You may not naturally think of becoming a nurse executive, which may seem far removed from the bedside and benefiting patients. Yet, you can significantly impact patient care as a nurse executive, such as a chief nursing officer.
“When you’re caring for patients, as a nurse, you’re caring for a set cadre of individuals,” says Elizabeth Speakman, EdD, RN, FNAP, ANEF, FAAN, senior associate dean, professor, and chief academic officer, School of Nursing, University of Delaware. “When you’re in a leadership role in the clinical environment, you may have thousands of patients you are responsible for.”
If that appeals to you, read on. In this article, we’ll examine a few programs available to prepare for the nurse executive role.
Students at the 28-month program “typically come with a master’s degree already and have some experience at a leadership level,” according to Kimberly Nerud, PhD, RN, dean at Post University’s American Sentinel College of Nursing and Health Sciences. Perhaps they have worked as a charge nurse or directed a healthcare unit, and “they’re looking to build on those skills that will help prepare them for those advanced opportunities within a healthcare system.”
At the Frances Payne Bolton School of Nursing at Case Western Reserve University, students who want to pursue a role as a nurse executive can choose from a range of programs, according to Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN, Elizabeth Brooks Ford professor of nursing, Frances Payne Bolton School of Nursing and distinguished university professor, Case Western. Those programs include a doctoral program with an executive focus and a postdoctoral and senior executive program. These programs are housed within Case Western’s Marian K. Shaughnessy Nurse Leadership Academy.
Although students need a doctoral degree to enter the postdoctoral program, for instance, the academy believes that “every nurse is a leader,” notes Dr. Fitzpatrick. “Our philosophy is you’ve already got the leadership skills. You may not know how you have been leading, but you have been leading as a clinical nurse.”
For example, Dr. Fitzpatrick notes, “Nurses are leading care at the bedside for the patient. They’re leading care for the patient’s families. So as they become nurses, they learn to lead in clinical care. We capitalize on the experiences they’ve already had as clinical nurses and help them to understand how they’ve been leading all along.”
The school emphasizes a relationship-based leadership model, according to Dr. Fitzpatrick. That includes components such as communication, executive presence, intentional communication, and helping the leader understand any individual’s influence in a leadership role.
The academy, says Dr. Fitzpatrick, is especially interested in identifying individuals to join the program who come from under-represented groups. The school also seeks to engage minority nurses in mentoring the next generation.
“Stackable Credentials”
According to Dr. Speakman, nurses considering executive leadership positions can benefit by focusing on two actions. First, “they need to know that leadership is not just your title. Leadership can be very informal. How you lead is more important than your position. How you hold yourself pedagogically in life and how you present yourself. I think that’s the first and foremost conversation.”
The second involves earning what Dr. Speakman calls “stackable credentials.” That can include fellowships, earning certificates, and joining leadership programs – gaining new skills. Another word of advice: “Before you decide you want to be the top executive, spend time with the top executive.”
Leading After COVID
In considering a role as a nurse executive, know that COVID took a toll on nurse leaders, making the need to prepare nurses for executive roles even more important. Dr. Nerud hopes that “we can help to rebuild that area of nurse leadership that decided to take a step back or step out or retire early because of all of the demands that came from the pandemic.”
Dr. Nerud stresses the need to have nurse executives view problems from a policy perspective “that we’re helping these leaders go in to help be able to think fast and be able to talk about the policies that need to be made to move quickly because we learned during the pandemic that that was huge. We needed to be able to focus on quick changes and quick policies and quick things that needed to happen.”
During the pandemic, leaders faced significant challenges, notes Dr. Fitzpatrick, as did clinical nurses. “We need to continue recruiting nurses into leadership roles because the challenges are still there,” she says.
Even though the worst of the pandemic is over, we still have to rebuild and revitalize the clinical systems,” says Dr. Fitzpatrick. “We want to be sure that we focus on nurses staying in the workplace, which falls to the leader. We know from the research that if you have good leaders, you have higher nurse satisfaction–that leadership is key to keeping the clinical nurses engaged.”
“There is No Box”
Nurse executives and leaders have opportunities in traditional healthcare systems, industries, and corporations. “We shouldn’t just think of nurse leaders being positioned in the traditional healthcare environments, but engaging them outside of the traditional healthcare environments into executive positions in corporations as well as in community health,” says Dr. Fitzpatrick.
“The potential is unlimited because nurses come with skills that help them to help others. I like to teach my students, we often talk about thinking outside the box, but what we try to communicate to our nurse leaders is there is no box.”
The World’s Columbian Exposition of 1893, held in Chicago, was known for many things: the World’s Fair that inspired the blockbuster book The Devil in the White City, where the first Ferris wheel premiered, and where the National League for Nursing (NLN) began.
The superintendent at Johns Hopkins Training School in Baltimore, Isabel Hampton, headed the group of superintendents at the fair. Together, they laid the groundwork for the first nursing association in the United States: the American Society of Superintendents of Training Schools of Nursing.
The name changed twice. First to the National League of Nursing Education in 1912 and finally to the National League for Nursing in 1952.
The Mission
“The mission is to promote excellence in nursing education to build a strong and diverse nursing workforce to advance the health of the nation and the global community,” says Beverly Malone, PhD, RN, FAAN, President and CEO of NLN.
According to Malone, the NLN was founded because, at the time, there were no boundaries, criteria, or standards regarding how nursing should be taught. “In the United States, it was going on your own. Everybody determined what would be taught, and the public deserved to know the criteria,” she says.
“It’s the same issues we have now,” Malone continues. “The public deserves transparency regarding the quality of nurses’ preparations. We were stretching beyond being the doctors’ handmaid. So, how does one stretch to become a professional? You start determining your standards. Not only would we determine them, we would live by them and operationalize them. That’s what the National League for Nursing started with, and that’s what we continue to do.”
The NLN Today
The NLN offers services for over 45,000 individuals and more than 1,000 institutional members.
In addition to its mission, Malone says that the NLN is also guided by its four core values: caring, integrity, diversity and inclusion, and excellence.
Malone explains what the first and last core values mean to the organization. “Caring promotes health, healing, and hope in response to the human condition. I think hope is something that we don’t appreciate enough,” she says. “The ‘excellence’ piece is cocreating and implementing transformative strategies with daring ingenuity. We don’t do anything by ourselves. We are into cocreating and co-implementing, and then transformation.”
The NLN offers members professional development, networking, assessment services, nursing research grants, and public policy advocacy. Regarding professional development, the NLN accomplishes this through a variety of centers.
The Center for the Advancement of the Science of Nursing Education, Malone says, deals with the scientific background for nursing education. While patients are expected to receive evidence-based care, that starts with nursing students receiving evidence-based education.
“With technology moving as fast as it is, we must understand the scientific basis for nursing education,” says Malone. “This distinguishes the National League for Nursing’s belief in the evidence-based.”
In addition, the NLN has a division for credentialing nurse educators. To date, about 15,000 nurse educators have received credentials. They have a certification for clinical educators and credentialing for newly-developed nurse educators.
“I believe that this is so critical to the nursing profession of holding us not just accountable, but also providing an opportunity for recognition,” says Malone.
The NLN’s Center for Transformational Leadership provides nurses with education regarding leadership, and its Center for the Innovation in Education Excellence gives education about simulation and technology and how it will be incorporated into the teaching and education of nurses.
Malone says these exceptional programs for nurse educators make the NLN crucial. “We believe wholeheartedly that unless you address the issues for nurse educators, including salary, the nursing shortage continues,” she says.
The National League for Nursing offers so much more for nursing educators. For additional information, check out their website.
The nursing industry has dozens of professional associations devoted to the art and science of nursing care and nursing specialties. And while many nurses know they exist, they may need to realize the depth of what associations do and how the skills and connections developed through membership can advance a career in ways they never expected.
American Nurses Association (ANA) president Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, says joining an association is an excellent professional move, and membership carries personal benefits that are just as critical. “Many people don’t consider that when they join the ANA or an association of another specialty, that they are advocating for the profession,” she says. “We are protecting our profession or specialty.”
“We grow in the ability to influence. So even if you feel like being a member isn’t an active form of involvement, it is; you are being counted when association leaders are advocating for change. We represent you, and you count.”
Be an Active Member
If you want to get the most from any professional association membership, active participation helps you and the organization. Even if your busy schedule leaves little time to devote, you can find something that will fit your schedule. Sign up for any newsletters and read them. Attend webinars, seminars, and conferences as you are able. “NAHN doesn’t have a chapter in every state yet, so if you don’t have a local chapter, I would encourage you to reach out to the national organization and connect with other members who live in your area,” says Nava. “Our national organization also has national committees, and volunteering for a committee is another way to become engaged.”
With so many nursing professional associations out there, it’s not hard to find the most appealing one. “Review the organization’s mission, vision, values, and goals to determine which organization may best fit your professional needs,” says Nava.” Do these align with your values and goals? If so, this organization may be a good fit, and you will find other nurses to collaborate with to meet those goals and stay engaged.”
There are many opportunities to get involved, but not all involve nursing skills. Associations need you to reach out to legislators or members of Congress, help produce newsletters, or advance fundraising efforts. “When you’re in an organization, it’s about the organization as a whole, and it’s not nursing specific,” says Kennedy.
All Nurses Are Welcome and Needed
Associations don’t require years of nursing experience for membership. Nurses across the entire career spectrum can learn from each other. “I often hear from students that they are too busy to join an association,” says Ann Kriebel-Gasparro, DrNP, FNP, GNP, FAANP, and president-elect of the Gerontological Advanced Practice Nurses Association (GAPNA). “And yet, this is the best time to join. Membership fees are often lower, there are opportunities for growth, and later on in your career trajectory, you may want to run for a state or national office in that organization. The opportunities are many–most associations/organizations offer scholarships, travel, and speaking opportunities, and networking connections are especially important.”
“A misconception is that novice nurses have nothing to contribute, which is a myth,” Kim Regis, DNP, RN, NEA-BC, CPNP-PC, BCC, and a member ofthe American Academy of Ambulatory Care Nursing (AAACN). “The voices of all generations must be at the table so that policies, practices, and standards reflect everyone working in the profession and the communities we serve.”
Regardless of where you are in your career, Kennedy says that mentoring plays a big role in many nursing associations. Whether you are a new nurse looking for guidance from a mentor or a more experienced nurse who can share your expertise and mentor someone else, a nursing association offers excellent opportunities to do both.
All the skills you acquire, and your work in an organization will also help advance your career. You may have yet to gain formal management experience, but if you have led an education campaign, board member, or committee in your organization, that gives you hands-on experience.
Nurses can also add to their knowledge and grow into leadership roles within an association. “Joining a nursing organization is a great way to expand your skill set within leadership, advocacy, research, and clinical practice,” says Nava.
The personal connections you’ll form in an association membership are also professionally valuable. “This is how you learn of job opportunities, fellowships, and academic opportunities,” says Nava. “Also, members and leaders within organizations, through your engaged involvement, will end up being the people who mentor you, or sponsor you, or write letters of recommendation for you, to advance your career.”
Nurses also know the opportunities they find through an association membership are often the kind they would not have found any other way. “As a new member [of AAACN], I had many doors opened to get involved in various committees and task forces,” says Andrea Petrovanie-Green CAPT(Ret), NC, USN, RN, MSN, AMB-BC, and a member of the leadership team supporting AAACN. “These experiences helped hone my leadership, management, and clinical acumen. As a result, I authored a white paper that established the first Specialty Leader in Ambulatory Care Nursing for the Navy Nurse Corps. Another unique opportunity I am grateful for was co-chairing the Tri-Service Military annual symposium. During networking events, I was introduced to several influential and inspiring leaders who mentored me to pursue additional opportunities. I subsequently served as a member of the nominating committee and currently as a director.”
Both Nava and Kennedy credit their association memberships with advancing their careers.
“I joined my first association because my aunt encouraged me to join with her our local Illinois Chapter of NAHN when I was a first-year nurse,” says Nava, noting the small chapter gave her opportunities to take on leadership roles including, eventually, president. “My ability to work with others and build a team, something I learned early on, has helped me grow and become the leader I am today as the national president of NAHN.”
Kennedy says she was starting her PhD when she first heard of the ANA. One of her classmates was the executive director of the Arizona ANA and asked Kennedy if she was a member. “I joined that day,” she says with a laugh, eventually becoming president of the Arizona ANA. As needs arose, she helped out and got involved, learning new skills along the way and developing close personal connections. “That’s what helped me most in my career,” she says, joining an association. “We need new individuals to carry on the profession. They must be involved to keep our profession and specialties strong.”
Kriebel-Gasparro says membership in an organization gives nurses leverage on areas they care deeply about. “This is why I belong to the Nurses of PA organization and offer my time to advocate for safe staffing and other issues,” she says.
Associations know policymakers without nursing experience are making critical, industry-impacting decisions. It takes nurses with lived experience and a passion for excellent nursing practice to move into roles where they can make those decisions.
“With over four million nurses in the United States and greater than 80 percent of those employed in the field, it is imperative that a unified voice, with a unified message, is brought forth on many of the issues that impact practice and the health of our communities in which we work,” says Regis. “The bottom line: there is a professional organization for everyone to find a home where they belong. If a nurse has not found a good fit where they are, it is almost guaranteed that there is one out there somewhere that will pour into them with mentorship and development. Don’t miss your opportunity to take your career to the highest level.”
Nursing is more than a profession. It’s a calling. And those who answer the call become the backbone of a high-functioning, compassionate health care system. People who become nurses are capable, compassionate, and strong scientists and clinicians who have worked hard to start their careers. Their expertise, patient care delivery, and commitment to the profession contribute a distinct perspective on how health care should be managed and delivered.
While nurses are strong and resilient, they can’t fix their biggest problem: a dire nursing shortage. A decade in the making, our national nursing shortage threatens our already struggling health care infrastructure. Studies have long predicted
that the demand for nurses would intensify as the U.S. population aged. And just like the trends in general higher education, nursing schools have become less accessible, as many face faculty shortages, limits on enrollment, and limited space for clinical training at teaching hospitals.
And, of course, the COVID-19 pandemic only accelerated these trends. Nurses came under incredible pressure from the increase in patient numbers and acuity, and public distrust surrounding politicized vaccines and treatments, with a large number of their peers opting to leave the field due to these pandemic stressors. The nurses who remain find themselves in professional limbo, looking for ways to squeeze in continued education and professional development, manage work demands and challenges, and find a healthy work-life balance.
And that is if they chose to stay. A staggering number of nurses have decided to leave. The total number of registered nurses in the workplace decreased by more than 100,000 in 2021, the most significant drop observed in four decades. The largest group to depart was nurses under 35.
We need to do everything in our power to create sustainable solutions that don’t simply “put nurses on floors” but will provide our nurses with the best possible experience, one that allows them to practice at the top of their license. The circumstances are challenging, and there’s no quick fix, but our patients, our communities, our health systems––health care itself can’t afford to continue in this direction.
At Trinity Health, we started developing solutions well before the pandemic and have seen first-hand how thoughtful solutions, informed and led by nurses, impact job satisfaction most. Programs that give nurses greater flexibility and options based on where they are in their career and what they want to do, innovative care delivery models that support their work and provide opportunities for professional development, continuing education, and alternative career pathways work.
Supporting Education and Career Advancement
Starting a career in nursing is no simple endeavor. So, when entry-level nurses are just beginning, it’s critical to jump on the moment’s excitement and encourage them to dive as deep into their new role as possible. In 2014 we collaborated with Vizient, the country’s largest member-owned health care services company, to create our Nurse Residency Program. This program helps orient entry-level nurses as they transition into practice. The evidence-based curriculum incorporates three key areas: patient outcomes, leadership, and professional development.
For experienced nurses, we provide a robust system-wide learning platform for those interested in advancing their skills in various areas of practice specialization. Obtaining the highest level of education doesn’t just support their careers and livelihoods, but it helps us ensure we provide the best patient care possible.
Opportunity must be equitable, and we are committed to living Trinity Health’s values of equity, diversity, and inclusion in everything we do. Unequal access to education, specifically for underrepresented communities, is a well-documented barrier for students who wish to pursue a nursing degree. To that end, we provide tuition assistance, flexible online programming through our nursing schools and seven academic partner schools, scholarships, on-the-job training, and career advancement programs to help level the playing field for nurses from diverse backgrounds. This is crucial for delivering health care that is representative of the populations we serve.
Multiple Options to Support Work-Life Balance
Nurses especially need work-life balance. Options for flexibility and roles that match their needs and goals are essential to increasing the longevity of a fulfilling and meaningful career.
Nurses at Trinity Health led the development of FirstChoice, our internal staffing agency that offers flexible scheduling and travel opportunities for nurses and clinical staff. Having our pool of travel nurses helps prevent colleague burnout and maintains continuity in patient care. In addition to FirstChoice, we’ve introduced a new care delivery model to improve patient care, experience, and nurse satisfaction. The delivery model has been well-received by nurses who are early in their careers and benefit from the unique mentoring experience and from more tenured nurses who can continue to work in a less physically demanding but gratifying capacity.
Beyond flexibility, we must provide other ways to support nurses’ well-being and resilience. A recent study reports that a quarter to half of the nurses reported feeling emotionally drained (50.8%), used up (56.4%), fatigued (49.7%), burned out (45.1%), or at the end of the rope (29.4%) multiple times a week. Mental health benefits are an essential requirement once considered a luxury perk or not considered at all. We began offering Colleague Care Resiliency Rounding, a real-time, one-on-one, human connection for colleagues in high-volume, highly demanding areas within the hospital setting. The program’s goal is to address mental health proactively and sustain their mental well-being in the face of the inevitable stress of the job.
To ensure that there are no barriers to mental health support, we offer six free therapy sessions and six free coaching sessions per calendar year, as well as options for personalized care, access to diverse providers, self-guided wellness exercises, personal medication management training, substance use support, work-life services, and more.
When someone is a nurse, their career can easily become their identity. Nurses love their job, and we love them for that. But we must recognize that every nurse is more than the exceptional care they give to patients. They are whole humans with lives away from the bedside. They need support that is designed with that in mind.
Empowering Nurses
Nurses have long been renowned for confidently taking control of situations many shy away from. While I firmly believe it’s up to administrators and health systems to provide the essential support nurses need to thrive, I also know nurses must have a hand shaping their work lives. From my 40 years of experience as a nurse, with nearly 30 of those as a chief administrator, here is my advice to nurses searching for a career that will meet their personal and professional needs and goals.
Find an organization that shares your values. Look at the organization’s mission, vision, and values. Does it align with your own? Can you see evidence of their commitment to these values? Make sure the operational structure meets your needs. Does flexibility matter? Ask about shift offerings, virtual opportunities, or options to work in multiple locations. Do you care about mental health access? See what benefits they offer from day one.
Make sure the organization will truly see you and hear you. Your input is key to creating improved work environments and patient care. You must feel nothing less than supported in asking questions and contributing your voice to the conversation.
Whatever stage of your career––recently graduated or 20 years in––make sure an employer is willing to support your professional development. Opportunities for a new nurse should look vastly different than those for someone who has spent decades in a specialized unit. Ensure you can access individualized educational opportunities that impact your career trajectory and help you meet your goals.
I can only speak for myself and my team, but until all nurses feel adequately supported, I won’t rest my case that urgent action needs to be taken. Patients’ lives depend on our ability to care for and empower the people who care for them.
I am encouraged by my colleagues who have taken notice and have started to make meaningful changes. Nurses have been through a lot in the past few years, and we never know what awaits around the corner. But a positive shift is coming. The momentum we’ve built so far must continue so that the next generation of nurses feels more supported, better equipped, and more passionate about their calling than they ever dreamed possible.
Nurses with disabilities find the nursing industry offers excellent career paths that help them fulfill their goals, regardless of disability. Whether nurses have a disability before they enter the workforce or become disabled after their licensure, they are needed to fill jobs and help broaden the diversity of the nursing workforce, says Karen McCulloh RN, BS, co-founder and co-director of the National Organization of Nurses with Disabilities (NOND).
Working with a disability might require accommodations to help you perform your job better or an open approach to different specialties. “Being honest with yourself regarding your strengths and weaknesses will go a long way toward facilitating success,” says Donna C. Maheady, EdD, APRN-BC, founder of ExceptionalNurse.com.
McCulloh, who lost her vision over a 24-hour span, says her nursing skills were enhanced. “We’ve found
that nurses with disabilities have a sense of compassion for patients and what they are going through because they’ve been there,” she says. But for nurses who become disabled while already working as a nurse, McCulloh says there’s often an adjustment phase. “You think about, ‘who am I now? What about my self-esteem, self-identity, self-worth, and self-confidence? Am I still the same person?’”
Every Path Is Different
Sandra Nosek, MSN, RN, has been a nurse for over 30 years with experience in management, staff development, QA wound care, long-term critical acute care, hospice, and skilled nursing facilities. She had a hearing aid in her right ear but woke up with sudden bilateral deafness in 2015. “It rocked my world and was very scary,” she says. Navigating without her hearing proved exceedingly challenging.
Nosek thought she’d have surgery and be able to return to work quickly, but her path proved challenging. She obtained her MSN in nursing education (with a 4.0 GPA) in 2019 and, after receiving improved Bluetooth processors in 2021, sent out more than 400 applications with little result.
She landed a job at a skilled nursing facility that restored some of her self-confidence lost in the job search process, and she eventually began working in hospice, a nursing specialty she loves. She recently obtained an RN case manager position with a small hospice in her community. “To other nurses with disabilities, don’t give up,” she says. “Continue to pursue options in your career.”
Kim Hickman, DNP, APRN, Adult PMHNP-BC, works as an adult psychiatric mental health nurse practitioner with the VA Health Care System and has more than 36 years of nursing experience, including in the Army Nurse Corp, as a lieutenant stationed at Walter Reed Army Medical Center (three years on active duty), and roles in medical surgical nursing, home health nursing, occupational health nursing, and volunteer work as a faith community nurse. But Hickman, who has a speech impediment of a stutter/stammer, almost didn’t pursue this career.
“I was unsure if I would be an effective nurse,” she says. “I shared my concerns with my mother, an ICU nurse at the VA then. My mother paused for a few minutes before answering. She looked at me and said, ‘Remember, it’s more important what you say than how you say it.’ Her confidence in me encouraged me to continue pursuing my nursing degree. From that point on, I focused on the content of my speech, making sure the information was accurate and relevant.”
Hickman says her stutter/stammer can fluctuate depending on the situation and her stress level. “Learning to be patient with myself has been a tremendous achievement. I am learning to accept that my stutter/stammer is a part of who I am,” she says, noting that it has positive impacts. “Stutter/stammering has allowed me to actively listen to others, to be patient with others, to be present, and to be compassionate and empathetic toward the suffering of others. It has also helped me recognize and value words’ power and importance. It has given me a chance to pause and decide if I want to say what I intended and time to decide if my comments add value or take away value to the conversation.”
Lois Taurman (who has a nursing degree, national certification as a poison information specialist, a master’s in educational counseling, a jurist doctorate, and also represented the United States as a wheelchair athlete in the Paralympics Games in Seoul) had plans to work in the Navy as a nurse or as a pediatric nurse when a fall from a ladder just before graduation paralyzed her (she can move her arms, but has no finger movement). Taurman, who now works in America’s Poison Centers, a poison specialist in the Kentucky Poison Control Center of Norton Children’s Hospital, says that while she isn’t doing hands-on nursing, her work fulfills her drive to help children.
That doesn’t mean the role was anywhere on Taurman’s radar. “I didn’t know poison center nursing even existed,” she says. “This is a blessing for my career, but also to feel like I have valuable nursing skills.” Her employer has made adjustments and accommodations so Taurman can work, including adaptive technology and spaces. Still, she knows not all nurses have such proactive employers and may feel like they can’t reach their dreams. “Be persistent in looking for jobs,” she advises. “Your skills may differ, but you can show them how to accomplish the job. It may not be how you envisioned it, but it is still possible. Disability isn’t something that should hinder someone.”
PoisonCenters.org is available for all health care professionals to access assistance during a poisoning emergency, and nurses can also find job opportunities there. Always keep the Poison Help number 1-800-222-1222 with you.
Work Options
Nurses must assess their interests and how they work when thinking about a nursing path. Consider the specialties you enjoy working in, determine how fast you can work or prefer, and what accommodations you’ll need to know what’s possible.
According to Maheady, the career options available for nurses with disabilities are very wide and include the following partial list:
Technology is changing the options available to nurses with disabilities. Some apps help nurses with color blindness, and assistive technology will read out information for those who can’t see it.
Accommodations
As a nurse with a disability, the Americans with Disabilities Act protects you from having to disclose your disability, but if you need accommodations, then you will need to disclose. Nurses with visible disabilities (such as amputation or paralysis) will likely address their needs earlier in a job search than those with invisible disabilities (such as anxiety or fibromyalgia). Nurses who an organization already employs could become disabled and will need to determine the next steps.
Despite the tendency for some nurses to not want to reveal any disability for fear it could impact their job, Maheady says sometimes that approach backfires. “Undisclosed invisible disabilities can provide a privacy shelter for some nurses,” she says. “However, it may not serve the nurse or institution well.” Colleagues and supervisors might not know about the disability and could make hurtful comments about not looking sick or faking symptoms to struggling nurses.
So, when is a good time? McCulloh says once you have a job offer, you should consider the need for any accommodations. But before that even happens, you’ll want to think about precisely what you’ll need to do the job best. Even the most accommodating human resources department can’t guess your needs, so having a detailed plan will help get you what you need and help human resources make the best plan.
When you have the job offer, approach the topic with your natural enthusiasm for the position, the new opportunity, and the skills you’ll bring. And then relay having a disability and needing specific accommodations to perform the job. Put everything in writing, says Maheady. See this Sample Language for Accommodation Request Letters from JAN – Job Accommodation Network.
Work with HR
The more specific you can be and the more resources and examples you can offer, the better your chances for getting the accommodations you need, says Maheady. “Do you need a sign language interpreter? If so, provide your employer with a list of resources in your community that provide sign language interpreters,” she says. “Offer to start a sign language club for staff to help staff learn basic sign language to work better with you and patients with hearing loss.”
She says that if you need frequent breaks, be specific about how often you need a break and for how long. Suggest to your employer ways you could be covered for breaks specific to your clinical setting/area of practice.
Nurses with mobility issues might need a scooter to navigate long hallways, so they can help their employer by providing resources for purchasing new and used scooters. “Show the cost-benefit of purchasing a scooter compared to the cost of hiring a new nurse or travel nurse for your position,” says Maheady.
Despite awareness around nurses working with disabilities and the protections of the ADA, not all employers are receptive. “If you are met with a negative response, don’t take no for an answer,” says Maheady. “Ask, ‘Who else can I talk to?’ ‘What else can I provide you with to help me be successful?’”
Role Modeling
Nurses with disabilities also reflect the diversity in a patient population and can show people that their life doesn’t stop after a disability. Nurses can share resources with patients and act as important mentors to other nurses. “I can share in an hour what took me ten years to learn,” says McCulloh.
Nurses are needed to help guide policy, and the information is particularly validating to listeners when it comes from a nurse with a disability. “Nurses with disabilities are transforming healthcare and patient care practices,” says McCulloh. “The priority with every nurse is to ensure patient safety. And because of the critical eye toward us, we have direct awareness of that requirement.”
Nosek, who eventually found a role in a specialty that is meaningful to her, says that all nurses must realize that no one is protected from having or developing a disability. “To all nurses, I strongly suggest obtaining some experience in an office-type position at some point in your career to be able to fall back on if you were to become disabled,” she says, noting that her extensive education and management experience wasn’t enough of a buffer to prevent roadblocks in her path to finding a job that would fit her needs.
“There should be more care and compassion by healthcare administrators to ensure healthcare staff can continue to work no matter their disability,” she says, noting industry-wide changes for additional skills training and compassion from health care administration when faced with a nurse’s disability are needed. “I would have gone right back to work had I had the support and training to do another job within nursing,” says Nosek.
Hickman advises nurses to embrace their differences, acknowledge their strengths, work on their weaknesses, and not hide behind a disability. “You are more than your stutter/stammer or any other disability you may have,” she says. “Above all, love, respect, and be patient with yourself and teach others to love, respect, and be patient with you. You truly are unique! You inspire and motivate someone because you have decided to be courageous, present, and speak up!”
Tara Rynders, RN, MFA, BSN, BA, admits she hasn’t had the easiest life. From when she was a child, though, she would heal from it through dance. In fact, she wanted to be a professional dancer before she thought about being a nurse.
“My earliest memory is of holding a neighborhood performance in my backyard—and it’s a lifeline that I’ve held on to through all of life’s highs and lows,” Rynders explains.
So Rynders graduated high school and headed to Hollywood. But she soon realized that the business was more focused on outward appearance rather than the inward healing dance provided.
“After my time in Hollywood, I realized that I wanted to be able to offer both emotional and physical healing. Nursing allowed me the entry point into that space. It’s a profession that offers flexibility to keep connected to my lifeline—dancing,” she says.
Trauma Hits Home
Rynders came to embrace dance and bring it into the world of nursing after her tough times. She cared for her mother until she passed. Rynders says that losing her mother made her entire world fall apart. At the time, she was working as a nurse but decided to reach out again to what had always helped—dance. So, she cut down her nursing hours
to earn a master’s degree in dance.
Her sister became ill during that time and went into a coma for months. Rynders took off a semester and went to live with her in rehab until she was transferred from California to Colorado, where Rynders was living.
“In my sister’s hospital room, my dance and nursing worlds began to collide,” recalls Rynders. “Every night, I would dance to Miley Cyrus’s ‘Party in the USA.’ And I discovered that although my sister couldn’t speak, she could laugh. That became my goal—to make her laugh.”
When Rynders returned to school, she created an immersive theater performance called You & Me that was connected to her experience as her sister’s caretaker and her work as a charge nurse in the ER.
The show You & Me traveled nationally and internationally to more than five countries.
“What I realized when I cared for my sister was the gift that comes from having one-on-one intimate moments with another human being—to bathe her, feed her, and help be her voice,” says Rynders. “During the day, I would hold the suffering and loss with my sister, and at night we would hold the joy as I danced. It felt like I had both my joy and my grief coupled together in all that I did.”
One more scary experience brought Rynders to where she is today. When her twins were six months old, she learned she was pregnant again. But this time, it was an ectopic pregnancy.
“When I arrived at the hospital, things moved quickly. I remember the ER tech rolling me on the bed with too much force to start my IV; the ER physician and his caring face took extra time to see and listen to me. I remember feeling his compassion for my situation. I remember being transferred to a room when my fallopian tube burst and my abdomen began to distend with blood,” says Rynders.
“They called a code yellow—the code they call before a code blue when your heart stops. My room was full of people,” she says. “I passed out, but I could still hear everything being said. I felt my nurse grab my hand. She leaned into my ear and said, ‘I am here, and you will be okay.’ I remember thanking her for remembering me because I was so scared and couldn’t speak.”
This experience caused Rynders to have an epiphany.“I realized that nurses are everything to their patients–their voices, their advocates, their support, their healing hands. I experienced this firsthand as a patient and realized how many opportunities I was missing as a nurse to connect and see my patients authentically. I became passionate about this in my practice as a nurse and began researching authentic connection in nursing,” she says. “Everything pointed to one thing: our nurses are tired, overworked, and our healthcare systems are not set up for them to thrive and successfully care for patients.”
Rynders decided she was going to change that.
Bringing Dance to the Nurses
Pre-COVID, Rynders says that nursing leadership was downplaying nurses burnout. And in 2017, nurses weren’t ready to talk about it openly.
But the CNO and CEO where she worked approved her creating a two-hour immersive theater experience at the hospital to raise awareness of compassion fatigue and burnout. She created the performance with artists Jadd Tank and Lia Bonfilio and worked with playwright Edith Weiss.
“The 2-hour performance took place in the hospital and was open to the general public. The nurses, doctors, and other healthcare personnel testimonials were breathtaking. Most along the lines of ‘Thank you for giving us a language to understand the unrelenting grief and trauma we have been carrying with us,’” says Rynders.
After raising awareness about burnout, Rynders co-created, with Dr. Clare Hammoor, a six-week grief and trauma workshop series. The nurses connected with it so much that they began having monthly meetings post-workshop, which continued until COVID.
“At the height of COVID, my CEO asked me if I would come off the floor and focus on caring for our nurses as they cared for our COVID patients. This told me he also saw that our staff would need ongoing support,” says Rynders. The position was temporary, though; she would eventually work as a clinical nurse educator at another health care system.
Today, Rynders is also an advanced grief recovery specialist and a RESTORE (Resiliency and Equity Support and Training for Organizational Renewal) peer responder who is on call for health care personnel when they need immediate support.
“I help teach resilience, equity, and anti-racism courses for our entire system. I do this alongside my position as executive director of The Clinic Performance. I see both of these roles mutually honoring each other as I bring my whole self into all my experiences,” she says. “We dance in the hospital at our meetings, and having a pulse on nursing in the hospital setting is vital to creating workshops that tend to our nurses—meeting them where they are emotionally.”
Tara Rynders in her dance workshop
Dance Workshops
Rynders workshops touched many people and were so effective that Kaiser Permanente asked her to bring them to nurses across California. These six eight-hour workshops with up to 600 nurses began in April and will run through September.
“Our workshops are now titled (Re)Brilliancy, a play on the word resiliency. I was tired of hearing everyone tell us to be more resilient during the pandemic. Nurses are some of the most resilient humans I know. We need resilient systems that reflect the brilliant and resilient humans we already are. (Re)Brilliancy workshops help us reflect on and honor the brilliant and resilient humans we already are,” says Rynders.
Until they experience the workshops, nurses often don’t even realize that their stories or experiences have continued to both of them.
Rynders knows that her workshops are keeping nurses from leaving the profession. “I have seen firsthand nurses ready to leave—completely burned out and done with the profession. [They’ve] attended our workshops on an ongoing basis and have a rekindled joy and fervor for caring for themselves and their patients,” she says.
But more needs to be done.
“Nurses go into this field to make a difference in the lives of others. At some point, we begin sacrificing ourselves to do this. We don’t have to sacrifice our mental well-being. These workshops help us disentangle our worth and identity as caregivers from being directly related to how much we can sacrifice our well-being. Our workshops help remind us what we love, what we are passionate about, and what we need to feel seen, heard, and cared for,” says Rynders. “If healthcare systems want to retain their nurses, they need to start thinking creatively and bringing in non-traditional and innovative ways to care for their teams. Wellness must be embedded as a cornerstone that everything else builds upon.”
