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.
As an academic nurse researcher from an underrepresented minority background, for years, I was plagued by a certain phenomenon: specifically, the imposter phenomenon. In 1978, psychologists Pauline Rose Clance and Suzanne Imes coined this term to describe the internal experience of “intellectual phoniness” that is prevalent in high-achieving women who, despite their academic and professional triumph, feel that they aren’t smart enough, that they have somehow deceived others to view them as successful, and that they will soon be exposed as frauds.
Of course, this phenomenon isn’t limited to women: a 2011 review article published by Jaruwan Sakulku and James Alexander suggests that 70% of all individuals experience imposter phenomenon at some points in their lives. However, in my article, I focus on how I myself experienced the imposter phenomenon as a woman with African roots within Western academia. More importantly, I share my experience to express how detrimental the imposter phenomenon is to educators in academia. Today, I feel obligated to share my story with my students through my teaching and mentoring.
What are the attributes of the imposter phenomenon? From the definition of the term, I identified at least three destructive factors that contributed to my personal experience of it: namely, self-doubt, negative self-statements, and socialization as an African female.
An individual who sports self-doubt lacks confidence in her own capabilities and thus relies upon others to assess her accomplishments, failures, and reality. Naturally, self-doubt fuels negative self-statements that this individual utters about herself and eventually comes to believe about herself. And her negative self-statements will ultimately reinforce what her society and culture demands of women. If this individual is African like me, she will be haunted by her society’s belief that women are a weaker sex, that they should not be heard but only seen, that they are given things and will never truly earn them, and that they are meant to be taken care of by men and other authority figures in their lives.
So, how did this series of negative reasoning come to plague me? It was several weeks after starting my new position as a Sickle Cell Scholar through a grant funded by the National Institutes of Health. A staff colleague was trying to get my attention as I walked through a hallway to my office and she whispered, “Dr. Ezenwa.” I cringed and quickly turned my head around to figure out who she was addressing. Of course, it was me. We were the only two people in that space. I thought, “Wow. Dr. Ezenwa, my foot!”
As soon as this astonishment faded, I went into my office and was arrested by a severe panic at the thought of my “lies” being discovered. My body felt hot, my heart clapped with a chaotic chorus of groans, and my stomach fluttered like a butterfly rain forest. Pearls of cold sweat dripped from my palms. I felt like a deceiver, a trickster. An imposter.
Slowly, my self-doubt magnified and my anxiety about achieving success intensified. I began to question myself: Did I learn enough in my PhD program to be an independent researcher? Do I know enough to teach at the undergraduate, graduate, and PhD levels? What was I going to tell my students? What if I ruin their lives and academic careers because I teach them the wrong things and extinguish their drive for continuous learning and growth? Will they even understand a word I say to them through my African accent?
These self-doubts naturally morphed into destructive self-statements: I am not good enough. I am not smart enough. I am not worthy. Then, perhaps most devastatingly, these destructive self-statements made me feel boxed in and limited by multiple historical and social orientations forced upon women, even though I had escaped them long ago.
As an African immigrant in Western academia, I worked hard to break through multiple levels of convention. I broke through many societies’ beliefs that the proper place for a woman is at home and her role is to bear children, cook meals, and clean up messes. I broke through the pressure of growing up poor and earning the opportunity to reach greater heights without any real road map or directions. I broke through to success as a black woman who American society believes is lesser than her white counterparts thus deserves less in life. I, as an immigrant, broke through the culture shock of living and working in America and always sought peaceful resolutions to clashes in culture.
But under the spell of self-doubt and negative self-talk, I began to think that even the actuality that I’d broken out of these social constructions was all a big lie. These feelings only magnified and manifested as psychological and cognitive obstacles that cornered me into mental blocks. I soon lacked the confidence I needed to effectively teach and conduct research, as well as to see myself as successful and accomplished.
Now, I first learned about the concept of the imposter phenomenon many years ago during my graduate program. Back then, I brushed the idea aside as silly. How could individuals who paid with blood and sweat to accomplish their goals diminish their accomplishments? But after spiraling into such depths upon simply being called by my appropriate doctorate title, I realized that I was not above this sort of destructive thinking. I had to take control of this phenomenon if I was going to effectively and full-heartedly serve my students, my institutions, and, most importantly, myself.
So, how did I cope with the imposter phenomenon? There are three major strategies that I endorse and have taught my students: self-accountability, accountability with a trusted partner, and continuous self-love.
First, self-accountability: I began by recognizing that I am accountable to myself to be the best I can be in all my life’s endeavors. I am accountable for the outcomes of my actions and inactions, as well as my failures and successes. Once I accepted this fact, I engaged in bone-deep self-reflection about the imposter phenomenon that I had allowed to take up residence in me. I asked myself, “Why do you think you’re not bright enough? Why do you think you’ve fooled anyone who believes otherwise? Why do you think you’re not good enough, that you’re unworthy?”
I wrote down my thoughts on a piece of paper and waited a few days to return to it. When I saw all the questions and my initial answers written out, other realizations came to mind. I, for instance, suddenly understood that the imposter phenomenon had been creeping up on me my entire life. Growing up, everyone had told me that I was “so smart” and openly assumed that I would become a medical doctor. I had always been afraid that I might not live up to this idea of intellectual perfection that my family and friends held about me, and, even after I became an academic doctor, I felt that I was not the genius everyone believed that I was.
When I had excavated my mind of these recognitions and purged any negative ideas that imprisoned my capabilities, I reached out to my accountability partner for a meeting. I shared with her the result of my self-reflection honestly and openly and, in turn, she worked with me on enhancing my confidence. My accountability partner assisted me in three important areas: changing my mindset, developing a strategic plan of action to combat the imposter phenomenon, and constantly checking in to see if the plan was on track.
To shift my mindset, my accountability partner coached me to see the opposite side of my negative thoughts. For example, if I doubted that I was not smart enough to have accomplished the current goals in my life, she empowered me to believe that my current achievements were not handed to me for free like Halloween candy. Instead, I had to earn them through a combination of my intelligence, efforts, and wise leveraging of available resources. She assured me that I already had a long record of accomplishments, and there was no reason for that trend to stop so long as I was willing to challenge myself and do the work required.
Once this mindset shift was underway, my accountability partner helped me develop specific, time-bound goals and strategies to succeed in my current endeavors. Finally, we set a timeline with consistent, scheduled follow-up meetings to assess my progress. During these follow-ups, we reevaluated my goals and strategies, as well as adjusted my timeline as necessary.
The third and final strategy I used to combat the imposter phenomenon was practicing continuous self-love. As a woman, both in African and American society, I was socialized to care for everyone else before thinking of myself. Consequently, I was petrified to upend the status quo and focus on myself for once in my entire life; after all, I had equated self-love with selfishness.
So, to successfully exercise self-love, I had to be intentional. I worked tirelessly to reprimand myself every time I felt guilty for focusing on my needs over other obligations. I reminded myself that, when I am overflowing with love for myself, I will have enough energy to achieve my goals and dreams and also healthily give to my family, career, academics, and finances. I made sure I celebrated my successes, both big and small. Every night in front of the mirror, I stood and told myself how deserving I was of all the accomplishments I worked so hard to earn.
So, with all three strategies combined, did I beat the imposter phenomenon? That I am still a professor and a researcher in one of America’s top ten public universities is a testament to how I conquered self-doubt and negative self-statements and how I refused to allow my ancestral background and cultural identity to confine me from living in my highest potential. That I was recently inducted as a Fellow in the American Academy of Nursing is evidence that my research on health disparities in pain management in patients with sickle cell disease or cancer made a difference in peoples’ lives locally, regionally, nationally, and internationally. That I am now an entrepreneur is a manifestation of my mindset that now asserts, “You are good enough. You are smart enough. You are worthy.” So, yes, these strategies worked!
The imposter phenomenon is a monster, and the struggle to overcome it is real. Successful women have systematically been robbed of important opportunities because of our own self-doubts, negative self-statements, and our giving into social orientations that seek to confine us. But there is hope and there is help. The strategies I mentioned here, as well as with professional help from psychotherapists, can move us toward controlling the phenomenon and casting it out of our lives.
The question is, are we willing to confront the imposter monster in ourselves? Are we willing to tear down limiting beliefs about academic success, professional success, business success, financial success, and whatever else we desire? Are we willing to free ourselves from the bondage of history, cultural codes, and oppressive gender roles? Are we willing to look in the mirror and say “I am good enough, I am smart enough, I am worthy?” Are we willing to do the hard work to love and respect ourselves?
And, finally, are we willing to do the work now? Not next year, next month, next week, or tomorrow. Now.
Are you willing to take the challenge?
You may write me down in history
With your bitter, twisted lies,
You may trod me in the very dirt
But still, like dust, I’ll rise.
—Maya Angelo, “And Still I Rise”