When Nick Escobedo DNP, RN, OCN, NE-BC, director of Inpatient Oncology at Houston Methodist Hospital, started his nursing career, he didn’t expect to land in oncology nursing. During May’s recognition of Oncology Nursing Month, Escobedo says the career has offered distinctive opportunities for personal and professional growth.
“I went into a basic acute care setting right out of nursing school because I wanted to get a good, solid foundation for myself in practice,” Escobedo, a former president of the Oncology Nursing Certification Corporation, says. But the learning process opened up new, and appealing possibilities. “I had an opportunity to learn the skill of chemotherapy,” he says, “and the more I got to learn about it and spend time working with patients, I quickly learned this specialty was for me, and I wanted to do that full time. It chose me.”
What sets it apart from the science and the practice part of nursing, he says, is that cancer affects every body system. Oncology nurses treat patients through a span that lasts from cancer diagnosis to remission or to end of life.
“I got to use my critical thinking skills, and I got to have knowledge of all the latest and greatest therapies available,” he says. Escobedo, a dedicated lifelong learner, says it’s imperative that he stays on top of understanding new technology and the range of cancer drugs and treatment options available to patients and the safest ways to administer them.
Thankfully, oncology nursing is very collaborative, he says, and so nurses work with physicians, frontline providers, therapists, chaplains, nutritionists, clinical pharmacists, and volunteers to understand how the different pieces help drive the care of a patient. Escobedo says a nurse might check in with a clinical pharmacist to find out more about a particular drug to learn about interactions, how a patient might respond to it, and how to use it safely.
Additional education is essential for oncology nurses, he says. “My journey toward certification was big,” he says. “That was one of my ways at looking at my competence as a clinician, to say I was an expert in the care of oncology patients. So my journey to pursue that certification and have knowledge to be successful was key. I’m a big advocate for certification.”
To balance the intensity of understanding the drugs and treatments used for cancer, Escobedo says the relationships oncology nurses develop with their patients is special. “You develop long-term connections with patients and their family members,” he says. “They give so much of themselves.”
Those strong connections can help nurses and patients through the celebrations of successfully completing cancer treatment or the more difficult prognosis or outcome. “This is very hard work,” says Escobedo. “The reward is that we get to do that work, but we need to balance that with resilience. This is tough work and we have to promote and champion a little of that balance. We try to look at the celebrations that happen.”
The success stories are uplifting and have a lasting impact on nurses. “We hear from patients who were treated years ago, and they come back to check in,” he says. Patients relay news of celebrating weddings and anniversaries and the arrival of children and grandchildren. Some have even paid it forward and after being treated for cancer, have embarked on fundraising campaigns to help others.
“Our patients push us to have that drive,” he says, “And we see lots of really good outcomes.” Patients can go through treatment that is long term and so being able to go through the process with them is something oncology nurses find so rewarding, says Escobedo.
Escobedo encourages nurses who are interested in exploring oncology nursing to find a way. “If you think you could be good at it, why don’t you try it?” he says. Find good mentors and be sure to seek out projects and opportunities that will get you out of your comfort zone. “Nurses don’t get lots of oncology nursing experience through training or nursing programs,” he says. “This is a full and rewarding specialty.”
Remember when you’d run home with your report card to show your parents how you did in school? Or were you the kid who hid it at the bottom of your bag so they wouldn’t see it? Well, your nursing career deserves a report card, too. So how’ve you been doing, and what grade do you think you deserve?
Report cards can measure performance, communication, talent, intelligence, diligence, attention to detail, time management, relationships, and many other categories. In some schools, letter grades are the norm, while in some alternative schools, there are no grades. Sometimes, our report cards are pass\fail, and we either make the cut or don’t. And sometimes, those grades don’t seem fair.
The Nurse’s Report Card
The nurse’s career report card can look different for everyone, and there are various classifications we can use to measure a nurse’s success. What do you think you excel in, and what could use a boost?
If we look at clinical performance, we can examine and assign a grade to different assessment skills (neuro, psych, cardiac, respiratory, etc.). Clinically, nurses also need to do well in collaboration, communication, documentation, and patient relationships. And those nurses who work in non-clinical roles (like yours truly) need an entirely different measure of their skill sets and responsibilities.
While I don’t use any clinical skills in my current career manifestation (except with friends, family, neighbors, and the occasional stranger on the street), I still think of myself as a nurse and have judgments about where my greatest and weakest skills manifest.
Do you play well with others? Do you readily share your toys? Do you hand in your homework on time? What would your nursing report card say?
What’s on Your Nursing Career Report Card?
Aside from evaluating and assigning value to your clinical skills, let’s examine your career. For those of you familiar with my blog or podcast, some of these will be familiar since I talk about them ad nauseam. Nevertheless, taking a few moments to assess yourself in a new way is important. Shall we?
Your career toolbox:
Let’s review what this means. Inside your nursing career toolbox is your basic resume, skeleton cover letter, and thank you note; your LinkedIn profile and LinkedIn strategy; your business card (yes, you need one); apps and tools that make your life easier; your professional network; and whatever else moves the needle for you.
If you were to give yourself a grade on the state of your career toolbox, would you get an A? Where could you lean in a little bit more?
Time management:
Time management can be a bear for anyone living in the 21st century. However, since nurses are more apt to care for their neighbors, friends, family, and even strangers, we can be hard-pressed to find time for some aspects of our lives that should receive at least a little attention.
What kind of a grade would you get for your time management skills? How often are you late for appointments? How often do you get home from work much later than you’d like? How badly are you challenged in managing your time professionally, and how does that impact your family and personal life?
Self-care and wellness:
Self-care and personal wellness can be inextricably connected to time management since we can easily let go of our self-care when time slips through our fingers. Get to the gym? “Impossible!” Take a leisurely bath? “Are you kidding me?” Go to a movie? “How indulgent!”
How badly are you falling down on the job of self-care, nurses? What would it take to reprioritize it again and get it back on the calendar? Is it solely a time management issue, or do we need to give you a D for prioritizing your health and well-being?
Collaboration, teamwork, and relationships:
Teamwork and collaboration are about getting along with others in the sandbox. Collaboration is key in most nursing and healthcare sectors; some of us are better at it than others. Is working on a team hard for you? Do you chafe at sitting through committee meetings? (I know, I know; meetings are usually deadly boring.)
If you work in home health, you must collaborate with the therapists, case managers, schedulers, and aides. In med/surg, you talk with doctors, surgeons, RTs, interventional radiologists, and other nurses. It’s a circus of personalities and ways of being.
Teamwork, collaboration, and professional development are so important; how are you doing? Is there something that needs to change so that you develop yourself in this career area?
Networking:
Many nurses wait to do assiduous networking until they’ve lost a job and are in the job market, desperate to find work. You’ll likely get a D or F in this category if you’re not consistently and actively building your network and nurturing professional relationships.
Happiness and satisfaction:
Being happy in your personal and professional lives should be measured on your career report card. Maybe you do all the “right” things, but you’re still miserable; in that case, something has to give.
Your resume may be awesome, and your nursing skills could be through the roof, but if you’re in the dumps every day about the direction your career is heading, it’s time for a change.
What is it that makes you tick? Where do you find satisfaction? How do you manifest joy in your life?
How would you grade your personal and professional happiness and satisfaction? Be honest!
Career/professional development:
It’s easy to fall into stagnation in your nursing career. We’ve likely all done it at times, and this type of complacency can lead to burnout, compassion fatigue, and downright unhappiness and misery.
Career development means different things to different nurses, depending on where you are in your nursing career.
For you, it might mean earning a BSN, MSN, PhD, or DNP. For someone else, it’s volunteering and meeting new people. For yet another nurse, it might entail becoming an EHR super-user or joining a QA committee at work. Finally, you might join your state nursing association and learn how to lobby your legislators about important public health bills under consideration. Career development is a personal journey, and how you develop your nursing career is as idiosyncratic as it is important.
Meanwhile, we acknowledge that there are times when doing anything about our careers is the furthest thing from our minds. When a baby has been born, a parent is ill, or a spouse is disabled or out of work, the personal understandably takes precedence over the professional. But when the dust clears and life is more or less on an even keel, it’s time to lean in again.
Make the Grade
Nurses, no one but you issues your career report card unless you engage with a career coach or other professional to help you raise your grades. Sure, I can tutor you in resume writing, LinkedIn, interview skills, and networking, but the final grade is up to you.
Would you like to change that calculation if you’re playing well with others but aren’t getting enough recess?
If you stay current on evidence-based nursing research but haven’t upgraded your resume in a while, is that an area worthy of focus and attention?
Have you made your well-being so low on the priority list that your health has suffered? Are you OK with that?
Making the grade is about you, what you want, and where you’re going in your nursing career. It’s not about the pressure from others about what they think you should do. It’s all about what will bring you the most joy, health, satisfaction, and professional success you desire to create for yourself.
Your Career Homework
Review the seven categories listed above and grade yourself between A+ and F. To review, they are:
Your career toolbox
Time management
Self-care and wellness
Collaboration, teamwork, and relationships
Networking
Happiness and satisfaction
Career/professional development
Once you’ve done that, decide which areas you’ll tackle, a timeline for doing so, and a set of actionable, measurable, and achievable steps to bring that grade up next “semester.” If you need a tutor and a cheerleader in that process, email me, and we can work together on bringing your report card up to speed.
Manifesting the nursing career you want isn’t always easy. Measuring your relative success and taking inspired action can also be a challenge. But in the interest of your career and calling as a nurse, you couldn’t choose a better way to focus your energy to create the life and career you want and deserve.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
The third week of every May (this year May 14-20) is dedicated to Neuroscience Nurses Week in recognition of and tribute to neuroscience nurses and the work they do.
Neuroscience nurses work with patients who have a range of health conditions or injuries that are related to the brain. Patients in the care of neuroscience nurses might have received a traumatic brain injury in an accident, may be recovering from a stroke, could be navigating brain cancer treatment, or may have a neurologically based condition such as multiple sclerosis or Alzheimer’s disease. The specialty treats a conditions that impact all ages of patients so they must be ready to care for issues as diverse as ALS or seizures to migraines.
The American Association of Neuroscience Nurses sponsors Neuroscience Nurses Week and is an excellent resource for nurses who work in the specialty or those who are considering this career path. Nurses in this specialty are drawn to the practice because it offers such variety of nursing challenges and opportunities. Because brain illness and injury isn’t relegated to one age group, nurses can treat across the lifespan or can focus on an age range they are particularly drawn to.
Nurses in brain-related specialties also have options for work locations. Their skills are needed in rehabilitation or long-term care centers and in physicians’ offices. Neuroscience nurses will also work in the operating room, trauma units, or the ICU.
The brain’s complexity is unsurpassed, and neuroscience nurses are fascinated by how the brain controls all the body systems. They are driven to provide the best care and find the best treatment plans for each patient. Nurses who work with these patients are highly detail oriented so they can notice the smallest changes in a patient’s condition or responses. They are also adaptable as the challenges for patients can change daily or even throughout the course of a single day. They will tolerate the frustration or fear from patients and also share the joys of their progress. The role is fast-paced and never the same.
Each patient will have a different experience with treatment and recovery and will have access to varied resources to help them heal. Nurses are there as advocates to help patients manage symptoms, which can be as overwhelming as learning how to do daily tasks or manage with reduced mobility or function. They will help families of patients navigate the complexities of home care so they have the tools to support their loved one.
Certification through the American Board of Neuroscience Nursing is an essential tool for nurses who want to remain current in the fast-changing field. Gaining this credential helps nurses gain the latest knowledge, and it also signifies to the community that they are an expert in this field of nursing. Nurses can choose to be a Certified Neuroscience Registered Nurse (CNRN®) or receive a Stroke Nursing Certification (SCRN® ). Some hospitals and workplaces offer courses to help nurses, who will already have the required work experience hours, prepare for the certification exams.
Whether you are a neuroscience nurse or thinking about moving into this specialty, the need for nurses in this field continues to grow and job prospects are good.
Yes, I said it. It’s time that nurses put nurses first!
This is our week, our month, shoot, it’s even our year. Come on. Let’s go. Ask for what you want both in your professional life and personal life. The world knows that we deserve more, and we deserve the best. We work hard, so we need to take care of ourselves. We give, give, and give and it is time to receive. However, we must be open to receiving and accepting greatness and gratitude. Don’t block your blessings.
According to Eckhart Tolle, “Acknowledging the good that you already have in your life is the foundation for all abundance.” One easy way to practice gratitude is to keep a gratitude journal and write everything that you are grateful daily.
Do not be afraid to ask for more. You are worthy of more, and you deserve more.
You do not need validation from anyone. You are a highly skilled professional and an expert in your field. So go ahead, ask for that vacation! Ask for that raise you have been thinking about asking but have been too afraid. Negotiating that offer, yes, please negotiate. Go ahead and take a day to do whatever your heart desires. Whether it’s going to the spa or salon. Hair done, nails done, everything done. Go ahead and relax! Enjoy.
Back to gratitude and receiving. I will leave you with some positive affirmations. And yes, there are a lot of money affirmations because we need to normalize talking about money and getting paid. Nurses need to eat, too. Happy Nurses Week!
I am open and ready to receive abundance in my life.
I am worthy of having more wealth.
Money comes to me easily and harmoniously.
My life is full of prosperity and abundance.
Money is rooted in good and leads to peace.
I am full of confidence, and everyone around me can feel that.
Happiness is a choice, and today I choose to be happy.
Angela Purcell, a nurse making a difference, has helped save patients’ sight and taught others how as part of the Flying Eye Hospital.
Purcell didn’t start her career expecting to help save people’s eyesight around the globe. In fact, she didn’t even start working as a nurse until an amazing experience changed her life permanently.
Purcell, now an RN with an Ophthalmic Nurse diploma and the Associate Director of Nursing for Orbis International’sFlying Eye Hospital, began her career as a legal secretary.
“When I was unexpectedly hospitalized, my life and career path changed forever. During that brief experience as a patient, I was inspired by the nurses around me. Good nursing depends on discipline, keen observation, and sound clinical skills. Those attributes attracted me to the profession,” recalls Purcell. “It was then I decided to start my training to become a nurse. I knew it was the right decision as I thought about the lives I could change by helping to improve the well-being of others.”
Purcell attended nursing school at Cambridge University Hospital in England, earning her RN degree in 1985. Her first job out of nursing school was working as part of intensive care teams at a cardiovascular heart and lung specialty hospital. “After a few years in this high-intensity specialty, I moved to specialize in eyes and earned my diploma in ophthalmic nursing,” she says.
During her ophthalmic studies, Purcell attended a conference where she heard an Orbis representative talk about their work. “I was captivated. I promised myself that I would join their Voluntary Faculty, a global force of more than 400 medical experts who share their skills with local eye care teams around the world,” says Purcell.
And beginning in 2012, she did just that. She began working as a volunteer faculty scrub nurse, and a few months later, she was offered a permanent position as Orbis’s Head Nurse with the Flying Eye Hospital Team.
Angela Purcell is the Associate Director of Nursing for Orbis International’s Flying Eye Hospital. Photo credit: Geoff Oliver Bugbee/Orbis International
Eyes in the Skies
According to Purcell, the Flying Eye Hospital is a fully accredited ophthalmic teaching hospital on board a plane. It travels to locations that don’t have access to quality eye care, and the staff trains eye care teams–ophthalmologists, nurses, anesthesiologists, and biomedical engineers–on how to deliver the same care in their community.
“Training is at the heart of everything Orbis does and everything I do in my daily role. I provide in-person, hands-on training to local nurse teams in infection control and emergency preparedness during training programs. I work with them on the plane and in the partner hospital,” explains Purcell. “During training programs, we care for children and adults with a wide variety of eye diseases, including cataracts, glaucoma, strabismus, and other conditions that can cause vision loss or blindness.”
Globally, she says, 1.1 billion people live with vision loss–90% of which is avoidable.
“The work I do is fighting to decrease this statistic,” says Purcell.
During the pandemic, when she couldn’t teach people in person, Purcell began teaching on Cybersight, the Orbis telemedicine and e-learning platform. Even when in-person programming returned, Purcell continued to teach online. “I found that virtual training is a great way to reach everyone,” she says. “It’s a fabulous complementary tool to every nurse’s training.”
Another crucial part of Purcell’s job is that she plays an important role in ensuring that the standards to obtain accreditation for the Flying Eye Hospital from the American Association of Accreditation for Ambulatory Surgery, are met and adhered to.
“In my role, I also ensure [that] Orbis employees are benefiting and growing, which, in turn, benefits my occupational development,” says Purcell.
Miracles Happen
One of Purcell’s greatest rewards in her job is hearing some of the patients’ stories. She shared this one:
“One of my favorite stories in my nursing career happened in April 2018 when I went to Trujillo, Peru, with the Flying Eye Hospital for a three-week training program. I worked with a volunteer nurse to care for patients before and after their surgeries. While she was preparing a patient for surgery–a young man of about 25 years old–I spoke to his mother. To my surprise, this was the second time her son had been a patient at the Flying Eye Hospital.
Twenty years ago, her son had surgery on his eye on the plane as a small child. She said she was so grateful and surprised the plane was back in Peru when her son needed urgent surgery. He had just had an accident and injured the same eye that had been operated on as a child. His mother proudly showed me pictures from the day of her son’s first surgery on the plane.
“As I looked at the pictures of the little boy and the nurse caring for him, I realized this was the same nurse preparing him for surgery again, so many years later. The nurse remembered him as a child, and the nurse, the patient, and the mother had a sweet, sentimental reunion. For me, as a witness to this fascinating story, I will always remember how it made me realize that miracles do happen in our ‘hospital with wings.’”
Purcell says she’s realized how well her job fits her skill sets. “I am great at networking and communicating with people from different cultures. Working with a global organization allowed me to collaborate, innovate, meet targets, help others, and challenge myself. Some of the highlights of my current role working at the Flying Eye Hospital have enabled me to meet quite famous individuals, including Cindy Crawford, HRH Duchess of Wessex, many heads of state, and the list goes on,” she says.
But there are many other reasons why she loves the work she does. “I love my Flying Eye Hospital team. We are like a family. We are a small, multi-cultural, close-knit team that supports one another and encourages progression and collaboration. We all share the same vision and are dedicated to fighting avoidable vision loss together,” says Purcell. “I am inspired by the people around me and how rewarding it is to see the results of our work.”
With the May 10 celebration of School Nurse Day, school nurses around the country will recognize how the role of a school nurse has changed dramatically over the decades. This recognition day helps highlight the increasingly complex medical, social, and community needs and duties school nurses are responsible for.
Bales spent several years in nursing before moving into this nursing specialty. “I had no idea about school nursing when I finished nursing school,” she says. After receiving her BSN from Tuskegee University, says her heart was set on pediatric nursing and that’s where she made her first foray into nursing. She spent many years working in pediatrics and in neonatal ICU units in Florida and Georgia.
But her path changed when her family settled in one area and her children’s school district had an opening for a school nurse. She was encouraged to apply, noting that her schedule would then mirror her children’s school times. “That was 21 years ago, and I am still here,” says Bales with a laugh. “I have the opportunity to marry my love of pediatrics with the school age group and grow in my leadership skills. It’s been quite a ride.” Bales herself has assumed increasing leadership roles.
As a school nurse, Bales has taken on roles that are diverse. She has worked as an elementary school nurse, an itinerant school nurse instructor, and a consultant nurse. In her current role as a nursing supervisor, she oversees school nurses across a county school district.
Throughout her career, Bales has worked with students of elementary, middle, and high school ages and has especially enjoyed seeing them grow. And even if she might not instantly recognize a grown adult who comes up to her and says, “Mrs. Bales, it’s me!” she’s always happy to hear about their adult lives. There are many students who remember the care and comfort their school nurse gave them, and even some who are inspired to follow a nursing path because of their school nurses. Bales recalls talking with past students who have overcome health challenges and gave Bales credit for her help. “Those are very heartwarming encounters,” she says.
As with many school nurses, being able to make connections with students and their families is what keeps the profession rewarding. There are plenty of challenges school nurses face. From the increasing complexity of health conditions to the wider family and community issues that impact school children, school nurses have to be well prepared for anything.
“Some of the biggest challenges are staff shortages,” says Bales. The pandemic has compounded nursing shortages in general, and school nursing hasn’t escaped the lack of nurses to fill roles. In addition, Bales says the staffing model can look different from state to state or even within a state, and can make school nurse staffing particularly challenging. Sometimes school nurses are paid on a teacher pay scale and sometimes they are paid using a different pay scale, so it’s difficult to lure nurses, who might otherwise be offered signing bonuses and larger salaries, to the school nurse arena, says Bales.
And school nurses must continually fight for the funding they do get. Bales says it gets tiring to have to justify the need for more funding and more school nurses to lawmakers and decision makers. A healthy school community relies on the school nurses who are able to act as a liaison between students, the community, and healthcare providers. It’s frequently said that school nurses and the school health services are the hidden health system in the country, says Bales. Helping students and staff to be engaged in the learning process, she says, requires school nurses to prioritize health and safety.
For nurses thinking of moving into a school nurse role or who may already be school nurses, Bales says she encourages them to take advantage of every single opportunity that comes to them professionally. Whether it is through mentors, preceptors, or a new opportunity for a new skill, don’t turn down a challenge, she says. Join an organization like NASN to learn from others and share your own knowledge as well.
“It warms your heart to know the significant impact you are making,” says Bales. “School nursing is truly a calling.”
