculum to embrace, so do so every moment you have. I promise you will not be disappointed.
It is not cool to have your shoelaces or velcro straps untied. This look appears anything less than professional. It is hard to take anyone seriously who has not taken the time to attend to such details before entering the clinical arena. Another detail worth addressing is gum chewing. Along with the former offenses, it is difficult to accept that the person who is chewing gum is focused on anything other than smacking idly while passively listening or speaking to their audience. In my profession, potential candidates for employment were simply dismissed during an interview because of gum chewing. Do not let this be your fate while seeking employment.
Confine all cracks, cleavage, tummies, and tattoos for activities aside from nursing. Let me be clear: cover all external crevices at all times while in uniform. Having these body images in view is unprofessional and if you want to be taken seriously, save this look for socializing (e.g., dating, clubbing, or spending weekends with friends). Your patient nor your instructor desires to be distracted.
While we are noting external appearances, there is a reason for us to request that you not wear jewelry larger than stud earrings and a wedding band. The focus on you should not be about your taste in jewelry. Jewelry is a vehicle for the transmission of germs, and while I am addressing the chain of infection, allow me to broach the topic of nails. Remember your lecture on infection control: hand washing in between patients, before and after meals, after smoking and toileting? You discovered how microbes harbor under long nails and in cuticles. The studies have been done, and the results are in. Nails are to be no longer than one-quarter of an inch. You cannot effectively palpate or percuss body contours and abnormalities with long nails.
Uniforms: the glorious look of a uniform, but only if it is clean and ironed. No wrinkles are allowed on uniforms or lab coats. Your first impression from your mentors and patients should exude professionalism as noted in unsullied and tidy apparel. Your patients want to know that they are safe with you—that you will protect them, not infect them. Not only does appearance count but so do scents. I will take the fresh aroma of antiseptic soap from thoroughly washed hands any day over the stench of cigarettes. While you are observing your patients, let it be known that they are observing you, too. Leave them with an impression you can be proud of. Think about your appearance this way: when you are practicing in the clinical setting, you are interviewing for potential employment.
When you are in class or clinical, you are in a work zone. No cell phones allowed! Please stop checking them. Instead, check the cell phones at the door and place them on silent, in your pocket, or in your car. I am looking forward to the day when administrators will mandate that cell phones be left with the instructor or outside of class and clinical altogether. I am aware of the potential family emergencies, children, health-related issues, etc. There must be arrangements for emergency calls. If a protocol does exist and despite this, we find our students clinging to these electronic devices making it difficult for instructors to maintain our students’ attention. For example, during clinical orientation (I am ashamed to say) students and educators are now being in-serviced regarding prohibiting cell phone use. Cell phones are not to be used in the facilities while practicing. It should be common sense that when you are at work, you should not have time for texting, checking emails, or Instagram. You should be working, which means meeting the needs of your patients.
In meeting patient needs, how do you communicate with them? Do you use “honey,” “sweetie pie,” or other affectionate terms with your patients? This is unacceptable as it is highly probable that your patients are older than you and as such, deserve your utmost respect. Along with respect for your patients, I would also like to add appropriate communication to use with your instructor: never use obscenities. You will develop a plethora of new words in this profession, none of which is profanity. Good communication skills entail proper dialogue with your instructor, among colleagues, patients, and health care providers. Using the last name with the prefixes Miss, Mrs., or Mr. is acceptable unless your patient has given you permission to call him or her otherwise. And how will you know how you should address your patients? If the patient does not inform you that they would like to be called by another name, simply ask them after having addressed them formally. You will always gain the respect of your patients by being respectful.
Did you know that your posture and gait say so much about you? Walk like you have purpose. Strut up that hallway and answer those call lights as if it were necessary, because it is. Exhibit energy and enthusiasm as opposed to being lethargic. You may be tired, but keep it moving! Your patients want to know that you have the vigor required to take care of them. For this emotionally and physically exhausting profession, I would advise you to follow the Beatitudes: be well rested, be fit, and be well nourished. Nursing is a taxing profession. Take care of yourselves so that you can take care of others.
Quite often a nurse will ask me how to become engaged in the health policy arena. I frequently advise nurses to get involved with their professional organizations as a start. Many nursing organizations have an advocacy and legislative agenda and are oftentimes engaged in advocating on behalf of patients and the profession. Here, we share a conversation with Aney Abraham, DNP, RN, NE-BC, who is a founding member and current president of the Indian Nurses Association of Illinois (INAI). Abraham discusses the origins of her organization and current issues they are addressing.
With regard to legislative issues, Abraham highlights a piece of legislation that was introduced during the 115th Congressional Session. The proposed legislation “H.R. 3592 South Asian Heart Health Awareness and Research Act of 2017” aims to address the high rate of cardiovascular disease in the South Asian community. And while the proposed legislation did not gain much traction during the 115th Congressional Session, the INAI is hopeful that the original sponsors of the proposed legislation will reintroduce it and continue to seek funding to support research focused on finding solutions to the high rate of cardiovascular disease in this population. This targeted approach to improving the health and well-being of this population takes into consideration cultural factors that may influence health status and calls for early intervention and treatment through education and awareness.
As president of the Indian Nurses Association of Illinois (INAI), can you share with me a bit about the INAI, its origins, its mission, and membership?
The Indian Nurses Association of Illinois was established in 2002. I was a nurse with about 18 years of experience at this time and among one of the few nurses that thought of this idea of forming a professional organization for nurses of Indian origin. There were many reasons for starting this organization. The first and foremost was that Indian nurses who immigrated to the U.S. faced many challenges as they transitioned in the United States.
At a Glance:
South Asians and Heart Disease
- South Asians are one of the fastest growing ethnic groups in the United States.
- Family origins mostly from: Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka.
- High cardiovascular prevalence not readily known due to lack of data.
- Research examining heart disease in Asians in general lacks subgroup analyses.
- Possible contributing factors include early onset of diabetes, cholesterol abnormalities, westernized diets, and lifestyle.
Source: American Heart Association
For a more detailed discussion of heart disease in South Asian populations, please see the American Heart Association’s Scientific Statement.
Foreign nurses become minorities overnight having little or no orientation to the country or health care facility that they worked for. We realized that many nurses were eagerly anticipating the birth of this organization and thus successfully established the organization in 2002.
The mission of INAI is to identify and meet the professional, cultural, and social needs of nurses of Indian origin. In addition to our mission, our purpose is to ensure that we provide representation and interact with other professional organizations as well as promote cultural awareness by communicating the uniqueness and diversity of the Indian culture.
What do you believe are the top nursing issues impacting our profession today?
Job safety is important to all professions; nurses are not exempt from working in unsafe environments. One of the top nursing issues impacting our profession is workplace violence. Every day, our nurses are impacted by violence perpetrated by patients, their family members, and visitors. Incidents that may start small can spiral out of control within minutes. Even though nurses are very familiar with incidents of violence, research seems to suggest that workplace violence is increasing. We certainly hear about these incidents through TV, print media, and reports from nurses.
The second issue that is impacting our nurses is stress and burnout. Nurses are on the front lines providing direct nursing care, advocating for patients’ medical needs, comforting patients/families, and working with a multidisciplinary team to ensure that patients receive safe high-quality patient care. Stress and busyness can easily escalate with the demands that are placed on nurses daily.
As nurse leaders and professional organizations, we need to work on finding ways to address awareness and ways to mitigate these issues that are facing our profession.
What are some of the top policy or regulatory issues impacting the Indian nursing community?
One of the issues impacting nurses of Indian origin is abusive employment practices. To address this, in 2008 the ANA released the Voluntary Code of Ethical Conduct for the Recruitment of Foreign-Educated Nurses to the United States. The code addresses minimum fair labor standards, civil rights, age discrimination, equal pay, and family/medical leave.
Another issue impacting Indian nurses (majority of which are of South Asian descent) is that they suffer from heart disease, high blood pressure, and diabetes too frequently and too early in life. Compared to other ethnic groups, South Asians are four times more likely to have heart disease, experience heart attacks 10 years earlier in average, and have a 50% higher mortality rate from heart disease. To address this, in 2017 Rep. Pramila Jayapal (D-WA-7) proposed H.R. 3592 “South Asian Heart Health Awareness and Research Act of 2017.” This is a very specific piece of legislation targeting Asian Americans.
What is the overall purpose of this legislation, and why is it important to you as a nursing organization and to the Asian community at large?
Representatives Pramila Jaypal and Joe Wilson co-sponsored this bill to raise awareness of the alarming rate at which the South Asian community is developing heart disease.
The overall purposes of this legislation are to:1) promote heart healthy eating among Asians; 2) conduct research to understand why South Asians are at an increased risk for developing heart disease and; 3) develop educational tools about heart disease for South Asians.
This legislation is important to us as a nursing organization and to the Asian community at large. The members of the Indian Nurses Association spend a tremendous amount of time offering free community services in the Indian community. Our advanced practice nurses spend time on the weekends visiting the various churches conducting health fairs, offering lectures, and educating the community on the dangers of heart disease and diabetes. Legislation that supports research will enhance our ability to learn more about the root causes of the high risk for the Asian community and prepare us to share lifesaving information with the community at large.
Are there any updates on this given this did not pass out of committee?
We will continue to monitor where this is going as the original sponsors are committed to raising awareness and supporting research in this area.
What are some of the ways that your organization has engaged in community education regarding Asian American cardiovascular disease?
Every year we host a minimum of three community health fairs and lectures in the Indian community. Our members, many of which are advanced practice nurses, have the skills, expertise, and knowledge to effectively lead these health fairs. In addition to the health fairs, we offer free BLS and ACLS certification.
How does INAI prepare its members to be influential advocates in the policymaking arena?
INAI invites public officials and elected officials to speak at our meetings and conferences. For example, some of our guests in the past have included, at that time, Senator Barak Obama before he went on to become President of the United States and Dr. Ann Kalayil, Bureau Chief, Cook County Bureau of Asset Management. Dr. Kalyil was the former President of the South Asian American Policy and Research Institute.
Additionally, members stay informed through educational seminars and educational offerings posted on social media outlets such as Twitter and Facebook. We also stay abreast of issues by following the legislative agenda of the American Nurses Association.
Are there other policy issues that are a part of your health policy agenda?
Many of our members are advanced practice nurses. Thus, we support the policy agenda of the National Association of Clinical Nurse Specialists (NACNS). Their priorities—including nursing workforce issues, health care reform, and health information technology—resonate with our legislative priorities.
The Indian Nurses Association is an organization of about 200 members. We can be more impactful when we combine our voices with other nursing organizations to enhance our policy advocacy on behalf of patients and the profession.
If you had to offer advice on why nurses should be engaged in advocacy and policy advocacy on behalf of patients and the profession, what would you say?
Nurses instinctively advocate for their patients. Equally important is for nurses to engage in legislative and political advocacy. This is needed to advance the profession and patient care. It is important for the voice of the nurse to be heard when any new legislation or bill is being introduced. An example of a recent bill is SB2151, a bill sponsored by Senator Hastings. This bill is about the Nurse Practice Act language surrounding delegation. Specifically, nurse delegation in community-based settings is of concern. Nursing has to provide the definition of what nursing practice entails, how nursing interventions and tasks can be delegated, and in what care settings the delegation can occur.
Nurses can stay informed on legislation that impacts their practice and profession by following nursing forums like @ANAnurses [and] @RN Action.
To stay engaged or not engaged in policy advocacy is a decision each nursing professional has to make, and he or she must always err on the side of staying actively engaged on behalf of the patients and those they serve.
Leadership—it’s the Holy Grail that’s stressed in business and health care administration. But how can you get there? And how do you know if nursing leadership is even right for you?
“Not everyone has the skills, desire, or disposition to be an administrative leader,” says Laura S. Scott, PCC, CPC, ELI-MP, CPDFA, president and founder of 180 Coaching, an executive coaching and leadership training provider based in Tampa, Florida. “I recommend that my clients go to a trusted supervisor and ask, ‘Where do you see me going as a professional and leader?’ and then just listen. You might be surprised at what you hear. If you have a role in mind, ask that trusted supervisor if they think you would be a good fit for that role and ask, ‘Why or why not?’”
Use caution when thinking about getting into leadership. “Don’t rush into what isn’t easily seen as an opportunity,” says Alisha Cornell, DNP, MSN, RN, a clinical consultant with Relias, a health care talent and performance solutions company. To decide whether a leadership role is right for them and what they want get out of it, Cornell says that self-exploration is necessary. “How did the nurses identify that they even wanted to be nurses? My recommendations are to stick to the original design. Whatever got you to nursing school and whatever helped to push you out of there, that’s your personalized equation.”
If you’re not sure if you want to be a leader, Romeatrius Nicole Moss, DNP, RN, APHN-BC, founder and CEO of Black Nurses Rock, says, “First, it is determined by the specialty you enjoy, followed by what you can contribute. Leadership starts now, as a staff nurse.” She suggests you ask yourself these questions:
- Do people often come to you for help, advice?
- Do you offer suggestions at meetings?
- Are you the go-to person for issues on the unit before elevation to leadership?
- Are you available, outgoing, approachable?
“If you are the unit leader, charge nurse, etc., these positions are set up to move you to the [higher] levels when opportunities arise,” explains Moss. “So be ready.”
If you know that you aspire to a leadership position, then move ahead. If you don’t or you try a leadership role and don’t like it, that’s okay. “If you don’t like nursing leadership, you can always go back to patient care,” says Thomas Uzuegbunem, BSN, RN, an RN administrative supervisor as well as the editor of the nursing leadership blog, NurseMoneyTalk.com. “Some nurses can get enough leadership fulfillment by being on a board. Others find that it’s not enough, and they want to move into nursing leadership as a career.”
Make sure that after self-reflection, you are the one making the decision to move into a leadership position. “Nurses who are seen as good caregivers are often promoted. While patient care is extremely important, being able to care for a patient does not mean that a nurse can care for a team of peers,” explains Bill Prasad, LPC, LCDC, CTC, a licensed professional counselor who has also worked as a hospital director and a leadership coach. “A nurse must understand that moving to a leadership role means you are moving from a focus on health care to a focus on organizational health.”
If that doesn’t fit in your life goals, there’s no shame in not pursuing leadership or moving into management. Yanick D. Joseph, RN, MPA, MSN, EdD, an assistant professor of nursing at Montclair State University in New Jersey sums it up: “Not everyone is destined to lead or to be an administrator,” she says.
Skills and Characteristics Needed for Nursing Leadership
“Leaders are born, but there are no born leaders,” says Prasad. “Becoming an effective leader takes training and education. Without this, you don’t know what you don’t know.”
Communication, flexibility, and organizational skills are the most important skills that Moss believes nurses wanting to move to leadership need to have. “Leaders should have the skills that allow them to be calm in stressful situations such as in crisis, emergencies, schedule management, and more,” she says. Nurses also need the “ability to work with different personalities and change leadership styles based on the staff member. Nurses should understand this even while working with their teams: you cannot use the same leadership style on everyone. Some people do better with taskers and checklists, while others need a little supervision to flourish.”
Moss says that leaders must be relatable and personable. “Allow your staff to see you get your hands dirty. Be the expert on the unit/department and show the team your skills and that you can handle the unit if need be. Start IVs, jump in on a code, participate while letting your team lead.”
One other characteristic Moss believes is imperative for nurses who want to lead is to be calm when challenged or with disagreements. “It is important to understand differences of opinion and to negotiate the best options. It’s even more important when dealing with difficult staff, family, etc. to not get emotional and to always be open-minded.” She admits that this was tough for her when she began to lead. “I had to understand the different personalities, politics, and overall strategic plan, and how they all come into play with decision making. Once you get this, your life will become less stressful,” she explains.
Scott agrees that good communication skills are crucial. “Effective communication and opening the channels for two-way feedback is very important. Also important is knowing what keeps these staff and providers on board and engaged so that you can give them what they need to stay motivated and fulfilled,” says Scott.
When communicating with others, Cornell says to keep this in mind: “Nurses are well-versed in the scientific methods of providing care from an academic perspective, but relating to ourselves, learning to listen for the conversation instead of solving a problem, and not reacting spontaneously are all critical skills of a strong leader.”
Nurses also need to be patient and have courage. “These characteristics are important because the normal job responsibilities of the nurse require quick thinking and paying attention to details. However, being a great leader requires the brain to slow down and digest the information in order to resolve a problem or at least know where to look to resolve it,” says Cornell.
Nurse leaders, Uzuegbunem says, must have an ability to accept diversity and understand technology. “Nurse leaders must be able to embrace diversity and adapt to those cultural differences of the nurses they lead as well as the patients the nurses take care of,” says Uzuegbunem. “Technology is having more of an influence in health care. From electronic medical records to the equipment nurses use. [Leaders] need to be able to adapt to these technological changes.”
While our sources have different opinions on how much education leaders need, one thing is certain: if you want to hold a leadership position, you must keep learning all the time.
“Nurses need to obtain additional education, certifications, and always continue to have a thirst for knowledge,” says Cornell. “A nurse leader should have, at minimum, a master’s degree in a focused area of nursing.” While she says other advanced degrees are helpful, one focused specifically on nursing “drives the objectives of nurse leadership and the shared experiences of nurse leaders. At the advanced leadership level—which includes directors and CNOs, they should have a doctorate. The terminal degree is a collaborative journey of nursing experience and leadership needed to facilitate a structured systems approach to patient care and organization of nursing teams.”
“A nurse aspiring a position in leadership should attain the highest level above what the unit or department requires,” suggests Moss. “Managing nurses who have higher credentials could lead to resentment or turnover as the staff nurse doesn’t see progression at the top. A unit should be led by the expert, in my opinion, the go-to person. This person should obtain the needed certification, education, and training to support this.”
Scott reminds nurses to check to see if the facility you work for provides funding for earning advanced education. “Many hospital groups will offer tuition reimbursement to qualified candidates, so you don’t have to go into deep debt to get this education,” she says.
Uzuegbunem believes that there’s no set educational path to leadership. “Depending on who you talk to, you’ll get different answers. Some will say that nurses should have at least a BSN before being able to get into leadership. I don’t. I also don’t think a certification is needed. All that’s required is a desire to lead others and a willingness to serve those you lead,” he argues.
Money, Money, Money
Besides the other skills, characteristics, and education that prospective leaders need, there’s another that many don’t consider—financial knowledge. Jane C. Kaye, MBA, president of HealthCare Finance Advisors, states that nurses in supervisory positions in all types of health care facilities need to have some financial skills. “The financial health of health care organizations depends on how well nurse leaders manage staff and supply costs. For example, salaries are the single largest expense line in any health care facility, and nurses represent the largest share of salaries. Similarly, nurses lead large departments such as surgical services, where supply costs are very high. If salary and supply costs are not managed, the sheer size of these spending areas can jeopardize the financial health of the health care entity,” explains Kaye.
According to Kaye, the types of financial skills nurse leaders need include: management of full-time equivalent staff, management of supplies, expense variance analysis techniques, knowledge of budgets, an understanding of operating statistics, and an understanding charge capture techniques so that all services performed are included on the patients’ bills.
For nurses who don’t have good math and finance skills, Kaye suggests that they find a trusted colleague in finance to help them understand financial concepts. “They should never be afraid to ask questions,” she says.
Attending webinars, seminars, and workshops on finance may also help.
A good way to prepare for a nursing leadership role, says Scott, is by taking on leadership roles outside of work. For those who want to become more confident speakers and grow in leadership presence, she recommends looking into Toastmasters, a national organization with chapters across the U.S. that help members learn to give great speeches.
Cornell says that networking is a must but can begin way before nurses are even considering leadership roles. “Knowing colleagues in the industry is always a plus, and it helps to learn what other nurses are doing. Volunteering for committees and sitting on boards are all great experiences, and nurse leaders should participate in these activities,” says Cornell. She cautions that doing this should be fine. If it’s not what the nurse is aligned with liking or doing then s/he will lose interest fast.
“Becoming part of committees and boards allows you to gain the experience and confidence you need to speak out on your opinions, work with different personalities, and see your strengths and weaknesses,” says Moss. “It can really show you what type of leader you naturally are.”
To prepare for taking a leadership role, Joseph suggests the following: reading professional journals, attending seminars, networking, joining LinkedIn, researching the role you want, reaching out to professional organizations for best practices, speaking to a mentor or someone who has made the transition, being proactive and enthusiastic about learning the intricacies of the new role, and being visible.
No matter what, being true to yourself is most important. “Being a leader is challenging, arduous, demanding, trying, and hard,” says Joseph. “But the joy of doing what you are born to do and have a passion to accomplish is indescribable.”
Employment projections are estimating that Registered Nurse (RN) needs will continue to grow rapidly—at the same time a shortage in nurses is expected. Due to this shortage, it is critical for health care organizations to implement a firm training program, have direct leadership relationships, and target minority populations. Doing this will assist in filling RN openings and help create an organization that truly invests and cares for their nurses, which will positively impact retention.
Nursing school enrollment is not advancing fast enough to meet the RN demand, and with nurse baby boomers aging there will be fewer nurses available as the health care sector continues to grow. For example, in the Orlando, Florida region specifically, there are over 1,600 current RN job openings available, with 191 direct employers competing to fill those open positions. Simply put, there are not enough nurses to fill all those critical needs in the market. This shortage is impacting the current nurses’ job satisfaction, increasing their stress, and even driving some nurses to leave the profession.
Without nurses we cannot run our health care organizations, which is why having a process in place to train and support them is essential. To invest, you must have a proper training program to support the nurse and ensure they are demonstrating safe quality care to patients. Certain organizations, such as AdventHealth, implement this in their Graduate Nurse Residency Program in the Orlando region. The first two weeks of the program are focused strictly on modules, simulations, and computer training. During that time the new nurse goes through a three-day simulation lab to provide hands-on learning before they even enter the department. The following months are focused on individual preceptor training. The nurse is partnered with an experienced nurse for a certain amount of duration (8-16 weeks depending on the acuity of the unit) to train the new nurse and will be with them every single shift side by side so they have the resources and training to be successful. After the focused preceptor training, the new nurse continues to be provided educational courses and simulations as needed. This shows the nurse that the company is investing in their future.
Proper training programs and support for nurse staff is essential for the nurse to feel like they have more opportunity, and desire to stay and grow as part of the organization. With the shortage of nurses, you need to ensure the nurses that you do have feel supported and uplifted to reach their full potential. Providing this training will provide a higher percentage of nurses to feel valued enough to want to stay in that organization and to have the desire to give back full circle to the organization that invested in their learning and education.
Leadership involvement is also a direct way for organizations to increase retention. If a nurse is feeling overworked, they need to at least feel appreciated for all they do. Open communication is critical for retention—and to really understand where your employees are coming from. Nurse leaders need to uphold regular one-on-one meetings and gain a professional relationship with their employees to understand their struggles. During this meeting it is also important for the leader to ask intuitive questions, so they are aware of the things that motivates their nurse employees to continue being a nurse every day to help others. Remind them why they started this career, so even through the negative days they resort back to the positive reasons why they started their nursing career.
In today’s recruitment efforts, the candidate pool of nursing talent is getting smaller since nursing schools can’t accommodate the applicants. Even though the schools can’t accommodate the volume of applicants, the nursing programs still need to ensure their selection process is fair in diversity selection as well. Health care organizations also need to focus on out of the box recruitment efforts targeting different populations—specifically, minority nurses. Health care in the United States is seeing a high influx of minority patients. When the number of minority patients increase, so does the demand for minority nurses to care for those patients. It is very important for the team of nurses at an organization to be well-rounded and diversified to care for patients from a variety of cultural backgrounds.
Implementing training programs, leadership engagement, and targeting minority nurse nurses will not only help with recruitment and retention, but also project longevity amongst nurse employees. Nurses need to feel wanted and valued. Nursing is one of the toughest jobs, but when an employer makes them feel respected, appreciated, and gives them the proper tools to be successful, they will be more likely to continue to stay within an organization that supports them wholeheartedly. Every organization needs to focus on these areas to be able to retain their nursing staff and provide the utmost care to their patients every day.