One of the American Nurses Association’s seven Bill of Rights for Registered Nurses is to “freely and openly advocate for themselves and their patients.” Yet, women and minorities may not be as effective advocating because they’re less likely to negotiate. There is a “win-win” negotiating style, developed at Harvard’s famed Negotiation Project, which may be more appealing. Practice them in small ways until they become second nature. Then when it’s necessary to advocate about safety, staffing, workplace violence, etc., you will be ready with a collaborative, problem-solving approach.
But if you don’t negotiate? Nurses who accept poor compensation or working conditions can end up feeling victimized, devalued, and unmotivated. With that attitude, they are less likely to provide excellent patient care and to get promotions. Don’t let that happen to you. Elevating your negotiation skills will lead to better communication, collaboration, and results for you and every other party.
Reframe the Concept of Negotiations
Given the overwhelming percentage of female nurses, it’s important to consider how gender plays into negotiation. Research shows that women are two and a half times more apprehensive about negotiating, while men are four times more likely to initiate a negotiation. In fact, 20% of women say they don’t ever negotiate, even when the situation necessitates it, according to Linda Babcock and Sara Laschever, authors of Women Don’t Ask: Negotiation and the Gender Divide.
That apprehension keeps many nurses from learning and practicing this important communication competency. “Negotiation is in the top five life skills that everyone should have,” insists Donna Cardillo, RN, author of The Ultimate Career Guide for Nurses.
“We negotiate all the time—with our kids, partners, patients, and coworkers, often without even realizing it. The word can have a negative connotation but only because most people don’t understand what it really is,” explains Cardillo. In health care, there is an additional connotation, and that’s terms of negotiation and union contracts, she adds.
According to Webster’s Dictionary, “negotiation” is defined as “to meet and discuss with another in order to reach an agreement.” But many of us suspect that in order to do that, one party must dominate, trick, or pressure the other into submission.
Sometimes, we have to reframe an uncomfortable concept, like negotiation, and perceive it in a new way, to make it more palatable, notes Cardillo.
“For example, say a nurse wants to attend a national nursing conference, and get paid time off, and expenses covered and so on. I’ll advise explaining the benefit to the hospital and the nurse manager. ‘By going, I’ll be able to bring back information from national speakers and experts to share. I will do an in-service session, or write a paper on it, and I’ll bring back printed materials,’” she explains. Nurses needn’t let a “No” response discourage them, either, adds Cardillo, because it may take repeated requests to get what you want. But if you don’t ask, the answer is always “No.”
Another way to reframe it, Cardillo says, is that by asking you’re planting seeds of change for the future, so you’re advocating for yourself and for your profession.
“Many of us were raised not to ask for what we want and to feel satisfied with whatever we got. I just saw a tweet from a nurse: ‘People say I need this job. I say this job needs me.’ That’s so true. Everyone is entitled to feel valued in the workplace,” she says.
Steven P. Cohen, author of The Practical Negotiator, has trained health care professionals in negotiation skills globally and agrees that nurses must self-advocate. “Your number one job is to look out for your own interests. Self-interest means maximizing circumstances to help you get what you need: good pay and benefits, rewards and resources that let you serve the patient. You must be well served.” He notes that if a nurse is treated badly, then he or she can’t function well, and patients suffer.
There are three kinds of interests to consider and prioritize in a negotiation—in conflict, complementary, or in common, according to Cohen. “If you’re going on vacation with a multigenerational family, how likely is it that you have common interests and all want to do the same things? Not likely. But you may have complementary interests. Your goal could be that everyone in the family will have a good time on the vacation.” He advises nurses to look for where there are complementary interests and no conflict, and to build step-by-step to a win-win solution. “Most anyone in a hospital, from aide to CEO, has similar objectives,” he adds “and is asking the same questions: How can I make the most of my job? How can I take care of the people I need to take care of?”
Negotiate in Your Off-Hours
One of the best ways for nurses to become empowered is for them to learn and practice good negotiation skills, asserts Michelle Podlesni, RN, president of the National Nurses in Business Association. “Why are we having nurses that don’t last two years in a hospital setting? Because they aren’t empowered and negotiation starts with assuming your power. I help nurses to understand their power,” she explains.
Podlesni believes that negotiation skills can be learned, like other important nursing skills. Earlier in her career she read The Power of Nice by Ronald Shapiro and Mark Jankowski, and it made a big impression on her. The book defines negotiation as using knowledge to get what you want, using the “three P’s” of preparing, probing, and proposing.
“Say a new nurse is getting scheduled in a certain way. How do they know it’s fair? You ask: ‘How is the schedule made?’ Nurses don’t always assess their own situation and propose what works better for them. We need to make a paradigm shift—your license is a license to start practicing in your business as a nurse,” Podlesni says.
Think of your negotiation skills as a muscle and flex it often in everyday situations. “Practice everywhere you go, even at the Macy’s makeup counter,” she says. “When you go to put lipstick on the counter, say ‘By the way, is this the best you can do?’ And then wait. And talk through a smile,” she advises. As long as you’re pleasant, salespeople will try to accommodate bargain-hunters, often pulling a percentage-off coupon from under the counter.
Even if they can’t give you a discount, clerks may have the power to sweeten the deal in some other way. “Another time at Macy’s I bought furniture and had to wait for an extended period during my workday, so I said to the clerk, ‘I know it’s not your fault but what can you do to help me out?’ She took away the delivery fee and saved me $150,” she adds.
For examples of opportunities in which to practice your negotiation skills and ideas about effective strategies, check out the blog The Daily Asker. A graduate student, Roxana Popescu, set herself the goal of negotiating a request everyday. So, at the farmer’s market, she might ask, “How about an end of the day discount?” She would often get it, or a free sample, or a bonus bag of produce. Over the course of one year, she asked for a discount 411. Analyzing her success rate, she discovered that she did better when she was nice (80%) versus when she was meek (58%). Perhaps unsurprisingly, she enjoyed the greatest success (85%) when she was very nice, or even flirtatious.
Negotiate with Coworkers
Whether delivering direct patient care as a manager, researcher, or as an entrepreneur, nurses need effective negotiation skills. Not every nurse is in a role that requires negotiating with patients, students, vendors, clients, or external agencies. But almost universally, nurses must negotiate with colleagues and coworkers.
“I’m a double minority, a male nurse and an ethnic minority,” says Usama Saleh, RN, BSN, MSN, PhD, a nurse educator. “Nurses are about 90% female today, but when I started it was only 3 to 5% male. I always felt like a minority in terms of gender, so I had to learn to negotiate with female nurses. Naturally there are differences in terms of negotiation styles. But I need to be able to work effectively within a female dominate profession.”
Usama was working as an RN in oncology and often negotiated with colleagues about the assignment of patients, for instance, and to resolve conflict so all parties are satisfied. In addition to ensuring an equitable workload, “it’s important to negotiate with your nurse mates on the team in order to deliver effective care. I always look at it in terms of quality of care,” he explains.
Usama came to the U.S. from the Gaza Strip and also had to become accustomed to the negotiation style of Americans who were born and raised here. “Culture and religion influence the etiquette of negotiation,” he says. “I wasn’t able to be aggressive; I was a soft negotiator. I admired it when negotiators were more assertive, but because of cultural factors I couldn’t do it.”
Usama also taught in China for short while and saw how negotiation is different there, as it is throughout the Middle East. Though he can adjust his individual style to the culture, overall, he’s happy with it. “I believe using a softer negotiating style has given me good results. It’s softer than usual in the U.S., but it is still effective and I’m very satisfied with the outcomes,” he adds.
Now You’re Ready for Salary Negotiations
“When I speak to groups of nurses I have a joke: Everything in life is negotiable except for the salary of a staff nurse,” says Cardillo. Most hospitals have set salary ranges for nurses, sometimes negotiated by unions, until you go on to be a case manager, supervisor, or manager.
If you’re not sure if salary negotiation is appropriate in your role or organization, Cardillo suggests you probe with these phrases:
- Is there any way to … ? (Boost salary, add benefits, etc.)
- Are any adjustments available?
- Is there any room for negotiation?
Where to get salary survey info: professional associations, National Association of Colleges and Employers (NACE), Salary.com, jobstar.org, bls.gov, medzilla.com, career fairs, career development centers, and coworkers.
Even if you can’t negotiate your initial salary, you may be able to negotiate during a wage and performance review or an improvement plan meeting. “Most of the time, nurses are nervous going in to that type of meeting,” says Podlesni. “Take ownership of the discussion and go in prepared with information and knowing your desired outcome.”
For example, in a performance evaluation where a nurse is judged poorly, he or she doesn’t have to accept an unfair assessment. In one such situation, “an emergency room nurse was told she did not have timely emergency room skills such as inserting NG tubes,” Podlesni recounts. “I advised her that evaluations need to be conducted fairly and use consistent criteria across that board…I recommended that she request a video or documentation of someone doing the skill in the timeframe suggested. They were unable to provide this, and as a result, she received her $10,000 annual salary increase.”
During a wage evaluation, you can always negotiate for a higher salary or better benefits package. “Say your salary is $60,000 a year,” Podlesni says. “What stops you from saying ‘I love my job and want to keep working here, but I need to get to $65,000 a year to spend that much time out of my home and to pay childcare expenses’?” You may not get that raise but at least it starts a conversation and then you can decide if you want to stay in the job or if it’s time to find a better paying employer.
Believe in Your Value
Minority nurses bring an extra dimension to their work that they may not recognize and value highly enough. “Being Latina and bilingual, bicultural, we’re typically in a culture that doesn’t boast,” says Adriana Perez, PhD, ANP-BC, FAAN, assistant professor of nursing at the University of Pennsylvania School of Nursing. “We’re taught that you have to be modest, don’t call attention to yourself. It’s about building relationships and taking care of others. We have to balance humility with self-confidence.”
At the National Hartford Centers of Gerontological Nursing Excellence leadership development program, Perez learned the essentials of career success, including salary negotiation.
“AACN publishes mid-to-average salaries for professors that might not factor in additional skills or expertise,” she explains. “I’m bilingual, board-certified adult nurse practitioner, and researcher addressing health equity issues that are national research priorities. There aren’t that many Latina nurse scientists so it puts me in a great bargaining position. I can help the school meet its inclusion and diversity mission. But that’s not enough. I have to produce results and demonstrate a measurable impact.”
Polish Your Negotiating Skills
Many organizations offer professional development workshops that focus on cultural diversity, communication skills, negotiation, and conflict resolution. The leadership program that Perez benefited from included a career-enhancing mentorship relationship.
“We grew from mentor and mentee to now colleagues and friends. I attribute a lot of my growth to that program,” she says. “I recommend finding mentors. Study the leaders in your organization whose style you like and who are well-respected. Ask them for coffee: ‘Can we schedule some time?’ Nurses are giving and want to help. They’ll share lessons learned and will tell you about programs, scholarships, training, and other resources out there.”
It’s true that some nurses will never enjoy advocating for themselves. But it doesn’t have to be that way, with a little practice they can increase their confidence and ability. The end result: Better outcomes for everyone.
Having a good credit score can provide you with a lot of benefits—we hear that all the time. Did you know, though, that it may also help you with your nursing career?
We didn’t either. So we went to April Brissette, Chief Credit Officer of Bankers Healthcare Group. She took time to explain how good credit can influence your career and how to make sure that you have it (or fix it if you don’t).
Please explain why having a good credit score can boost your nursing career. Can it help you get a better job? Do employers now look at credit scores before hiring or promoting?
A lot of employers do background checks, particularly those hiring for professional level positions, and your credit score can be part of the background check. No one can pull your credit without your permission, but that is often in the fine print of the background check you sign off on. Of course, you can decline a background check if you’re concerned about your credit score, but that might be a red flag to the employer.
Your credit score can be viewed as a reflection of your character. Someone with good credit illustrates being trustworthy and responsible; someone with poor credit can paint a very different picture. If an employer sees that you have public records (for example, bankruptcy or tax lien) or you’re past due on accounts, it can tell a story about your financial history.
For temporary positions, like a traveling nurse, background research has a tendency to go up. Why? Because when you’ve had numerous employers for a short period of time, they may not be viewed as strong references.
As a representation of your financial health, your credit score can open or close a lot of doors—not just for financing approvals, but for even getting a job.
How can a nurse find out what his/her credit score is?
Sign up for CreditKarma.com—it’s a free app/website where you can access your credit score as many times as you want, and you pay absolutely nothing. (Advertisers use the site to market to people, which is why it’s free.)
It’s incredibly important to know your score; it’s a laborious process to get things removed, so you’re better off being informed about what your report says. Check it regularly. When you’re doing a self-inquiry—checking your score yourself, also known as a soft pull—it does not impact your score, and nobody will know your credit is being looked at.
CreditKarma alerts you about anything that affects your score and gives you recommendations on how to improve it, as well as approval odds for different financing options, tailored specifically to you.
Suppose nurses don’t have good credit scores? What can they go about doing to raise them?
The best way is to keep your accounts current: Pay everything on time.
Reduce or eliminate the amount of inquiries you have. Only have your credit hard pulled if it’s absolutely necessary. For example, when buying a car, you don’t want to have three dealers pull your credit—because dealers then send it to their banks and before you know it, a ton of people have accessed it and then your score drops.
Keep your revolving availability at least 50%, ideally 75%. Let’s say your available limit on your credit cards is $10,000 total; you want to ideally keep your balance at $2,500 or less, but never past $5,000. The lower your availability, the more your score goes down, and that can be an indication that you’re struggling, from a lender’s perspective.
It takes time to improve your score. The most derogatory credit items can remain on your report for 7 to 10 years. They will have the largest impact on your score when they first appear. Over time, the impact it has on your report decreases. If you’re coming back from a terrible life event, you just have to take time to work toward improving it—but it’s important to use that time to get your score back up by doing everything right.
Ask to be added as an authorized user/signer—perhaps a parent or spouse can add you to use their credit card or to just have you added to the account. It doesn’t make you the authorized payer, but it goes onto your credit report and history. Just be warned that if the actual signer is late, it will also affect your score.
What are some tips to create a good credit score?
The number-one common mistake that young professionals make is opening a ton of credit card and store card accounts. This increases the number of inquiries and hits your credit score. They think it’s helping build their credit because creditors want to give them a card, but it won’t help get your score up. Ideally, you should limit your inquiries to 1 to 2 times a year. Every six months, try to establish credit with an institution—a credit card, auto loan, etc. And remember, make all of your payments on time and don’t go over 50% of your limit.
Pay off your balances in full on your credit card every month if you can. There’s a misnomer that if you don’t carry a balance, it won’t help your score—but it’s actually the opposite. Pay off in full if you can.
Don’t over-borrow. There are a lot of lenders that will give you more than you should borrow. Be smart, and don’t borrow something if you can afford to make the full monthly payment comfortably.
What are some things that nurses absolutely should do or shouldn’t do with their finances to keep a good credit score?
Do not pay anything late, no matter what it is.
If you can make even the minimum payment, do it, because if something is late, it’ll show up on your credit report. Credit cards should be used as a tool rather than a crutch. Use them to get your rewards or in an emergency situation.
Put everything on autopayments. This is a great way to make sure your payments are never late. It’s a great safety net; it won’t get your balance down unless you schedule to pay it off in full, but it can reduce the stress in that you never have to worry about incurring a late fee. A lot of lenders will offer you a discounted rate if you set up auto-payments—just ask.
Do not co-sign for someone else. In our experience, what we see is a lot of borrowers will co-sign for their children for auto-loan/school loan, and their child doesn’t make the payment—then their credit score can suffer. There is a misunderstanding that as a co-signer, not the main borrower, you’re less of a risk or free from it, but it’s not true.
Should they see a financial advisor for help? If so, what should they look for in one?
I don’t think it ever hurts. Seeing a financial advisor might not do anything for your credit, but they can help you take control of your finances.
Do your research—choose someone who is a certified financial planner. The credentials prove they’re educated and certified.
Is there anything that you think is important for readers to know?
You wouldn’t want to miss out on the perfect career opportunity because you haven’t protected your financial health.
Lots of nurses get into the field because they like to help people and they get deep satisfaction from the nursing duties that allow them to do that. Many nurses are also fascinated with science and with always advancing their own knowledge to help patients or to discover how nursing can impact lives in the most helpful and positive manner.
With so many nursing career choices, those who are especially inclined to dig into the scientific background and facts around nursing might consider a role as a nurse researcher.
According to the National Institute of Nursing Research, “Nursing research develops knowledge to:
- Build the scientific foundation for clinical practice
- Prevent disease and disability
- Manage and eliminate symptoms caused by illness
- Enhance end-of-life and palliative care”
Nurse researchers are typically removed from daily patient interaction, but their skills are no less crucial. Using their knowledge and education, nurse researchers build a career designing, carrying out, and/or interpreting the results from studies. Researchers may follow their own interests to find out how to best advance care or cures or they might fulfill the research needs of their organization.
Beyond a nursing education, nurse researchers must have advanced training in research methodologies so they know how to design studies and interpret the results in an unbiased and accurate manner. This training is often obtained during MSN studies or even in a PhD curriculum (researchers are often funded for their PhD work). You’ll be able to explore your interests by focusing on specific areas, whether that is a disease, pharmacology, a body mechanic, or medical devices.
Nurse researchers are an important piece of the healthcare puzzle as they are able to establish the building blocks to help patients have a better quality of life, to cure disease, or to make the tasks of medical professionals easier, more efficient, and more effective. With your research skills, you’ll be able to examine how to improve the lives of individuals, groups, communities, and specific populations to bring to light new information or to interpret old information in a new and groundbreaking way.
If you are particularly interested in the science behind nursing, finding our more about a career as nursing researcher can set you on an ideal career path. Associations like the Eastern Nursing Research Society or the Midwest Nursing Research Society are great places to start investigating.
You gave your patient a shot and he or she passed out! What did you do wrong? Nothing.
No patients were harmed in this photo.
Vasovagal syncope is one of three related syncopes that share a common pathophysiology. Together, they are called reflex syncope. The three are vasovagal, carotid sinus, and situational. Vasovagal is what just happened to your patient. Pain, seeing blood, emotional reaction, and prolonged standing are triggers of vasovagal syncope. Situational is triggered by urinating, coughing, or swallowing. Carotid sinus is triggered by stimulation of the nerve bundle located in the carotid sinus of the neck.
These neurologically induced losses of consciousness are brief and resolve without specific treatment. They are usually preceded by feeling dizzy, sweating, tunnel vision, odd feeling in the chest, or feeling very hot or very cold. The pathophysiology is an abrupt slowdown of the heart rate and a dilatation of the blood vessels leading to hypo-perfusion of the brain. Basically, the pump can’t get blood to your brain and you pass out…and you fall down.
First of all, it’s important to NOT PANIC. There is nothing you can do to fix it. Prepare for it by observing your patient immediately after giving an injection or drawing blood because these are prime times for a vasovagal episode. Make sure the patient is already seated and if you notice your patient is getting pale, sweaty, stuttering, or acting odd, gently guide your patient to a lying position with the feet up. Sometimes the loss of consciousness comes with muscle twitching that looks like a seizure. Unlike a seizure, there is no prolonged postictal period, muscle clenching, or incontinence. While the loss of consciousness will resolve as soon as the patient lies (or falls) down, he or she will probably pass out again if he or she gets up so keep the patient under observation and lying down. It’s a good idea to get serial blood pressures so you can document the resolution. Every five minutes is fine. Your first blood pressure will be low with a heart rate in the 60s or high 50s. Over the next five to 15 minutes the vasodilatation and bradycardia will resolve without intervention but if you let the person stand up…boom! Don’t let the patient get up until they have a documented normal BP and HR. You can bring them a blanket, a drink of water, some juice, anything you like. Nothing is going to make it resolve any faster.
How do you know it’s vasovagal syncope? Easy: Did you just give this person a shot, draw blood, or let them see a bloody bandage or wound? If so, did they then get pale and sweaty and fall down? When they were horizontal, did the loss of consciousness resolve? Yes? That’s it! The only thing you can do wrong is try to stand them back up again!
So what do you do if this happens to your patient? To recap, don’t panic, make sure the patient is safe, call for help, get serial blood pressures, and observe the patient until the BP and heart rate are normal. Usually there is no need to call for an ambulance unless the patient actually fell down and hit his or her head or the symptoms are not resolving.
Remember, it’s a common occurrence and patients that are prone to it will probably do it again. You didn’t do anything wrong!
For 41 years, nursing assistants have celebrated National Nursing Assistants Week during June. Career Nursing Assistants Day on June 14 kicks off the week of honoring the nursing assistants who care for elderly or disabled patients, especially in long-term care facilities, hospice care, home care, or nursing homes.
According to the National Network of Career Nursing Assistants, nursing assistants are a vital connection to patients as they help them with the basic care and activities of daily living. They help patients feel cared for and comfortable, while also providing the essential hands-on care that keeps patients healthy. While helping patients do things like bathe, eat, or gain movement, they are also able to form trusting relationships. Nursing assistants spend so much time with patients they are able to get to know them and learn about their lives.
When patients are away from the comforts of their home or far away from family and friends, nursing assistant s give a companionship so necessary for feeling better. They provide a gentle care from which patients and residents feel respect and a sense of belonging. When nursing assistants greet them by name and ask about their health or their physical ailments, they are taking an assessment of how the patient is doing on a basic physical level. Those are assessments that are essential to the medical team that oversees the patient.
But because of their close proximity to people, nursing assistants are also able to ask about the favorite foods of patients or residents, their upbringing, how they celebrated milestones, and family and friends who were once or are still close to them. They may get to know the visitors who come often and are able to hear and share stories with them. With that kind of knowledge, nursing assistants have many topics of conversation they can use to engage patients. Their familiar presence becomes reassuring and comforting as a patient’s moods may go up or down or as their physical discomfort increases or decreases.
According to the Bureau of Labor Statistics, the demand for this role will continue to rise at a faster-than-average rate. Those looking to get into this career field will find plenty of opportunity to offer compassionate and skilled care to populations that needs it most. The median salary of $27,500 annually will fluctuate with location and demand, and you’ll need to pass a competency exam. Like other jobs in the medical or care field, the work can by both physically and emotionally demanding, but the rewards of caring for patients and making a difference in their lives is great.
Help celebrate National Nursing Assistants Week by noting and thanking nursing assistants for the tremendous work they do.