Sometimes nurses know they are destined for a lifelong nursing career; for other nurses, it’s as if the career chooses them.
That’s how Jonathan Llamas DNP (c), BSN, RN-BC, PHN, found his way to nursing. Knowing the career would be a good fit for his compassionate nature and his innate ability to have empathy for others, Llamas applied for nursing school right out of high school.
“I knew the work was selfless and inspiring,” he says, “but I went into nursing school with some naiveté. I knew I had the qualities to be a successful nurse, but I didn’t understand the amount of hard work and dedication required for me to excel in the heavily science-based coursework.”
Llamas was unprepared and struggled with the demands of the course load. Looking back, Llamas sees how his path started to become rockier, even as he wanted to succeed. He lacked the mindset to focus on his work. “I didn’t commit the time necessary for me to be successful,” he says.
Transferring to community college, Llamas finished his prereq courses, but says his lackluster GPA set him up for a cycle of rejections from other nursing programs. Determined, Llamas pressed on but struggled with setbacks that would have had other students choosing another path.
“Based on my GPA, my community college counselor said, ‘You don’t have what it takes to be a nurse,’” says Llamas. Feeling demoralized by the comment, Llamas still felt that nursing was his calling. He just had to find a way to get there. “I had to prove to myself I could do it,” he says, “and that I could do well under pressure.”
The toll from the rejection was growing though. As a first-generation college student from a supportive Filipino family, Llamas recalls his mother’s upset at all the rejection for him and it struck a nerve.
“I looked in the mirror and thought, ‘How do I want to be remembered? Do I want to be a father who inspires his kid to rise above adversity or fold under pressure?’” Llamas says. “I didn’t want to be the latter. I wanted to make something of myself.”
Determined to succeed, Llamas applied to West Coast University’s nursing program, and they gave him another chance. He didn’t throw it away and graduated in 2013. I learned that if I wanted to be successful, I have to apply myself,” he says. “I carry that now. If you want something, you have to work for what you want. We are all different in terms of the resources we have initially. We are not all starting at the same starting line.”
“Hopefully my story will inspire others,” says Llamas. He wants students to be academically and mentally ready at the outset so they aren’t surprised by the intensity and high expectations of nursing school. “You have to sacrifice to be successful,” he says. “It’s hard, but it’s temporary. Do your research, and know why you want to be a nurse. Have a vision for yourself and your future.”
As Llamas has learned, there is a level of commitment to nursing that is necessary to be an exceptional nurse. “There’s a difference between your passion and your purpose,” he says. Having the inherent ability to be a successful nurse often makes one’s passion for nursing grow stronger, he says. “I understand that nursing requires sacrifice, but the most rewarding thing you can do is provide such incredible care to a patient.”
For Llamas, persistence has paid off. He is set to graduate this spring with his DNP from Loma Linda University and juggles his academic load with a full-time schedule as a psychiatric mental-health nurse. “I am fortunate to have hit this stride in my career,” he says. The advanced degree will help him reach his future goals of influencing change in nursing by providing a different form of influence beyond the bedside. He envisions working as an NP, becoming an educator to help future nurses, and using his platform to help other nurses.
“If you had said to me 10 years ago that I would accomplish this, I would have said you were crazy,” he says. “If I have impacted someone’s life for the better, then I have lived a life worth living. I feel blessed, humbled, and grateful for the opportunities that have come my way.”
“Diabetes is so prevalent in our society, and I feel as though I have a better understanding of my own patients with diabetes,” says Heather Weber, an RN who works in a busy outpatient GI department. She has type 1 diabetes, and she has experienced what it is like working as a nurse with diabetes. “I recently had a GI sickness at work, and as a result, my blood sugar dropped rather quickly after lunch,” she relates. “My coworkers noticed that I was diaphoretic and quickly sat me down, giving me some apple juice to drink. I ended up going home since I was sick with a GI bug, but only once my blood sugar was stable enough to drive. I was grateful for my coworkers’ assistance.”
Since diabetes is such a major problem amongst the population, it only stands to reason that nurses can have diabetes, as well. According to the American Diabetes Association, 30.3 million people in America have diabetes. In addition, 1.25 million adults and children have type 1 diabetes. How can nurses manage their condition? Nurses have a difficult time eating a balanced diet due to skipping meals. They are also on their feet most of the time, putting them at risk for complications of the foot, such as ulcers.
Fortunately, many nurses want to share their experiences to help others navigate the challenge of balancing diabetes and providing excellent patient care. Diabetes educators strive to help all people who have diabetes, and they are an excellent resource for nurses who want to manage their diabetes.
Nurses generally know how to handle their condition. They know diabetes front and back through the job, and they are intelligent professionals who know how to adapt those ideas for themselves.
“I can usually slip away for a few minutes or have a coworker cover for me so that I can test and/or eat a snack,” explains Weber. “When I worked as an ICU nurse doing twelve-hour shifts, I would typically eat snacks to prevent low blood sugars as I did my charting at the nurses’ station.”
Tips like this are invaluable because they are grounded in the actual experience of being a nurse with diabetes.
Fran Damian, MS, RN, NEA-BC, works at Boston Children’s Hospital and is a staff member at Diabetes Training Camp. She has tricks that she uses, as well. “Managing well with diabetes requires good planning and being well prepared with extra supplies all the time,” she says. “I live a healthy lifestyle as much as possible. That includes regular exercise and a well-balanced diet. I feel best when I eat a lot of fruits, vegetables, and lean protein, and I drink a lot of water …. [I] always have glucose tablets on me in case I start feeling low.”
“Our unit was pretty good if we were slammed and did not get lunch,” says Danielle Kreais, MSN, RN, CPNP-PC. She got her diagnosis and learned to cope, all while working a busy OB unit on nights. “The manager ordered lunch meat sandwiches and chips for us. There was another diabetic I worked with and the advice she gave me was to make sure I always had one of those Nature Valley bars in my work bag, in the glove box of my car, and my locker. The peanut butter ones have protein and they are a carb, so it was a great combo if lunch was missed.”
She continues: “She told me for lows to keep those peppermint striped candies [in your pocket] that are soft, and you can chew them. They are enough to bring your sugars up, plus they don’t melt.”
Nurses newly diagnosed with diabetes would do well to carry glucose tablets at all times to prevent low blood sugar. Be sure to tell your manager and your coworkers what’s going on so that they can help you when needed. Snacks and water are essential to good blood sugar control. Don’t forget to use your resources, such as endocrinologists, dieticians, and diabetes educators to plan the right meals and strategies for you to use on the job.
Although tips from nurses can be invaluable, they are nothing like the kind of focused information that can come from a certified diabetes educator (CDE). These are medical professionals who are responsible for teaching all people with diabetes in all situations how to manage their lives and prevent complications.
One such expert is Lucille Hughes, DNP, MSN/Ed, CDE, BC-ADM, FAADE, director of diabetes education at South Nassau Communities Hospital in Oceanside, New York, and treasurer of the American Association of Diabetes Educators. Considering some of the challenges nurses can face when dealing with diabetes on the job, she had tips for some of the most common ones.
Nurses often don’t get the chance to eat during a shift, and this can severely impact blood sugar levels. “When nurses with diabetes find themselves in this situation, planning and being prepared is the best medicine,” says Hughes. “Keeping snacks on hand that are a blend of carbohydrates, protein, and fats can be a tremendous help in these situations.”
“Meal planning is the secret to living with diabetes and being a healthy person,” Hughes continues. “Investing in a good lunch bag (or two) will allow you to plan and pack all the essentials to eating and snacking healthy. Being unprepared and finding yourself at the mercy of a vending machine is not a good situation to be in. It is very unlikely you are going to find a ‘healthy’ lunch or snack option.”
In addition to poor nutrition, nurses also face significant impact to their feet, and this can cause foot related complications for nurses who have diabetes. “First and foremost, investing in a good pair of comfortable shoes is essential for anyone who spends most of their day on their feet,” says Hughes. “Calluses and skin evulsions due to rubbing of a shoe on a toe, heel, or ankle area can be dangerous and yet avoidable.”
Here are six tips that Hughes has on how to find shoes that fit and how to determine if they are a healthy choice:
- When trying on a shoe in the store, make sure it feels comfortable. If it isn’t comfortable, don’t buy it.
- Many think that new shoes require a bit of breaking in and you must endure the associated pain. This is not true. If new shoes start to hurt, immediately remove them and don’t use them again.
- Don’t think that the only shoes you can wear as a nurse with diabetes are unfashionable ones. There are many options for shoes that fit, so do your due diligence and find shoes that will protect your feet.
- In addition to finding the right shoes, foot inspection is vital in protecting your feet. Check them every day. Use a mirror to see the bottoms and sides of your feet. If you notice any redness, cuts, or blisters, see your podiatrist immediately. Take care of small changes immediately before they expand into something unmanageable.
- Podiatrist. Yearly, no exceptions. More often if necessary.
- Finally, any time you see a medical professional, ask them if they will take a look at your feet at your office visit. This could be your primary care doctor, your endocrinologist, or any other specialist you may see—within reason, of course. Many dentists would have trouble with this request. Seriously, though, any professional who looks at your feet could possibly see a problem early enough to stop it. Use these resources.
Nurses spend so much time taking care of others that the self is often forgotten and ignored. Unfortunately, this is unhealthy for any nurse, but particularly troublesome for a nurse with diabetes. Yet, these challenges are not insurmountable, although they may take a little work. Planning your diets and meals are key to ensuring that you will have food on hand for sudden lows. Meal planning can also help you keep your high blood sugar under control. For your feet, planning is again essential. You must find shoes that are comfortable—no questions asked.
Following these steps, nurses with diabetes should be able to function well as nurses—and many are! If you find yourself troubled by mixing diabetes and nursing, let your doctor know. They may be able to refer you to any number of professionals who can help. The most important item, though, is to catch things early and always plan how to confront any challenges.
The concept of effectual leadership is an important aspect in the field of nursing and health care. Leaders have a significant role in creating a culture and mindset that not only inspire but also unite individuals within a group or society. Since the perception of leadership is different to certain individuals however, various leaders around the world function and interpret leadership in unique and distinct ways. As a result of this realization, the following principles and philosophies are necessary to becoming an effective and successful leader in the health care arena.
1. Master and Perfect your Unique Craft.
Since all leaders have distinct leadership styles and abilities, every leader must learn to recognize and master their unique leadership craft. Understanding this concept is crucial because all leaders are responsible for the effectiveness of organizations and provide a guiding purpose to those who need them. In order for this to occur, an individual must be willing to listen to his or her inner voice and remain true to who they are. Only after the individual fully accepts themselves and their idiosyncrasies can they move on to the second step in the leadership hierarchy.
2. Appreciate the Fundamentals of Leadership.
Fundamental leadership is composed of various ingredients that an individual must grasp before he or she can successfully lead. The first ingredient is defined as the guiding vision, which is the individual’s overall goal for himself or herself. All leaders must have a clear idea of what he or she wants to do—professionally and personally—and the strength to persist in the face of setbacks or failures. This ingredient is vital because it exemplifies the importance of possessing a strong sense of conviction in both aspects of the individual’s life as well as the importance of knowing what you desire and how you plan to achieve it. The second and third ingredient in fundamental leadership is passion and integrity. Passion is when you put more energy into something than is required to do it. It is more than just enthusiasm or excitement, but ambition that is materialized into action to put as much heart, mind, body, and soul into something as humanly possible. In addition to this, integrity is also a much-needed component in becoming an effectual leader because it is based on honesty and a steadfast devotion to principle and ethics. Without these three ingredients, leaders will have a difficult time not only motivating others but also gaining the trust and support necessary to accomplish a shared goal or objective.
3. Embrace your Inner Self.
The third and most important step in becoming an effectual leader is learning how to embrace your inner self. The premise of authenticity is a central theme in effectual leadership because the most charismatic and effective leaders are those who are genuine representations of their innermost nature. One of the best ways individuals can gain this is by experiential learning, which provides the individual with a rich and solid foundation for the future. Through experiential learning, individuals are exposed to the repercussions of their choices and as such, decide for themselves whether or not to make the same choices in the future. This exposure ultimately shapes and forms the leader to become emotionally mature and develop the mental acumen required to be authentic and transparent leaders across the health care spectrum.
Enrolling in a Doctor of Nursing Practice (DNP) program can be a daunting task for many students due to the rigorous academic requirements often associated with it. Although DNP school can be intimidating, students who choose to enroll not only embrace the significance of pursuing higher education but also the possibility of advancing their roles as prominent health care leaders in the nursing profession. As a DNP candidate myself, I’ve grown to appreciate the triumph and struggles associated with pursuing a terminal degree. Therefore, I believe students who are considering pursuing their DNP degree must harness these seven attributes to ensure that they are not only readily prepared but also successful in their scholastic endeavors.
1. Clear Vision
Setting a vision and goal for the future is vital for success in the DNP program. Possessing a clear vision is necessary because it helps you organize your individual objectives and helps you maintain accountability throughout the program. If choosing to enroll in DNP school perfectly aligns with your personal and professional goals, having a vision that is well defined will not only help you focus on your objectives but also create a sense of purpose that ultimately becomes your own measurement for success.
2. Ability to Prioritize
Students who know what and how to prioritize tend to be more successful in DNP school because they know how to differentiate tasks as either critical or noncritical. One of the best ways to prioritize in DNP school is by looking over the program and course objectives of each class and determine which tasks need to be completed first. By knowing how to prioritize your tasks wisely you will not only be able to minimize stress but also maximize results more effortlessly and efficiently.
3. Effective Time Management Skills
Possessing excellent time management skills is an important trait prior to beginning DNP school because of the high academic workload associated with pursuing a doctoral degree. Managing your time effectively will allow you to accomplish more tasks in a shorter period of time and help lower your stress and increase your concentration and attention. To ensure that your time is properly managed, it helps to keep a written or electronic record, diary, or calendar to ensure that you know what tasks are required and when they must be completed.
4. Strong Work Ethic
Maintaining a strong work ethic is essential in determining your overall success in DNP school. Students who possess a strong work ethic understand that success can only be achieved by practicing the ideals of discipline and hard work on a regular basis. To maintain a strong work ethic, it is vital to practice positive habits consistently every day so that hard work is almost automatic. Forming respectable habits such as exercising daily, staying punctual, maintaining your obligations, and finishing tasks immediately help establish your credibility and image as a doctorally prepared nurse.
5. Healthy Work-Life Balance
While it is important to study and work hard in DNP school, it is equally important to create a healthy work-life balance and set aside much needed time for yourself and your loved ones. Learning how to care for yourself is extremely important in DNP school as working too much can ultimately cause you to become overwhelmed, overworked, and overstressed. To avoid this, it is best that you take consistent breaks throughout the day to maintain your overall well-being. Learning how to take ample rest breaks is vital to ensure your physical, mental, and emotional health is adequately cared for in DNP school.
6. An Understanding that Excellence is a Lifelong Process
One of the key principles that DNP students must understand is that excellence is a lifelong process. Understanding this concept is vital because sustainable success in DNP school and in life is not something that is built overnight but rather an extended period of time. As leaders in the nursing realm, DNP students must understand that sustainable excellence requires constant monitoring, learning, and improvement with the realization that the journey is just as important as the destination.
7. Perpetual Curiosity
DNP students who remain perpetually curious are more susceptible to success because curiosity not only propels innovation but also self-reflection. Fostering your curiosity in DNP school is essential because it allows you to be fully present in the moment. Curious people are not only happier but also more successful because they are non-blaming, non-shaming, supportive, and focused on exploring options to find the best solution that supports collaboration and innovation.
The annual Gallup Honesty and Ethics Poll was just released and the results show the most trusted profession, ranked #1 for an astounding 17th consecutive year!, is—drum roll, please—nursing.
When a sampling of random Americans were phoned and asked to “please tell me how you would rate the honesty and ethical standards of people in these different fields,” more than 84% rated nurses as “high” or “very high.” (Other ratings they could have chosen were “average,” “low,” or “very low.”)
Gallup has sampled the public’s views since 1976, and while the professions change from year to year, nurses have outpaced all others since 1999 when the role was first included. That is, nearly every year, because there was one time when nurses didn’t top the list. That happened in 2001, after the 9/11 terrorist attacks, when firefighters were included for the first and only time and scored highest. Gallup conducts the telephone survey in late November and releases the results in December.
Health care professions usually dominate the top of the list, and this year is no different. The most trusted groups after nurses were medical doctors, scoring 67%, and pharmacists, coming in right behind at 66%. The lowest rankings for honesty and trustworthiness go to telemarketers and sadly, members of Congress, tied for last place at 8%.
What is it that makes nurses so esteemed for their ethics and honesty? There are many theories, ranging from degree of intimacy (we stand naked—both literally and metaphorically—before nurses) and the fact that nursing is a female dominated profession. The Gallup data suggest that women, on the whole and on average, are seen as more trustworthy than men.
(Estimates are that 90% of nurses are female, according to the American Nurses Association, but that percentage is dropping as more men enter the field.)
Additionally, nurses have a code of ethics to uphold, and they study that topic seriously in nursing school to prepare for difficult ethical dilemmas with life and death consequences. Their licensure also compels them to do what’s right for the patient, not just what’s expedient or in their own (or their employer’s) best interest.
In the end, though, trust is based on personal experience. With nurses making up the largest portion of the health care workforce, almost everyone has had a relationship with a nurse, either as a patient, family member, or friend. They’ve most likely seen that nurses are always there, and always for you, as caregivers and patient advocates.
“Every day and across every health care setting, we are on the frontlines providing care to millions of people,” says ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Nurses’ contributions to health care delivery, public health challenges, natural disaster relief efforts, research, education, and much more, are unmatched and invaluable.”
Unmatched they are! We would like to congratulation to all the extraordinary nurses for ranking at the highest level for your ethical standards. We know that nurses have many super powers—trustworthiness is maybe the greatest one.
Of all the various facets of the nursing field, hospice, many people think, is the most emotionally difficult to work in. But Connie O’Malley, RN, a hospice nurse for the past three years at Gilchrist Hospice Inpatient Unit in Towson, Maryland, loves her work.
That’s not to say that the work isn’t challenging; it often is. But it also holds a lot of rewards.
How long have you worked in hospice? Why did you get into this area of nursing? What drew you to it?
I’ve loved hospice for more than two decades. I was a geriatric nursing assistant about 25 years ago and worked on one of the medical nursing home floors. A patient with metastatic bone cancer could no longer live at home, and there was no space on the inpatient hospice unit. His prognosis was approximately four to six weeks. He was 60 years old an army veteran and a really wonderful, beautiful human being.
When I first met him, I didn’t want to bond with him because he was dying. And so I put up a barrier around my heart and gave him good care, but was not my normal self like I was with other patients. I found this exhausting after only a week.
One day when his hospice nurse came to check on him, we spoke about this. I told her that I was holding back from getting to know him and love him because he was dying. But at the same time, I felt like maybe our paths have crossed for a reason. This hospice nurse said, “Don’t think that we don’t love our patients and grieve for them when they die. When we care for people in their homes, we are invited into their families. We sit in their favorite chairs and interact in their lives in a way that is different than any other kind of health care. We grow to love them, and when they die, we are sad. You are allowed to love him, and it is okay if you cry when he dies. You can’t have a meltdown where you need to be sent home or take a bereavement day. But if you go take a 5- or 10-minute break to cry on the patio, that is okay. You will find your own way to grieve the patients you lose—whether it is a special song you listen to on the way home or if you drive home silently. You will make your own way to grieve them and honor them. But please love your patients.”
Some people might say that working with those who are dying is depressing. Do you feel that way? Why or why not? What do you think you bring to people who are dying?
Working with dying people is an honor and completely humbling for me. I get to care for people when they are at the very end of their life, and for their families in one of the hardest parts of life’s journey. The majority of families open themselves up and allow me not only to provide my nursing expertise and care for their loved one, but also love the patient and their family.
When you care for someone for several weeks, nurses and staff become family to the patient and their loved ones. It is an honor that I am aware of every day that I work. It is much like being with a friend who is giving birth—it is a special place between this world and the next. To be able to help someone’s body be comfortable through the process and provide education and support and normalcy to their loved ones is an amazing thing.
When I first came to hospice, a dear friend told me he thought that it was such a depressing job. I don’t allow myself to focus on the fact that I lose patients. I feel the exact opposite—I get people. I get to care for people at their absolute most vulnerable state of being. I get to hold their families’ hands and help them learn how to let go. I get to give them education to make a terrifying situation less scary and a little bit easier. Every family changes my life, and I don’t feel that I lose them when they die. I feel fortunate that our paths have crossed and that I have been able to be their nurse at this time.
How do you keep your spirits up?
Being a hospice nurse is exhausting—especially in the inpatient setting. We care for people of all ages. Young people are especially tough on our hearts and minds, and sometimes when families are struggling, it wears on us.
To combat the heaviness that I carry, I make sure that when I am off work, I do things that make me happy and are relaxing. I’m a creative person. I like to crochet, and I make sure that I have projects to work on. I spend time with family and friends enjoying them. Simple things like getting coffee at a diner or spending the night at my mom’s apartment and watching movies together are priceless.
What kind of skills do nurses need to be able to work in hospice?
I came to hospice with four years of cardiac telemetry hospital experience. Despite our patients being at end of life, we use all of our nursing skills daily. We still have patients that have complicated care that needs to be given, so anyone with any kind of nursing background would do well. Very often a lot of people have the idea that everything is very low-key in hospice, but honestly there are nights that I am clinically busier than I ever was on a cardiac unit.
What are the biggest challenges of your job?
Families who fear medication interventions for comfort. Even though hospice has been around for 30 years, there is still a lot of fear around administering morphine and other comfort medications to patients. My biggest challenge is to educate families in what pain looks like and reassurance that medication does not accelerate death. The second biggest struggle is educating people about normal end-of-life occurrences—mainly the truth that everyone stops eating at end of life and that it is normal. A lot of families and visitors struggle when our patients stop eating.
What are the greatest rewards?
The greatest reward is to meet a family on their first day who is struggling with a terminal diagnosis for their loved one, and who are so resistant to any comfort measures and any education about what happens at end of life, and to watch them walk the path and see their minds and hearts change and grow in this process.
A lady was with us for 10 weeks, and all of the staff grew to love her and vice versa. When she was in her last few days, I approached her husband to ask for a good time to come say goodbye to her as I did not want to intrude on his and their daughters’ time with her at the end. He put his arm around my shoulder with tears in his eyes and said, “You come when you want to and as often as you’d like; you are family. Please tell all of the staff too. You have loved us all and become our family, and you are welcome at this time just as much as the last 10 weeks.”
If nurses would like to work in hospice, is there any specific training, certifications, or experience that they would need?
A valid nursing license in whichever state you want to work in. I would say that hospice is a field that a nurse has to be drawn to. It is intense and there is a lot of psychological and emotional weight that we carry on a daily basis. A large number of the nurses that I work with have had family members—parents especially—who have died under hospice care, and it seems that we seek out this work to repay that care that we received when our loved ones were dying.