A law is defined as a system of rules that are enforced through social institutions to govern behaviors. As citizens of our respective countries we all try our best to abide by the laws that have been set forth by our government so we can avoid any havoc in our lives and remain in a state of freedom. But what about laws for success and or to navigate this thing called life…do we have a system of rules in these capacities? According to Deepak Chopra there is a system of rules that have been set-forth to govern our path to success and life. In the book titled “ The Seven Spiritual Laws of Success” we are presented with a set of laws that serve as a practical guide to the fulfillment of our dreams.
My first thought when reading the title of the book was “ok so now I have another set of laws that I must adhere to if I want to be successful and have a fulfilling life, here we go with more rules and regulations”. However, after reading the statement “ Success is a journey, not a destination” and that “the law of success and life is the process by which the unmanifest becomes the manifest; it’s the process by which the observer becomes the observed; it’s the process by which the seer becomes the scenery; it’s the process through which the dreamer manifest the dream” in the introduction alone, I knew there was something different about these laws. I had a sense that these laws were getting ready to go into a deep spiritual space in which I honestly knew needed to be rattled up within me, so I dived in head first.
After being intrigued by the introduction, there laid the seven spiritual laws to success which were The Law of Pure Potentiality; The Law of Giving; The Law of “Karma” or Cause & Effect; The Law of Least Effort; The Law of Intention and Desire; The Law of Detachment; & The Law of “Dharma” or Purpose in Life. Each of these laws made me have a “ That’s Right ”moment as they went deeper and deeper into my spiritual space.
Psalm
The law of Pure Potentiality let me know that I need to be still! Often times with the daily hustle and bustle of life and all the different moving pieces of our lives we don’t have to time to just sit in stillness. God has an assignment for each one of us and wants to give us special spiritual instructions to carry out our divine assignments, to go in the direction he wants us to go, or operate in the capacity in which he wants us to operate in but we are not in a state of stillness to hear from him.
The law of giving impressed upon me that I am not given money, joy, peace, etc. to hoard it, but rather I am given these things to share with others and every time I encounter someone I must GIVE! I must give a prayer, a compliment, a word of encouragement, or a flower. My giving can be material or nonmaterial but the bottom line is I must give something.
The law of “Karma” or cause and effect made me realize that before I perform any action, I need to ask myself two important questions, which are “what are the consequences of this choice that I am getting ready to make? and will this choice bring fulfillment and happiness to me and those involved?” and if the answer to these questions are not favorable then I need to stop in my tracks and consciously rethink my actions.
The law of least effort made me aware that I am not obligated to defend my point of view to anyone, but rather take that energy and put it toward something more purposeful.
The law of intention and desire provided me with a sense of ease as it let me know that my attention needs to be in the present, then my intent for the future will manifest because my future state is being created in my present state, as I must accept the present as it is.
The law of detachment forced me to come out of my comfort zone and to go into the area of uncertainty which is where all possibilities are located. When we detach from the norm then we are no longer attached to the things in which we are truly fearful of because in attachment lies our fears and insecurities.
The law of dharma or purpose in life encouraged me find my divinity. I was created for a purpose that me on only me can fulfill. It doesn’t matter how many other people do what I do, only I can do it my way with the talents and gifts that I express only the way that I can express them. Once I had the courage to truly get to know thy self then I was able to serve humanity by living on purpose.
To sum up what these laws have done for me is simple, they are ensuring that I am a law-abiding citizen who lives on purpose!
Charlotte Thomas-Hawkins, PhD, RN, CNN, assistant professor at Rutgers, The State University of Jersey, College of Nursing, and winner of the American Nephrology Nurses’ Association (ANNA)’s 2005 Nurse Researcher of the Year award.
According to the dictionary, nephrology is “a branch of medicine concerned with the kidneys.” To nurses who work within this specialty, however, it is a great deal more.
“Nephrology nursing offers a lot of career choices,” says Adrian Priester-Coary, MSN, RN, CNN, a nurse educator at the University of Chicago Hospitals. “A nephrology nurse in a hospital can go into an acute/critical care, home training, in-center or clinic setting. You can choose many different paths as you grow in this field.”
Those career paths may include such options as:
direct care of patients with end-stage renal disease (ESRD) who receive dialysis or who undergo renal transplants;
education of patients, communities or health professionals about risk factors that can lead to chronic kidney disease (CKD);
research into the effectiveness of treatment modalities and the impact of nursing practice on patient outcomes;
advocacy, such as working with government agencies to develop health policies that will improve the care of kidney disease patients.
No matter what their area of expertise may be, nephrology nurses in all of these career settings are working toward the same goal: to help patients who have or are at risk for kidney disease lead the healthiest lives possible.
According to recent statistics, 10 to 20 million Americans have kidney disease, although many are unaware of their condition. The primary risk factors include diabetes (the leading cause of ESRD), hypertension and a family history of kidney problems. People who have at least one of these risk factors are almost five times more likely to develop kidney disease than those who have none.
With both diabetes and hypertension on the rise, especially among African Americans, Hispanics, American Indians/Alaska Natives and Native Hawaiians/Pacific Islanders, it is small wonder that the risk for kidney disease is also much higher in these populations. African Americans, for example, are four times more likely to develop ESRD than Caucasians.
These disparities mean that nurses of color have the opportunity to make significant contributions to the care, education and overall well-being of minority patients with kidney disease. “[Being a minority nurse] gives you insight into the patient’s culture, some of the things that have happened in their lives and why they may have postponed their treatment,” explains Janie Martinez, BSN, RN, CCRN, CNN, a nephrology nurse clinician at Alamo Kidney Health at Bexar County Dialysis Unit in San Antonio. “For a lot of the men, it’s the macho instinct. For women, it’s the nurturing belief that their family comes first, so the little money they have is spent on the family and not on their medication.”
Charlotte Thomas-Hawkins, PhD, RN, CNN, assistant professor at Rutgers, The State University of New Jersey, College of Nursing, and winner of the American Nephrology Nurses’ Association (ANNA)’s 2005 Nurse Researcher of the Year award, agrees that having first-hand knowledge of a minority kidney patient’s culture can be helpful. “Because [minority nurses] have many life experiences similar to those of our patients, we share an understanding,” she says. “When patients respond to health care professionals with cultural cues—for example, particular facial expressions or hand movements that may be unique to a certain culture—minority nurses pick up on those cues more easily because we understand them. And we can help nonminority nurses understand the background, experiences and responses to illness that are grounded in minority patients’ cultures.”
Caring Across the Continuum
Nephrology nursing encompasses total patient care, because the kidneys affect every other major system in the body—cardiovascular, pulmonary, gastrointestinal, etc. Comorbidities, especially diabetes and high blood pressure, are usually causative factors in CKD and must be addressed concurrently. And because treatment for kidney disease is costly, patients also face numerous psychosocial and financial issues.
For More Information About Kidney Disease and Nephrology NursingAmerican Nephrology Nurses’ Association
www.annanurse.orgNational Kidney Foundation, Council of Nephrology Nurses and Technicians
www.kidney.org/professionals/CNNT/index.cfmNational Institute of Diabetes & Digestive & Kidney Diseases
www.niddk.nih.govNational Kidney Disease Education Program
www.nkdep.nih.govNational Kidney Disease Education Program
www.nkdep.nih.gov National Institute of Diabetes and Digestive and Kidney Diseases, 2002. National Kidney Foundation, March 2005. U.S. Renal Data System, USRDS 2004 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, 2004.
“Many of [our ESRD patients] are indigent. Most are already on Medicare, so getting medication becomes a problem,” says Martinez. “For young people who now have to have dialysis three times a week, it changes their lifestyle completely.” Even patients who are not on dialysis must face many lifestyle changes, such as alterations to diet and exercise and possible side effects from medications.
Nephrology nurses may work with patients at any point along the continuum of care: people who have one or more risk factors but have not yet been diagnosed with CKD, patients who have been diagnosed with abnormal kidney function but do not yet require dialysis, ESRD patients on dialysis and kidney transplant patients.
Although renal failure cannot be reversed, early diagnosis and intervention can slow the disease’s progression. According to Gwen Bryant, BSN, RN, CNN, facility administrator for two DaVita dialysis centers in Detroit, “Seventy percent of renal failure is related to either diabetes or hypertension. So if [nurses] can get out and talk to the population about risk factors, get people to look at the warning signs and know what they are, they can start intervention and slow down the disease.”
Dialysis treatment is so time-consuming that for many patients it can feel like a part-time job: They must come in three days a week for three to four hours at a time. To promote continuity of care, charge nurses work the same days (Monday/Wednesday/Friday or Tuesday/Thursday/Saturday) and the same shifts (sometimes 10 to 12 hours) so patients always have the same caregiver. Working alongside specially trained technicians who actually operate the dialysis machines, nurses keep track of patients’ responses to treatment, monitor their overall health and provide education.
“You spend time with your patient and you learn from each other,” says Bryant. “You can share information that’s going to make their lives—and their families’ lives—better.”
Dialysis centers and hospital dialysis units aren’t the only practice settings where nephrology nurses help ease the burden on ESRD patients and families. Many dialysis patients also require home health care and personal care because they’re too weak to perform some of their common daily activities, plan their diets or accurately monitor their medications. Plus, in today’s increasingly cost-conscious health care industry, in-home dialysis is a growing trend.
“Unfortunately, many of these patients don’t have family support,” says Wanda Chukwu, RN, MA, owner of Assertive Health Services, a home care agency in Detroit that specializes in dialysis patients. “One of my goals is to help promote their needed lifestyle [regimen] when they’re home. If you can increase a patient’s compliance, you’re going to decrease hospitalization.” Home care nurses are also in an excellent position to educate patients and families about risk factors and preventive measures before kidney disease enters the picture.
Moving to Management
Some clinical nephrology nurses find that they have an interest in and aptitude for working with the bigger picture. “I knew I wanted to be a manager,” recalls Sue Jones, RN, CNN, regional director for Gambro Healthcare in Philadelphia. “But I didn’t want to just lead or just manage; I wanted to educate my staff and share knowledge.”
Jones oversees seven dialysis centers with an average daily patient census of 600. Her responsibilities include touring the clinics and communicating with clinical directors about patient problems, adequate staffing and survey readiness. She also makes a point of greeting patients and observing the care being delivered.
Bryant is another manager who shares this interest in maintaining contact with the patients her facility serves. “Because I’m a nurse and I love hands-on work, I come in and make rounds at least twice a day to see all my patients,” she says.
In addition to reviewing clinical outcomes, profit/loss statements and budgetary targets, she also participates in community and corporate education programs, visiting worksites and other community locations to talk to people about kidney disease prevention. For example, in DaVita’s Kidney Education and You (KEY) program, nurses hold seminars, talk to community members about renal failure and risk factors, take blood pressure readings and give out information from the National Kidney Foundation (NKF) and the National Kidney Disease Education Program (NKDEP).
Educating the Masses—and the Nurses
Nephrology nurses agree that this type of educational outreach is critical to stemming the kidney disease epidemic. Many nurses get involved in outreach efforts because they have firsthand experience of how devastating the disease can be.
“I have friends with renal disease who are currently on dialysis and one who is awaiting a kidney transplant,” explains Diana Brown-Brumfield, MSN, RN, CNS, a clinical nurse specialist for surgical services at the Cleveland Clinic Foundation. “I became involved with NKDEP two years ago as a pilot project to educate the Cleveland community about renal disease and how it disproportionately affects minorities. I started doing some education in our local churches about the disease and the effect it has on the minority population. Although I’m not a nephrology nurse, working in surgery affords me the opportunity to get the word out on prevention, because this is a preventable disease if we really focus on it.”
Early education is a goal for many organizations involved in kidney disease prevention, including NKF, the National Institutes of Health (NIH) and state and local support groups for chronic diseases such as diabetes. For example, the goal of NKDEP, an initiative of the NIH’s National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK), is to increase awareness of kidney disease, its risk factors and the importance of early diagnosis and treatment. The program offers extensive informational resources for both patients and health professionals, including “You Have the Power to Prevent Kidney Disease,” a national public awareness campaign targeted to African Americans.
Indeed, patients and the public are not the only ones who need information about kidney disease. Nurses who can provide specialized nephrology education to other health care professionals are needed in hospitals, dialysis centers, universities and colleges.
Priester-Coary works as the nurse educator for three chronic units, one acute unit and one home training unit. “My responsibilities are usually project-driven and based on findings from the CQI [continuous quality improvement] group or other hospital initiatives,” she says. “I review the literature, update policies and procedures, develop the necessary teaching tools and then go on the road to educate the staff.”
Shaping the Future
The sharing of nephrology knowledge is not restricted to the education arena. By making their expertise available to government agencies and other influential health organizations, minority nurses have excellent opportunities to help shape the development of policies, best practices, treatments and products that can improve care for renal patients of color.
For example, NKF has a Council of Nephrology Nurses and Technicians (CNNT) that helps develop health policies that impact professional practice and the delivery of patient care. The council also recommends speakers for NKF’s annual clinical meeting and helps moderate sessions. In addition, council members participate in national activities such as the Kidney Early Evaluation Program (KEEP), in which volunteers provide free screening for CKD in community settings such as churches and in dialysis centers.
Participation in professional associations such as ANNA is another important way for minority nurses to make sure their voices are heard. “One of our goals is to actively recruit minority nurses as elected leaders, committee chairs and members,” says Suzann VanBuskirk, BSN, RN, CNN, president of ANNA.
Association involvement can offer various ways for nephrology nurses to share their “real world” experience with health care policymakers. For example, “ESRD networks are contracted with the federal Centers for Medicare & Medicaid Services (CMS),” VanBuskirk explains. “The individuals who work for those networks—many of whom are nurses with previous experience in dialysis and transplantation—work as quality managers and data analysts. They are involved in quality initiatives and educational offerings and they have wonderful opportunities to work as contracted government employees to make a difference in the outcomes and quality of care that is delivered.”
Nurses’ front-line experience and knowledge is also in demand by manufacturers of dialysis equipment and related products, as well as pharmaceutical companies. These firms hire nephrology nurses as quality/outcomes consultants, clinical educators and/or marketing representatives.
Doing the Research
With the emphasis on evidence-based practice throughout the health care field, the development of policies and best practices depends on the results of careful research. And who better to conduct research on nephrology nursing best practices than nurse scientists?
“As an advanced practice nurse in the dialysis unit, I became interested in what nurses did and how they affect patient outcomes,” remembers Thomas-Hawkins. “I realized I needed to get into a doctoral program to learn how to measure patient outcomes and try to figure out, in a measurable way, what nurses can do to have a positive impact.”
The term measurement may cause some confusion about how researchers actually work. Most nurses in clinical practice are familiar with quality improvement projects in which they collect, analyze and present data on outcomes such as patient falls and nosocomial infections. These projects are good starting points because they help staff understand a problem and try to correct it. Researchers, however, apply far more precise tools and scientific methods when measuring rates of comorbidities, effects of treatment modalities and so forth. This ensures that data gathered from different organizations and demographic areas are comparable; if they are not comparable, they are not useful.
“The importance of having more minority nurse researchers [in nephrology] is probably our interest in addressing issues that are important to the minority community,” says Thomas-Hawkins. “We’re able to tap into issues that are important to our respective [ethnic] groups because these are problems we or our families have actually experienced.”
Diversifying the Ranks
Although no demographic information about the percentage of racial and ethnic minority nurses in the nephrology nursing workforce is currently available, nurses in the field seem to agree that minority representation is low. The numbers obviously vary by geographic region and setting (urban, suburban, rural), but the fact is that many patients of color aren’t receiving care from nurses they feel truly understand them and their needs.
How can you find out if a career in nephrology nursing is right for you? Talking to nurses who are already working in the field may help. And it’s worth noting that nephrology nurses tend to remain in the specialty for a long time.
“I’ve been in nephrology for almost 20 years,” says Janie Martinez. “To me, it’s not a profession, it’s a vocation. There are a lot of rewards when you see younger people and they get to go back into the world.”
Gwen Bryant agrees that the patients make the difference. “Chronic renal failure affects every aspect of a patient’s life—their diet, their family life, their work. If you ask me why I’ve been in nephrology for 25 years plus, I’d say it’s because these patients are the most courageous in the world.”
Learning What You Need to Know
Undergraduate nursing curricula are notoriously lax about including more than a passing mention of nephrology, and even the offerings at the graduate level are meager. Therefore, nephrology nursing education often occurs on the job, whether in an acute care setting or a dialysis clinic/unit.
Most training programs run eight to ten weeks and include classes in anatomy, physiology, the disease process and the principles of hemodialysis, peritoneal dialysis and transplantation. Nurses who will be working with dialysis patients are partnered with a nephrology technician to learn how the artificial kidney works and the impact it has on patients while they are dialyzing. The nephrology nurse-in-training also works with a mentor to learn about the pharmaceuticals used in the specific setting (medications differ between outpatient and acute care settings). If the facility handles specific patient populations, such as pediatrics, nurses also must develop age-specific competencies.
Certification for qualified registered nurses can be obtained through the Nephrology Nursing Certification Commission, which offers two options. The certifiednephrology nurse (CNN) examination is designed to test proficiency in nephrology nursing practice. The certified dialysis nurse (CDN) exam is a competency-level test for nephrology nurses working in a dialysis setting. More information is available at the commission’s Web site, www.nncc-exam.org.
Most employers looking to hire nephrology nurses want RNs with at least one year of work experience rather than recent graduates. A background in medical-surgical and/or critical care nursing is highly recommended. “In med-surg, you learn the general basics of patient care and disease processes,” explains Sue Jones, RN, CNN, of Gambro Healthcare. “Then with critical care you go on to the sicker patients and see the impact of what a chronic disease can do. It really helps the nurse to see that continuum from diagnosis of another chronic disease like diabetes to a patient with the need to start on dialysis.”
The various career paths open to nephrology nurses have their own requirements for education, experience and skills. For example, nurses wishing to make the move into management of a dialysis center or unit will require a working knowledge of how that facility operates, usually by working as a charge nurse first. Managers also need excellent communication skills (both oral and written), computer savvy, organizational and time management skills and the ability to deal with conflict among both patients and staff. An understanding of financials, such as budgets and profit/loss statements, is strongly recommended; this can be acquired on the job or through an advanced degree. In addition, managers must be familiar with federal and state regulations to ensure their facilities are in compliance.
If you are interested in starting your own home dialysis, renal care or home health care business, an advanced degree in a related subject is probably helpful. “I’m working on a PhD in organizational management,” says Wanda Chukwu, RN, MA, owner of Assertive Health Services. “I think it helps immensely with the kind of services I offer.”
Nurse researchers require doctoral degrees to learn the rigorous scientific methodologies necessary to conduct accurate studies. “To do a research project, you need to make sure that the instruments you use are valid and reliable and that you’re getting the information you need,” explains researcher Charlotte Thomas-Hawkins, PhD, RN, CNN, assistant professor at Rutgers, The State University of New Jersey. “Certainly nurses with master’s degrees can also conduct research, but they really need to do it with a doctorally prepared researcher. Because there are so few doctorally prepared nurses in any specialty setting, the model for research is for those researchers to do collaborative projects with nurses in clinical practice.”
Nurses interested in becoming nephrology educators may or may not need an advanced degree, depending on the setting. But certification is always a plus, as is a mastery of public speaking. “If you have the desire to learn, plus motivation, patience and compassion for your students, you can teach,” asserts Adrian Priester-Coary, MSN, RN, CNN, a nurse educator at the University of Chicago Hospitals. Nurses who wish to focus on patient education, either at a health care facility or in the community, need to understand the fundamentals of teaching and learning. This knowledge and expertise can be gained as part of degree preparation and nursing practice. To teach at a college or university, however, a master’s or doctoral degree is usually the minimum requirement.
Over the last decade, there has been talk of an impending shortage of nurses. Even in light of the economic downturn, the soaring demand for more educated nurses is expected to continue as baby boomers age and health care coverage expands. For nurses who are entering or are in the field already, this demand presents an excellent opportunity to advance their careers and expand their knowledge.
So what is the logical next step? Often, it is to obtain an advanced degree. Once the decision to pursue higher education has been made, the next question is where to enroll. As online degree programs have increased in popularity over the last few years, many prospective students may wonder about the similarities and differences between online and traditional nursing programs. Before making your decision, consider what type of institution and program will best suit your needs and situation.
Benefits of an online education
Many nurses say the primary reason they chose an online program is because of the convenience and flexibility. Online learning offers students who are trying to balance a family, career, and other commitments the opportunity to earn a degree without sacrificing their other interests and obligations. An online nursing program may also offer a wider variety of degrees than a local university—if a local university is even an option. Especially in rural areas, the distance and time to travel to a brick-and-mortar institution may make this option impractical.
Another benefit of online learning is the asynchronous environment. In an asynchronous learning environment, students can participate at their convenience instead of being limited to participating at the designated location and the time when a class is offered. In the online format, students can generally post their homework and contribute to discussions when it works best for them. This is an especially important benefit to nurses who work shifts that potentially preclude them from attending traditional classes.
Some nurses believe that enrolling in an online program means losing out on the networking and interaction opportunities that occur in a traditional classroom. While it is true that actual face-to-face interaction is limited, nurses still have the opportunity to connect and network with other professionals online. The online setting also allows students to network with classmates and faculty from across the country and potentially around the world. As a result, nurses have the opportunity to hear about what’s happening beyond their local area, as well as benefit from the practical experience and knowledge shared by colleagues in other locations. The ability to connect with professionals from different practice settings and to share experiences and challenges is also cited as a unique feature of online learning. And other student resources, such as career advisement and even tech support, are typically as accessible and readily available via online universities as traditional.
Face time
While it may be the solution for some, online learning isn’t for everyone. There are students who want or need a traditional learning environment. For instance, an online classroom lacks the nonverbal cues that visual learners prefer. Some students simply need the face-to-face interaction. Many feel most comfortable having conversations in person and not over the phone or via an online discussion.
In addition, online and traditional nursing programs have different communication styles. On the job, nurses are taught to be succinct in their writing style because of the volume of required documentation in electronic records and because much of their work is done via checklists. Nurses who choose online education participate in a more intensive writing program than traditional education offers, since nearly all of the communication online occurs in written form. Prospective students should keep their personal communication style and preferred learning format in mind when selecting a program.
For both traditional and online nursing programs, practicum or clinical experience is required. However, practicum arrangements vary by degree program as well as by institution. Undergraduate practicums in face-to-face programs are usually arranged by the institution, while undergraduates in online programs typically propose the facility and preceptor. For graduate practicums, the trend for both online and face-to-face programs is for the student to propose their facility and preceptor.
No back row
Class participation is a very different dynamic in an online program versus a traditional program. In a traditional classroom, faculty members typically lecture, and grades are often based on exams and papers rather than on classroom participation. On the other hand, an online program places greater emphasis on participation: everyone participates in discussions by posting their thoughts—there is no back row.
The asynchronous online environment is an unexpected benefit for many students, because it allows students to think about what they want to say before they actually say it. Online students have time to reflect on the discussion, and they are actually more engaged. Traditional students who fear public speaking tend to stay silent in class, whereas an online setting can help build confidence in shy individuals or help those for whom English is a second language compose their thoughts before speaking.
Above all else, quality
Regardless of the delivery method, it is important that students find a quality nursing program. When researching which program or type of institution is best, one of the first things prospective students should check is the accreditation. The program should be accredited by either the National League for Nursing Accrediting Commission (NLNAC) or the Commission on Collegiate Nursing Education (CCNE). Additionally, the school should also have a Higher Learning Commission (HLC) accreditation if it offers doctoral programs, as Ph.D. programs are not NLNAC- or CCNE-accredited.
Let’s Get Quizzical You’ve already given careful thought to that mother-of-all continuing education questions, “Should I go back to school?” Now that you’ve decided to venture down that path, you’re faced with another pressing question: “Online or traditional nursing education?” As with so many important decisions, answering that question comes with a little self-reflection and consideration. Here’s a short quiz to help you figure out which learning environment is best for you.
How much face-to-face interaction with my professor and classmates do I want or need?
What kind of flexibility does my work and family schedule allow for my educational pursuits?
How do I feel about writing-intensive assignments and interactions?
How do I feel about class participation?
Is my home environment conducive to study?
How comfortable am I using the Internet, e-mail, instant messengers, etc.?
How accessible are the closest brick-and-mortar nursing schools?
Another consideration when choosing a nursing program is to look at the level of faculty preparation and experience. Faculty credentials are important, and faculty members should be teaching in their areas of expertise—as established through both academic preparation and experience. Faculty members should be experts, and they should be certified in their areas of practice.
For an online nursing program in particular, it is important to see how long the institution has been in the business of teaching and offering classes online. Many schools are now offering classes online, but that doesn’t mean that their classes are designed for a truly online experience. To provide a high-quality online nursing program, it is necessary for the school to have expert instructional-design knowledge as well as the technology support that online students need.
Above all, prospective nursing students need to be diligent and research the institution. Talk to an enrollment advisor about the program and the various resources available. Also, reach out to faculty members and current students, as well as alumni who have gone through the program. Ask them questions about their experience, course content, and how the degree has helped them succeed. Prospective students can also check out benchmarks with the American Distance Education Consortium (ADEC), the American Federation of Teachers (AFT), and the National Education Association (NEA) to see if the institution they are interested in enrolling in is meeting those benchmarks.
At the end of the day, there is no significant difference between student outcomes for traditional and online nursing programs. Both can provide a rewarding learning experience, but, ultimately, it is up to the student to determine which program and delivery method are best suited to his or her current situation and needs.
No one can say nursing is a stagnant profession. Even freshly minted grads can feel they are scrambling to keep up with new procedures, technologies, treatments, and processes. If you’re a nurse, you might start to wonder what skills you will need to succeed and stay current in the coming years.
There are a few qualities shared by all successful nurses. Being an excellent multitasker, having empathy, and being nearly obsessed with details never failed a nurse. No matter what your specialty, your location, or your aspirations, experts agree that a few skills in your wheelhouse will not only advance your career, but also help you satisfy your goals of being the best nurse for your patients.
“The first thing you have to have if you want to be the best nurse possible is you have to really want to do it,” says Leigh Goldstein, assistant professor of clinical nursing at the University of Texas at Austin School of Nursing. “You really have to want to be a nurse and not just bring people pills and plump pillows. To get there, you have to put in the hours and put in the study. There’s that little thing in you that tells you, ‘This is it,’” says Goldstein. “It makes learning all the other skills easier.”
LaDonna Northington, DNP, RN, BC, professor of nursing and the director of the traditional nursing program at the University of Mississippi Medical Center, agrees that nurses need a passion for the job. “This is not for the faint of heart,” she says.
Looking ahead, here are some of the essential skills nurses will need to meet job demands at any career juncture.
Develop Critical Thinking/Critical Reasoning
The best nurse thinks outside the box. Adapting to changing situations, unique patient presentations, unusual medication combinations, and a rotating team takes awareness. Assessing and evaluating the whole picture by using the critical thinking developed in school and on the job is essential to success.
“Nursing is not like working in a bank,” says Goldstein. “It’s not 9 to 5. It’s always a unique set of circumstances. You have to tailor and adjust the care you deliver based on the picture the patient is giving you.”
According to Northington, nothing in nursing is static. Nurses can’t usually just treat one patient issue—they have to determine how the patient’s diagnosis or disease has affected them across the lifespan, she says. And nurses have to consider not just the best choice for the patient and the best option for the nurse right now, but they also have to consider those things in light of the city they are in, the timing, and the resources they have at hand or that are available to them.
Make Friends with Technology
Nursing moves fast, but technological advances are sometimes even faster. While new nurses might lack years of direct patient experience, they often have essential technological familiarity. “Most nurses are probably aware that the world of electronics has just taken over,” says Barbara Vaughn, RN, BSN, BS, CCM, chief nursing officer of Baylor Medical Center in Carrollton, Texas. “The more senior nurses who didn’t grow up in the technology world tend to struggle more than nurses who grew up with that.”
With apps that allow nurses to determine medication dosages and interactions and websites that allow patients access to electronic health records, technology is an integral part of modern nursing. “Technology is changing how we practice and will change how nurses function in the future,” says Vaughn.The benefits are incredible. Instead of having to make the time-consuming drive into the ER when needed for an emergency, a specialist might now be able to save precious minutes by first examining a patient remotely with the help of monitors and even robotic devices. Nurses will have to adapt to this new way of doing things.
Nurses have to practice with technology to gain a fluent understanding, says Vaughn. Vaughn, who is studying for her PhD, says she didn’t grow up with online training as the norm, so when her new classes required online work, she wasn’t prepared. Realizing this could be a hindrance, Vaughn asked newer nurses about how to do things, and she practiced navigating the system until she became better at it.
Whether you are accessing patient records, navigating online requirements for a class, or learning a new medication scanning program, technology will improve your work day and help you take better care of your patients. In the meantime, Vaughn just recommends playing around with the computer when faced with something new. In her own department, Vaughn recalls some nurses who were especially stressed out about learning the new electronic health records system. With training and practice, they excelled. “They were later identified as superusers for their unit,” says Vaughn with a laugh.
Adapt to the Broader Picture
With all these developments comes new and greater responsibility.
“As an inpatient nurse, you used to worry about the 4 to 6 days when the patient was under your care,” says Vaughn. “Now if you are in a hospital based setting, you are going to be more involved in patient population health.” That means an inpatient nurse not only has to get the whole story of what happened before the patient arrived at the hospital, but also think about working with the care team to give specific instructions for when patients get home that will be practical.
“The more specialized medicine gets, the more fragmented health care becomes,” says Northington. Technology and that broad view can help reign that all in—and nurses need to know how the puzzle pieces fit together and where and how patients are receiving care.
“More patients will be followed in nontraditional health care settings,” says Vaughn. “Our world and the world we know is going to change,” says Vaughn of the health care industry. With more patients being followed by health care centers in easily accessed sites like Walmart and Walgreens, telemedicine is going to become more important to understand and to navigate.
Practice Effective Communication
Thirty years ago, communication about patient care was effective, but certainly not at today’s level, says Northington. “We have to communicate,” she says. “You have to ask, ‘What do you know that I don’t know that can help this patient?’ or ‘Are these therapies contradictory?’ Nurses are in that integral place to facilitate that interprofessional education and communication.”
Good communication isn’t always easy. Beth Boynton, RN, MS, author of Successful Nurse Communication, says the most effective communication is based in speaking up and in listening.
Especially in fast-paced and dynamic health care settings, the underlying interpersonal relationships can have a huge impact on how colleagues communicate and relate to each other. Nurses need to not only recognize the dynamics at play, but also learn how to work within the environment.
“We all think this is easy,” says Boynton, “but we have to recognize this is harder than meets the eye. Be patient with the learning curve.” Nurses might be assertive about speaking up for their patients’ needs, but not for their own, explains Boynton. So, as nurses look to the future, they should be mindful of not only fine-tuning their ability to speak up, but also listening to both patients and colleagues in return without judgment so everyone can work towards the best possible outcome.
Stay Current
“The nurse of the future has to stay committed to learning,” says Northington. “Take what the research is saying and use the best practices. Ask the questions like, ‘Why are we doing it that way?’ and ‘What can I do differently that will produce a better outcome?’”
To be the best nurse, you must stay current in the newest developments. Take the time to learn new procedures, but also recognize where your skills need updating. For example, if you know you’ll need to deal with chest tubes, don’t just assume you’ll know what to do when the time comes. Make an active effort to gain current experience.
Develop Mentoring Relationships
Every nurse needs a mentor. It doesn’t matter what your role is, how many years of experience you have, or even how many months you have been practicing. If you want to advance and learn the intangible skills needed to excel in nursing, you need to actively cultivate a mentoring relationship. Nurse mentors are often found at work, through networks, or within professional organizations.
Refine Your Personal Compass
A little bit of a thick skin will do wonders for any career nurse. “You have to defend your patient from everyone and take care of them,” says Goldstein. That means when a physician makes a call you disagree with or you overhear an unfriendly comment, you need to speak up when it matters and let it roll when it doesn’t.
And some of the personal work nurses have to do isn’t easy, including reflecting on and adjusting for any personal feelings or prejudices they have about patients in an open and honest manner. “We need to be able to take care of people no matter what their circumstances or color or what they did to get here,” says Goldstein. “You can’t treat patients differently. You need to take care of them and not make a judgment.”
Prepare for the Unexpected
You never know what your day will bring, so lots of personal reflection, discussions with others in your profession, and cultivating skills can help you when you are faced with something you’ve never had to deal with before.
“I think whether you are starting out as a new nurse or you are a seasoned nurse, nursing care is constantly changing, and being flexible to those changes is paramount,” says Princess Holt, BSN, RN, a nurse in the invasive cardiology department at Baylor Medical Center in Carrollton, Texas. It’s not easy, she says, to constantly adapt to new approaches and new practices, but nurses need to sharpen their focus. “When I get frustrated, I always go back to put myself in the mindset of my patient I am caring for or of my physician who is making this order or of the family I am taking care of to find new ways of looking at it. It grounds me and helps me understand.”
Developing all the coping skills to deal with job stress is a personal approach that nurses will cultivate as they go.
“New nurses don’t always take care of themselves and the emotional baggage you take with you,” says Goldstein. “You have to incorporate those experiences into a coping strategy that you have to develop on your own. Every nurse needs to figure out what they need to do to handle that.” And if you aren’t able to really learn how to cope, nurses must have the skills to either recognize that some kind of career shift is necessary (maybe even just moving from the ER to postpartum, suggests Goldstein) or to be open to hearing it when others recognize it.
Recognize Your Private Life Impacts Your Career
Nurses have to realize their career choice is 24/7. And while you have to balance your life and leave the hospital behind, you also have to somehow adapt to always being a nurse first. Family picnics can turn into a mini diagnosis session, neighbors might ask you to look at a child’s rash, and your private life can impact your job very directly in a way that won’t happen in other professions. “Nurses are held to a higher standard than the average citizen,” says Goldstein.
Learn Where to Learn
Yes, nurses in school learn the hands-on nursing skills like hand hygiene and infection control, says Goldstein, but, like any nursing skill, mastering them takes time.
Some hospitals have new nurse orientation programs that help new nurses acclimate to the setting, but if you don’t have that option, rely on your own observations, ask questions, and take classes to help get you up to speed. When you’re on the job, watch others to see how they incorporate things like patient safety into their routine interactions with patients. And Holt, who has worked in departments from ER to interventional radiology, says moving around builds skills. “I have seen it all,” she says, “and there is still more to see.”
Put It All Together
When nurses consider all the skills they need to succeed, some are easier to gain than others. “You need to understand what goes on behind all the mechanics,” says Northington. “It’s the knowledge behind the skills you need. They can teach nurses things. Nurses have the rest of their lives to learn things. We need nurses who know how to think, to problem solve, [and] who know when they are in over their heads to call for help. The most dangerous nurse is one who doesn’t ask a question.”
And nurses must keep moving forward and adapting even when the pace seems relentless. “We’ve come a long way,” says Northington. “And in 20 years, nursing won’t look like it looks now. Nursing is one of the best careers because it’s always evolving.”
In today’s global society, nurses care for patients with diverse cultural backgrounds and varied expectations about the role of health care in their own lives. Though often unintentional, cultural insensitivity by health care staff can hinder a positive patient experience—and even physical health. As the role of medicine and nursing practices vary greatly from culture to culture, nursing schools are strengthening their efforts to attract more minority students and diversify the nursing workforce.
Why is it important to attract underrepresented groups into nursing? According to the U.S. Census Bureau, individuals from ethnic and racial minority groups accounted for more than one third of the U.S. population (37%) in 2012, with projections pointing to minority populations becoming the majority by 2043. A 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers found that nurses from minority backgrounds represent approximately 17% of the registered nurse workforce: African Americans 6%; Asians 6%; Hispanic/Latinos 3%; American Indian/Alaskan Natives 1%; and Native Hawaiian/Pacific Islanders 1%.
Jan Jones-Schenk, DHSc, RN, NE-BC, national director for the College of Health Professions at Western Governors University, believes that achieving greater health in our nation depends on having health care providers that “are like” the patients we care for in ethnicity, culture, and other demographics.
“The insights and understanding [that] people of like cultures and backgrounds can bring to the health care experience are difficult, if not impossible, to teach,” says Jones-Schenk. “The shared, lived experience can create a bridge for understanding and improving patient and family acceptance and engagement in health-related activities and behaviors.”
By using a combination of targeted outreach programs, eliminating cultural barriers, and preparing students to treat diverse populations, nursing schools are rising to meet the challenge of expanding student diversity and promoting a diverse image of the nursing profession.
Recognizing the Need
Numerous schools are looking at strengthening their recruitment through outreach campaigns that serve to develop community partnerships with culturally diverse organizations and geographical areas. Last year, the University of Delaware School of Nursing won a three-year, $1 million grant from the federal Human Resources and Services Administration to enhance nursing workforce diversity. The purpose of this grant is to implement an innovative and comprehensive recruitment and retention model that will help increase the diversity of the nursing student body, as well as foster a welcoming environment that promotes interest and success for underrepresented minority and disadvantaged students.
The Nursing Workforce Diversity (NWD) grant funds nine undergraduate nursing students from underrepresented minorities and from economically disadvantaged or educationally disadvantaged groups. Current NWD scholars hail from four different countries; six have parents who were born outside the United States; and the participants speak six languages among them: Spanish, Tagalog, Korean, Shona, German, and English.
“Enhancing nursing student diversity contributes to the value of every student’s learning experience, as each person brings their own unique cultural and ethnic backgrounds to the classroom with discussions and interactions that serve to enrich and enlighten everyone’s academic, professional, and personal development,” says Kathy Kump, RN, MSN, MHSA, CWOCN, FNP-C, the director of nursing at Ottawa University. “This will positively impact the needs of all individuals in our culturally rich and linguistically diverse society that complements the demographics of our current population.”
Removing barriers that may have historically prevented culturally diverse nurses from entering the workforce is an effective tool in diversifying the nursing student population. While Chamberlain College of Nursing does not have a program specifically for Arab American students, in an effort to address their unique cultural needs, Chamberlain College introduced the concept of Chamberlain Care, which encourages colleagues to consider the whole student and not just his or her academic needs.
As an example of Chamberlain’s focus on students, after noticing a number of Arab American student nurses enrolled in the nursing program, one professor contacted the executive director of the National American Arab Nurses Association and helped coordinate a workshop for students and colleagues to gain greater understanding of the cultural differences of the Arab American community. Additionally, for an upcoming clinical course, Arab American students who wear hijabs and long, modest skirts daily requested to wear an alternative to the standard scrub pants. The campus dean, student services advisor, and clinical coordinator worked together to identify a long, scrub dress option that complied with the students’ needs while also meeting the clinical site’s requirements.
“It is a priority at Chamberlain College of Nursing to prepare student nurses to enter the workforce with the knowledge and skills to provide extraordinary care, help our students identify resources that will help them feel more comfortable in their future profession, and engage with peers in different ways outside of the classroom,” says Jaime Sinutko, PhD, MSN, RN, the dean at Chamberlain College of Nursing’s Troy Campus. “We are all vested in all our students’ positive outcomes.”
Preparing Students to Treat Diverse Patient Needs
Central to any nursing school is preparing nursing students to treat diverse patient needs and develop empathy in the workforce. As part of the RN-to-BSN curriculum, Ottawa University offers a Nursing and Cultural Diversity in Healthcare course, which assists the student in improving cultural awareness, cultural sensitivity, and cultural competency as a nursing professional. The course examines how cultural diversity affects health beliefs, health care behaviors, and health/illness dynamics.
“Each week, the student is introduced to diverse population groups through lecture, discussions, videos, and case studies in order to expand their understanding and appreciation of various health care beliefs and health care behaviors in our society,” explains Kump. “It is also designed to prepare students to better implement and evaluate individualized plans to improve health care delivery in today’s global, but increasingly smaller, world.”
In addition to this specific class, Kump says they emphasize cultural competency as a foundation and continuing theme in each course throughout the nursing curriculum and highlight the importance of this competency not only in course objectives, but in the program’s overall learning outcomes, as well.
Kelley Johnson looked like any other nurse as she stepped onto the stage of the Miss America pageant. Wearing a dark blue set of scrubs, a stethoscope draped around her neck, and her beautiful hair pulled back away from her face, she looked like any other nurse you may meet in your facility.
It took a great deal of courage to do a monologue for her talent portion. After all, how do you illustrate the talents that it takes to be a nurse? Kelley took a deep breath, steadied herself, and launched into a touching story about an Alzheimer’s patient who moved her. Nurses knew what she meant to convey with that story. All of them have had similar experiences.
What was not expected was the backlash that started a movement with Kelley at the center.
Kelley was born in Fort Collins, CO in 1993. Even as a young child, she knew she wanted to go into a helping profession. “I always wanted to take care of people when I was little, but was unsure in what capacity I would practice as an adult.”
Like most potential nurses, Kelley did her homework and found nursing was her calling. “I loved shadowing nurses and doctors in junior high school. After science and anatomy courses in high school I completed my CNA course. I knew that nursing was for me as I headed into college.”
College proved an exciting and rewarding experience for Kelley. She attended Colorado Mesa University from 2010 to 2012, graduating with a BSN as the valedictorian of her class. Despite her stunning good looks, Kelley has found that she was never discriminated against because of her 6’1” frame, her long blonde hair, or her participation in pageants.
“No, I have not [been treated differently because of my looks]. I have never felt like my patients or their families didn’t take me seriously, either.”
As a student and a new grad, Kelley probably never thought that she would be the center of controversy, a rallying point for nurses, or a potential ambassador of the profession. She states, “I did not anticipate this incredible reaction. I am thankful that the amazing and experienced nurses of America are receiving a newfound recognition that they deserve.” The recognition they are now receiving is a result of her courage in expressing her talent, and the backlash from a popular talk television show.
By now, everyone knows that the commentators on The View poked fun at Kelley’s heartfelt presentation. Although they were criticizing pageants in general, they referred to Kelley’s scrubs as a “nurse costume” and the stethoscope around her neck as a “doctor’s stethoscope.” The reaction of nurses around the country was immediate and outraged. The comments made by these talking heads degraded the contributions nurses have to the medical system and showed a marked lack of understanding about the profession as a whole.
Kelley never realized she would be in the center of such an intense media storm. Perhaps it is the deplorable depiction of nurses in the media. Kelley feels differently, though. “There are both positive and negative portrayals of nurses in the media. I don’t believe that media had an effect on the backlash from the View. I believe, as they said themselves, it was a lack of understanding.”
Unfortunately, this lack of understanding about nurses is far too common. The public simply does not know what nurses do, and the comments by the ladies on The View only exemplified the relative knowledge of most of the public. Although The View tried desperately to backpedal on what was said, even going so far as having a nurses’ day on the show, the apologies rang hollow to most nurses. Kelley, however, kept a positive outlook and would rather focus on the issues in nursing than the media storm.
Nursing has many issues, and like most who work in the trenches, Kelley has opinions on how to deal with the major problems. For instance, short staffing is a problem everywhere. She offers this advice, “I think it’s important to continue to have recruiting efforts through nursing schools and student associations.” Recruiting is definitely needed to help with the profession’s major problem of short staffing. Engaging potential nurses through schools, such as high school and college, could help make an impact on this issue.
Another problem in nursing is the crushing loans that are required to pursue a degree. Kelley has come under some fire because the Miss America pageant will pay her student loans, but she agrees it is a problem. Her solution is both practical and simple. “I believe in nursing incentive programs provided by hospitals for continued education. I also believe that student loans are an issue for most professions, not just nursing. We need legislation to decrease costs across the board for students and make loans more affordable and accessible.” Loans are a countrywide problem, but nursing is hard hit. Incentive programs seem like the best solution, but loans are a problem that needs to be addressed in nursing immediately.
Despite the backlash of The View and the problems nursing has, Kelley remains dedicated to pursing her career in nursing, including going on to get her MSN. “[I want to pursue] nurse anesthesia. I love math and pharmacology, and I want to increase my scope of practice in those fields within nursing specifically.” For someone with so many strengths, she is sure to excel in this program as she has in so many other aspects of her life.
While being a contestant on Miss America would be stressful for most people, all nurses know that the most stressful part of being a nurse is handling a code. Kelley sums up her feelings this way: “Being in a code is definitely more stressful. Being in the Miss America competition was exciting and rewarding, but it was not stressful for me.” Most nurses would likely agree.
