Stress in nursing is most likely attributed to the physical and emotional demands of patients and families, work hours, shift work, interpersonal relationships, and other pressures that are central to the work nurses do. Stress adversely affects the health, safety, and well-being of nurses, patients, and health care organizations alike; therefore, it is essential for nurses to reduce job stress and increase their happiness through their work.
Studies show that loving your job has less to do with your job and more to do with you. That’s right, there are simple ways you can ensure your own happiness at work every single day. Because happiness is the sum of love, optimism, purpose, courage, productivity, health, perspective, humor, and fulfillment, you must manage to achieve. Happiness won’t come to you if you do nothing.
Here are six simple actions you can employ to reduce stress and enhance your happiness.
1. Find out what makes you happy.
When you know the answer, you can add it to your life. If you are not sure, you should start taking detailed notes whenever you feel happy.
2. Create and write down a daily goal of joy each day.
Creating a goal allows you to focus on who you are in the moment, recognize and live your values, and achieve your emotional energy and happiness. Try to create one thing that you can look forward to each day at work, whether it’s seeing a specific coworker or your special lunch break. Whatever it is, the simple act of looking forward to it will increase the happiness you associate with work.
3. Make yourself familiar and comfortable with each of your coworkers and patients.
Studies show that working with unfamiliar coworkers and in different settings negatively impacts you at work. Make sure that you take time to introduce yourself to your coworkers and get to know your patients. Being familiar with your coworkers and patients increases your confidence and happiness at work.
4. Be optimistic.
Research shows that positive people are less likely to become ill. Optimism has been linked to an improved sense of well-being so try to look on the bright side whenever you can.
5. Love yourself and take care of your health.
Caring for yourself must be a priority. Eating well, staying hydrated, and getting enough sleep can make you feel good. And when you feel good, you have the physical and mental energy to work through daily challenges and focus on what’s good about the day. Make time to do the things that make you happy in the moment as well, such as listening to your favorite song during a lunch break.
6. Last but not least, put a smile on your face, act happy, and laugh every day.
Acting happy and keeping a pleasant expression on your face puts your mind in a positive state. Try to let go of negative feelings and learn to forgive because forgiveness will help give you inner peace.
Around the world, patients rely on transplant nurses to help them navigate the complicated path to a transplant.
To honor the work these nurses do, the International Transplant Nurses Society (ITNS) established Transplant Nurses Day to be held annually on the third Wednesday in April. On April 18 this year, transplant nurses around the globe will celebrate the life-saving, life-giving, and life-changing work they do.
From its Chicago, IL headquarters, the ITNS helps nurses around the world connect with others in this specialized field and offers information to remain professionally current.
Transplant nurses work with patients who are having or have had solid organ transplants, so in addition to patient care, they also must stay current with the advances in transplantation itself. Education and professional growth are topmost issues for ITNS and nurses are encouraged to remain continually engaged with learning.
Transplant nurses have particular concerns about their patients and will interact with them along the entire spectrum of their transplant care. Theses nurses can specialize in one particular area—transplant coordinator, staff nurse, or post-operative, for instance—but understanding the entire transplantation spectrum helps them offer better care.
And while Transplant Nurses Day is a highlight of the year, the society also offers awards for transplant nurses and a yearly essay contest (the winner is announced on Transplant Nurses Day). The organization helps nurses interact with other nurses in the same specialty. Hearing from and learning from others in the field helps bring a fresh perspective and a new drive to their personal and professional commitment. Celebrations and struggles are understood and tips about certification or insight into transplant patient care can be shared.
And because transplant nurses work with more than just the patient, they are also able to address issues related to the family and loved ones of transplant patients. The ITNS Foundation offers grants and scholarships for professionals who want to further knowledge in the field as well.
Help the transplant nurses in your life celebrate their success on Transplant Nurses Day!
A nursing career in public policy was considered unique decades ago. However, increasingly nurses have developed the skill and expertise needed to inform the policy-making process through their professional and voluntary endeavors. Nurses now serve in numerous leadership roles where they use their health policy expertise to shape the policy discourse, monitor the impact of legislation, and oversee regulatory processes.
In addition to the increased numbers of nurses working in governmental and nongovernmental agencies, nurses serve as elected officials and work as health policy consultants or health care lobbyists. Regardless of role or setting, nurses working in the policy arena are required to use their public policy acumen to inform legislation, oversee regulations, or advocate for policies that are of benefit to consumers, patients, and the profession.
Nurses serving as elected/appointed officials or health care lobbyists are immersed in the policy-making process and have a front row seat in influencing the public policy agenda. Both opportunities require a comprehensive knowledge of the complexities associated with lawmaking and a willingness to listen and assess varying perspectives. The ability to communicate well and build partnerships while working with diverse stakeholders cannot be overemphasized.
Noteworthy, three nurses are serving as elected officials during the 115th Congress. Representative Karen Bass, APRN, represents California’s 37th congressional district and is in her fourth term. Congresswoman Bass serves as a ranking member of the Subcommittee on Africa, Global Health, Global Human Rights, and International Organizations.
Representative Diane Black, BSN, has represented Tennessee’s sixth congressional district since 2010. She serves on the House Ways and Means Committee.
Representative Eddie Bernice Johnson, BSN, is the first nurse elected to the U.S. Congress and is now in her thirteenth term representing the 30th congressional district of Texas. Representative Johnson serves on the House Committee on Science, Space and Technology; House Transportation and Infrastructure Committee; the Aviation Subcommittee; the Highways and Transit Subcommittee; and Water Resources and Environment Subcommittee.
Many nurses are familiar with former representative, Lois Capps. Capps represented California’s 24th congressional district after winning the seat in 1998 after her husband died in office. She championed numerous nursing and health care issues and started the Congressional Nursing Caucus.
No doubt, other nurses are well poised to follow suit bringing their expertise to an elected office. For example, Lauren Underwood launched her campaign last fall to represent the fourteenth congressional district in Illinois. Underwood brings a wealth of nursing and government expertise and is passionate about ensuring access to high-quality health care for all.
Nurses are also well suited to serve as health care lobbyists because of their vast knowledge of nursing, health, and health care. An extensive knowledge of these and other areas is critical to advocating for legislation aimed at improving access to health care, enhancing health outcomes, and transforming our health care delivery system. Additional competencies needed for such a role include strong interpersonal communication skills, research/analytical skills, detail orientation, knowledge of political, legislative, and regulatory processes, and the ability to create and deliver messages to a wide array of diverse stakeholders including legislative officials. Health lobbyists are responsible for conducting policy analyses and summarizing information that is suitable for a variety of audiences. Nurse lobbyists may work as a consultant employed by a professional/specialty nursing or non-nursing organization, health care facility, insurance company, or pharmaceutical company, to name a few.
The current push to increase the number of nurses serving on boards provides yet another opportunity for nurses to become more engaged in aspects of the policy-making process. Depending on the mission of the organization, board members may be responsible for shaping a legislative or advocacy agenda on behalf of the constituents they serve. To illustrate, I acquired some of my health policy skills while serving as the Chair of Public Policy for my local Susan G. Komen Affiliate. In this capacity, I along with board members advocated for breast cancer funding for underserved women and helped to shape and monitor the organization’s legislative agenda. This experience provided a unique opportunity for me to serve as a lead spokesperson providing testimony before my state legislature regarding the “Reducing Breast Cancer Disparities bill.” This bill includes significant provisions designed to reduce breast cancer disparities among underserved and underinsured women across the entire state.
In addition to some of the previously mentioned career opportunities in the health policy arena, nurses in the following roles utilize their policy knowledge and expertise to advance the nursing profession and transform today’s health care delivery system:
- Dean/Associate Dean of a School or College of Nursing
- Director of Government and/or Regulatory Affairs
- Office of Government Relations
- Director/CEO of a Government Agency
- CEO or Executive Director of a Nonprofit Health Care Organization
- CEO of a Professional Nursing Organization
- Chief Nursing Officer
- Surgeon General/Assistant Surgeon General
- Chair of Health Policy Committee for a Professional or Specialty Organization
- Health Commissioner
- Board Member for a Health Department, Hospital, or Community-Based Health Care Organization
- Chair of a Health Policy Committee for a Voluntary Organization
- Nurse Attorney
- Hospital Administrator
- Executive Director of a State Board of Nursing
- Health Policy Analyst
- Nurse Regulator
Nurses wishing to pursue a career in health policy can begin by first identifying what is most important to them. Nurses who do not have a background in political science or law may need to invest in professional development through formal/informal education. Taking health policy courses is a good step as such course work provides an overview of the policy-making process and may provide some exposure to in-person or virtual lobbying.
Getting involved with the advocacy/legislative arm of one’s professional or specialty organization is yet another great way to gain exposure and experience related to the policy-making process. Many nursing organizations have a policy agenda and work to ensure that their voices are heard on things of importance to the profession and those they serve. Serving as an intern in a legislative office for an elected official may also provide some beginning exposure to the policy and legislative process. These types of experiences can enhance one’s credibility when launching a career in public policy.
Participating in health policy fellowships, internships, or other structured immersion activities can go a long way in laying the foundation for future engagement in the policy arena. I cannot overestimate the value of talking with those already in the field. Elected officials, nurse/health care lobbyists, and individuals currently running for office as well as other nurse leaders can provide valuable insights regarding the expectations for this type of role. Attending a state board of nursing meeting is another excellent way to become acquainted with the regulatory aspects of the policy-making process. Finally, staying abreast of current and emerging issues in health care and nursing provides a critical foundation for future advocacy and political activism in the health policy arena.
Nurses aren’t just meant for hospital work, as they have plenty of career options to choose from now. Spending time and money to prepare for nursing school opens a wide variety of opportunities, which can help you recover your investment even without the need of pursuing a job at the hospital. Here are five non-hospital jobs you should consider.
1. Cruise Ship Nurse
This position provides many registered nurses the benefit of work and travel at the same time. Working as a health care provider on an ocean liner definitely has some similarities and differences with those of land-based jobs. Like most hospitals or clinics, you would need to have a Bachelor of Science in Nursing degree, but nurses who have earned their master’s degree are given priority.
Those who aspire to work on board would need to have their registered license of course and certifications for both Basic Life Support (BLS) and Advanced Cardiovascular Life Support (ASL).
Below are the expected skills of a cruise ship nurse:
- Organizational skills for document sorting
- The ability to stay calm under pressure
- Critical thinking
- Excellent communication skills with a pleasing personality
- Good problem-solving skills
- Must be emotionally stable at all times
Employers hire those who have at least two to three years of working experience, preferably in emergency or acute care. Since you will be working with a small staff and limited supply, these responsibilities will be divided between each personnel:
- Direct patient care (from first aid to a serious medical case)
- Oversee proper patient documentation
- Provide first aid training
- Assist in staff drug testing
- Conduct lifeboat safety drills
- Check and restock medical inventory
- Accompany patients or evacuees to land facilities via small boat or helicopter
Typical schedules would be 10 to 12-hour shifts with one day off (on rotation) and a high possibility of on-call situations. The contract presented to nurses would run a minimum of 6 months to 1 year depending on the cruise line and the salary offer would be around $3,000 to $5,000 per month.
Some pros for this job include: all-expense paid travel, large workloads earning better experience, and great for those who settle for short-term and recurring contracts.
However, the cons of this job would be the very strict and competitive market (e.g., employers preferring nurses with bilingual skills or work experiences in multicultural settings), small salary rate, and having to be away from loved ones, especially those who are tied with responsibilities at home.
2. Nurse Coach
Are you considered a great influencer? Then being a health coach might be the perfect career for you! A lot of companies (including insurance firms) hire these nurses to assist employees (especially those with chronic diseases) with achieving their health goals.
Nurses who have a BSN are qualified to apply for this job, but note that a master’s is preferred for this role as well. You can be board-certified as a nurse coach (NC-BC), a holistic nurse coach (HN-BC), or a health and wellness nurse coach (HWNC-BC). The American Holistic Nurses Credentialing Corporation is the agency that administers the certifications. To learn more, visit ahncc.org.
Here are the skills that are expected for this particular career path:
- Must be confident
- Exercises self-control at all times
- Very patient and understanding
- Must have knowledge regarding lifestyle-related topics and chronic diseases
- Must be optimistic
- Excellent communication skills and influence
- Excellent personnel management
- Must be willing to cooperate and collaborate with the client
- Excellent problem-solving skills
- Must have initiative
Employers expect each health coach to work closely with their clients and make sure that each responsibility is met:
- Empower patients with chronic illnesses to live a healthy lifestyle
- Teach proper health care to avoid further medical complications
- Help client realize health goals and construct a SMART (Specific, Measurable, Achievable, Realistic, Time-based) plan to achieve it
- Conduct health-related wellness seminars and training
There are many pros to this career, such as a possible salary of $66,000 per year, the benefit of working with diverse personalities, and a wide range of employers.
Personal stress, uncontrollable shifts (on-call situations), and unruly clients/patients could be some of the cons to this job. However, you should always have yourself ready for these can be present in any work environment.
3. Insurance Firm Nurse
If you have a knack for organizing documents, interviewing clients, and resolving complaints, then you might want to consider working for an insurance firm.
Of course, aspirants would need to have a BSN or MSN degree and a RN license to practice. On top of that, a minimum of 2 years work experience is needed.
An insurance firm expects that every candidate possesses these skills:
- Organizational skills, such as documentation and bookkeeping
- Problem-solving skills for case handling
- A keen eye for analytical situations
- Interpersonal skills
- Good personnel management
In this field, multiple positions are available for both LPNs and RNs, such as:
LPN available positions
- Appeals Nurse Associate: handles member appeals and resolves complaints and grievances.
- Health Coach Associate: works with the employees of an organization where health challenges are identified to create wellness campaigns and incentive programs to reduce member complaints.
- Quality Management Nurse Associate: conducts interviews and reviews along with health care providers to promote the highest quality of medical procedures and outcomes.
RN available positions
- Health Coach Consultant: manages lower level associates and conducts campaigns for both organizations and facilities to improve overall performances for companies or hospitals.
- Nurse Educators: educates patients on an academic level regarding selected medical professionals as well as appropriate medical treatment. This is only for rerouting and no medical advice can be provided by these nurses.
With the diverse tasks given out to nurses who work in an insurance firm, they are able to earn as much as $80,000 per year.
The pros of this career include being home-based work wherein they can just appear in the office for about 2 to 3 times a week, which leads to another pro: more family time!
A disadvantage is that it is more clerical than medical and if needed, you might be called to work in out-of-state field cases.
4. Medical Sales Representative
This field needs nurses who have very influential vocabularies and can close sales. If you think you can turn a hard “no” into a graceful “yes,” then being a “med rep” is the job suited for you!
It doesn’t strictly need a bachelor’s degree in the medical field, but one requirement is that your degree is health care, life science, or marketing-related. You should also consider becoming certified, which you can apply for with the National Association of Pharmaceutical Sales Representatives (NAPSR).
To be a successful sales representative, these skills are must-haves:
- Pleasing personality
- Well-versed and influential
- Excellent communication skills
- Knowledgeable about medical updates, especially in the field of technology and treatments
- Have a keen eye for analytical situations
- Organizational skills for document preservation and revision
This field is very competitive and challenging because of the following responsibilities:
- Establish and maintain relationships with possible clients
- Provide newly developed samples of medicinal products or equipment
- Document and organize the records of all established contacts
- Monitor and analyze competitor’s products and actions
- Appointment setting with clients with a well-presented discussion of new products
Of course, with every difficult task and every sweet “yes,” sales reps are rewarded with a high salary that could reach up to almost $96,000 PLUS a bonus or incentive for each sale that one makes. Based on a 2017 salary report, the average overall compensation for a sales rep reached up to a whopping $147,424. Hard work definitely pays off!
Building connections with suppliers as well as creating ties with clinical offices that could possibly be the next workplace are just some of the pros of this job. Don’t forget the high salary and incentive!
However, the price comes with a demanding workload and honesty. Even the best salesman still gets a “no” from time to time so expect that another con would be the days without commissions.
5. Parish Nurse
This field is a combination of tasks that are present in both health coaching and insurance firm nurses. This focuses on a more holistic approach to a person’s health.
To enter this career, applicants would need to have a BSN or MSN degree. A nursing license registered in the same state as that of the parish is required along with 3 to 5 years of nursing experience.
Some parishes also require that candidates undergo theological classes, which could run for about 1 to 2 weeks.
Here are the skills needed for this role:
- Excellent communication skills
- Pleasing personality
- Familiar with spiritual and cultural activities
- Ability to refer patients to other medical professionals
- Knowledgeable about nursing practices, medications, tools, and equipment
Responsibilities for parish nurses may include:
- Personal health counseling to the faith community
- Training volunteers
- Assisting in developing support groups
- Educating the community on self-care and personal first aid
- Referring patients to medical facilities and professionals for direct treatment
Taking all of the responsibilities into consideration, it comes as no surprise that the salary range for a parish nurse is anywhere from $45,000 up to $92,000 per year, according to Payscale.com.
A few benefits of this career include the perks of working close to home since you will be at your local parish daily and the power to gain complex knowledge that only priests can provide.
On the other end, you will not be providing any direct treatment and there will be instances of out-of-city work that you would need to attend along with the authorities of the parish.
Helping other people is not bound by the white walls of an emergency room or by the great halls of a hospital. These settings certainly allow nurses to further diversify their experiences and gain more knowledge as a basic and holistic health care provider. With this, nurses can definitely expand the use of their medical expertise.
How often should a man get breast and cervical cancer screenings? Should a woman get screened for prostate cancer? The answer to these questions and more depends on knowing if your patient is transgender.
The Williams Institute estimated the transgender population in the United States to be 1.4 million in 2016. A recent study in Minnesota of 9th and 11th graders found nearly 3% of students identify as transgender or gender non-conforming. When it comes to health care, are we ready to meet these patients’ needs? Several cases where a transgender or gender expansive person was not properly identified or their provider simply was not aware of issues regarding transgender individuals have been in the news lately.
My county hospital is rolling out changes to our HIMS to try to capture this complete information on all of our patients, including transgender and gender expansive patients. These questions are called SOGIE, which stands for Sexual Orientation, Gender Identity, and Expression, and we ask them at intake:
- What is the sex listed on your original birth certificate?
- What is your gender identity?
- What is your sexual orientation?
Source: Benny O’Hara, Office of LGBTQ Affairs, County of Santa Clara
Our initial goal is to capture 10% of our patient population with rolling increases as we move forward. In the hopes of meeting all of our patients’ needs we will ask these questions just one time over the patient’s lifetime. However, the patient can initiate changes at any time in the future.
Our LGBTQ patients can have health issues that are occult if we don’t have correct data. A female-to-male, or FTM, person with residual breast cancer did not know he needed breast cancer screenings. By the time it was diagnosed, the cancer was advanced. Another patient, male to female, or MTF, did not discover her prostate cancer until it metastasized to her bones.
What are the barriers to care for transgender patients? The first is the patient’s comfort with disclosing information about their sex assigned at birth and current gender identity. For a variety of reasons, transgender and gender expansive patients might not trust their caregiver or the health care system in general. A person who has transitioned has spent a great amount of personal capitol to live the life they need to live. It’s not a lifestyle change. It is the core of a person’s being.
A 16-year-old patient who has made the transition from female to male tells me, “I’m not transgender. I’m a boy.” He does not identify as transgender. Practitioners find this a common outlook in their transgender patients. Some transgender individuals may feel that they have always known their gender, and that it was society and other persons who incorrectly assigned or perpetuated a gender identity on their behalf – one that did not ring true for them. Sharing of this information with a caregiver who is not familiar with the patient might not happen if the patient is not trusting or believes the information is not germane to the situation. For a primary care provider not in the know, this creates problems with preventative care with serious consequences. The SOGIE questions start a conversation that might not otherwise have occurred.
Another barrier is on our side of the street. Are we comfortable asking a patient if they are gay and/or transgender? While rolling out our new SOGIE questions, we find push back in unlikely places. Care providers and nurses at our in-service had these objections:
“My patients will be insulted.”
“Patients of some cultures will be offended if I ask that.”
“Some patients will not understand the difference between sexual orientation and gender identity.”
“This will take too much time.”
For some, a supposed patient objection is a mirror of their own feelings. “I would be offended if someone asked me if I’m gay.” For others, cultural taboos of their own might get in the way. Are we projecting our issues onto our patients? Personally, I’m excited to see my patients’ reactions to the questions and I look forward to educating them on the meaning of the terms. It’s a valuable tool to identify health care needs and an opportunity to destigmatize a subject that might seem uncomfortable.
You can’t tell if a patient is gay, straight, or anything else just by looking. The original birth certificate does not indicate the patient’s current sexual orientation. Often, a transgender person will legally change their birth certificate to reflect their correct gender identity. We just don’t know by looking at a person or their documents what gender identity or sexual orientation they are. Health issues can’t be addressed if we don’t know.
Annette Smith, a nurse at Santa Clara Valley Medical Center in San Jose with 35 years of experience, has insight into changes in practice like the new SOGIE questions: “At the beginning, there is a lot of push-back. ‘The sky is falling! The sky is falling!’ But after a while, the process becomes normalized and it’s not a big deal. We end up wondering what all the fuss was about!”
A paper or electronic patient health care information record serves two major purposes: communicating information both within and outside the practice and creating written history in the event of later questions or challenges. Complete, accurate, and legible health care information records document all phases of medical treatment, including the care plan, laboratory and diagnostic testing, procedures performed, and medication provided.
The new Nurse Practitioner Claim Report: 4th Edition from CNA and Nurses Service Organization (NSO) analyzed 287 closed professional liability claims against nurse practitioners (claims that resulted in an indemnity payment of $10,000 or greater) over a 5-year period. The report’s analysis revealed that the majority of claims against NPs resulted from an alleged failure involving core competencies, and demonstrates that nurse practitioners are responsible for reviewing, following up on, and documenting the results of appropriate tests and consultations in a timely manner.
The following general principles of documentation can help the practice maintain a consistent, professional patient health care information record:
- Ensure that hard-copy notes are legible and written and signed in ink, and also that they include the date and time of entry.
- Avoid subjective comments about the patient or other health care providers.
- Correct errors clearly by drawing a single line through the entry to be changed.
- Sign and date the correction, as well as the notation giving the reason for the change.
- Do not erase or obliterate notes in any way. Erasing or using correction fluid or black markers on notes may suggest an attempt to purposefully conceal an error in patient care.
- Document actions and patient discussions as soon as possible after the event. If it is necessary to make a late entry, the entry should include the date and time, along with the statement, “late entry for ______” (i.e., the date the entry should have been made).
- When dictating notes, include all vital information, such as date of dictation and transcription. Sign transcriptions and write the date of approval or review.
- Never alter a record or write a late entry after a claim has been filed, as this may seriously compromise legal defense.
- Develop a list of approved abbreviations for documentation purposes. Review and revise the list as necessary and at least annually. In addition, maintain a list of error-prone abbreviations that should never be used, such as this one from the Institute for Safe Medication Practices.
- If using a form, complete every field. Do not leave any lines blank.
Furthermore, to help nurse practitioners avoid this segment of risk, nurses should ensure their practice has a written policy governing documentation issues, and all staff members are trained in proper documentation practices. The policy should address, among other issues: health care information record contents, patient confidentiality, release and retention of patient health care information records, and general documentation guidelines.
And while rare events may be difficult to prevent, nurse practitioners can glean lessons from the experiences of their colleagues to help evaluate and enhance their own patient safety and risk management practices.
Disclaimer: This article is provided for general informational purposes only and is not intended to provide individualized business, risk management or legal advice. It is not intended to be a substitute for any professional standards, guidelines or workplace policies related to the subject matter.
This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to [email protected] or call 1-800-247-1500. www.nso.com.