Every year, the week of November 1-7 is designated as Urology Nurses and Associates Week as a way to celebrate this specialty and honor the nurses who work in this field.
November is also Bladder Health Month and focuses on the varied issues people face with different symptoms and diagnoses and the impacts that these conditions have on their daily lives. Conditions involving the urinary tract can also impact other health conditions, including the reproductive tract or a patient’s nutrition needs, so urology nurses must understand all these connections. They also act as resources and supports for patients who are navigating bladder conditions and symptoms and help them connect and work with related specialists if needed.
Because they are in a specific field, urology nurses are usually expected to have general experience before moving into urology nursing. If you’re a nursing student and considering this career path, it’s a good idea to work in the specialty to see if it’s something you’d want to pursue as a specialty. The Society for Urologic Nurses and Associates (SUNA) is an excellent resource for education, networking, and understanding the importance of evidence-based urology nursing practice. Nurses interested in working with children will find the Pediatric Urology Nurses and Specialists organization helpful.
Urology nurses work in many settings and interact with all ages. They can work in a physician’s office with a small or large practice, a hospital setting, surgical clinics, community health clinics, or a pediatrician’s office. Because urology nurses can bring their skills to such varied settings and practices, they are in demand. Nurses in this field are often able to find a new position where they can gain more experience with a new patient population or in a new region.
As a urology nurse, you’ll treat varied conditions that range in severity from bladder cancer to chronic bladder incontinence. Patients with painful kidney stones, overactive bladders, or bladder symptoms from treatment of reproductive tract cancers are all part of a nurse’s patient spectrum. Each requires different treatment, but frequently urology nurses will also find themselves addressing patients’ embarrassment and discomfort of coping with bladder issues.
Compassion and understanding are part of the urology nurses skill set as is compiling resources that can help patients. Particularly with new patients, urology nurses can use their vast knowledge and interactions with patients to reassure and help people cope–whether that’s being ready to share tips for dealing with incontinence, managing pain, or preventing infection. SUNA offers a wealth of patient education tools for nurses to use.
As with other specialty nursing areas, gaining as much education as possible will elevate your nursing practice, allow you to give patients the best care, and may help advance your career. Certification gives nurses the extra credentials they need to show they have attained additional knowledge and skills in their field. The Certification Board for Urologic Nurses and Associates offers certification and recertification exams for nurses along with guidance for exam taking and preparation.
Urology nurses are especially appreciated by their patients for their skills and compassion, and they are an integral part of any medical team.
What are some reasons you do not disclose your race or ethnicity? Have you ever felt better not responding to this information? Why or why not? I know I have never felt like I should go back in an application and check the box as being Black or African American. There has been a certain level of gratification of going into an interview without this information being disclosed. I remember getting rejection letters and wait list letters from universities and often thought why when explanation was not given except for the high number of applicants. As a registered nurse with experience and higher than a B average in all undergraduate studies these questions often surfaced. Was I not selected due to information disclosed about my background? One starts to wonder when meeting exceeding the minimum qualifications.
There is a great feeling of being considered for employment or chosen for a nursing program by review of my accolades from my curriculum vitae without my race and ethnicity being accounted for. The question of demographic reporting was brought up in a meeting last week. The question was asked about why some students do not check this box when applying to nursing programs. Is this information necessary to disclose? Why should they disclose?
Should students have to be asked this information or encouraged to do so? My first thought was this demographic data is great reporting to nursing program accreditation. However, currently diversity in students and faculty is reviewed but, not a criteria that will impact a nursing programs ability to obtain accreditation. What made me feel uncomfortable in this conversation was that only one other faculty could answer the question for the most likely cause along with myself as to why these questions are often left unanswered. It is hard to fathom that itself racism and structural racism barriers continue to exist in higher education.
Students of color may fear a difference in treatment or not getting acceptance into the program if they chose to disclose. We have to continue working toward breaking barriers in the area of structural racism. This is an example of a potential bias that may be occurring to students from diverse backgrounds. We must continue to have faculty from diverse backgrounds available to mentor these students and who look like them in university settings.
Another question would be do we eliminate this information from the applications. Is this discriminatory in any way? Should the results be seen only from an administrative view? There are so many questions about why this information is used. We could potentially limit who see’s this data. Admissions committees should be limited on this information so that implicit bias are not occurring.
October 10 kicks of a celebration of the work emergency nurses do with Emergency Nurses Week. In the past year and a half, emergency nurses have faced a pandemic and the overwhelming care needs of a staggering patient load. Frequently, emergency nurses are the initial care provider for people who have COVID-19 symptoms, and they have taken on a care caseload filled with some of the sickest patients these nurses have ever encountered.
Emergency nurses are needed more than ever. As pandemic cases continue to rise and fall and as patients who put off needed care are presenting with even more advanced needs, emergency nurses are in perpetual demand.
As the need for their skills rises, emergency nurses are especially prone to exhaustion and burnout. Taking care of themselves becomes a low priority when the demands of the job are so high, so continual, and so overwhelming. If running to the bathroom is considered a break, how can emergency nurses be expected to keep up the pace?
And while there’s no magic potion to improve the work balance (let alone a work-life balance), nurses can be aware of doing whatever they can to make life any easier right now. And remembering that eventually, this impossible time will pass.
With an unrelenting job, nurses need to let themselves take shortcuts when they can. Buying premade meals or getting groceries delivered saves time and effort that are in short supply. The shortcut doesn’t have to lead to unhealthy choices. Focus on foods that give you the biggest nutritional bang for the buck. Prepared salads, cooked veggies, chopped fruit, and grilled meats are great choices. And when you’re too tired to even think about eating, a comforting soup–pureed or hearty–with bread and cheese will fill you up and nourish you.
Asking for help is often a nurse’s Achilles heel. After giving so much care, nurses are reluctant to admit they need some help. Whether it’s childcare, elder care, transportation, or mental health care, a little assistance can make your life easier–and that can make the world of difference. Even connecting with other nurses through an organization like the Emergency Nurses Association can give you the support you’re seeking.
Find the Joy
For many nurses, there’s been less joy this year. As waves of patients remain high, the emotional toll on nurses and healthcare workers is evident. Keep yourself going by finding the small joys in your day. A great playlist, a funny podcast, a movie that lets you escape (even if it takes five sessions to watch because you keep falling asleep), or even the softest socks that soothe your aching feet at the end of the day are good choices. Bonus points if it requires no extra effort and double bonus points if it’s something you can look forward to.
During Emergency Nurses Week, honor those who work in this demanding specialty. And if you are an emergency nurse, thank you for all you are doing!
This week’s celebration of Pediatric Nurses Week (October 4-8) is a reminder of the specialized work these dedicated nurses offer to their young patients.
For anyone interested in a career as a pediatric nurse, it’s helpful to know the responsibilities of this job. Nurses who work with children are the biggest advocates for their young patients. From toddlers to teenagers, pediatric nurses will become familiar with, and fluent in, the issues facing these ages.
Nurses who work with children will have an understanding of everything from toilet training and toddler play habits to social media and adolescent decision making habits. Pediatric nurses will see children for well visits, minor illness like a stomach flu, and life-threatening diseases including cancer.
Because of the range of ages, potential conditions, and situations, pediatric nurses have to know myriad relevant medical information and also how any issues or concerns will impact the family. Working with so many different families while focusing on a young patient can be challenging for pediatric nurses. Families are also the best advocates for the child and so creating a good working relationship with families is especially helpful. Compassion and understanding go a long way, but calling attention to concerns is also a pediatric nurse’s responsibility.
The Society of Pediatric Nurses is an excellent resource for nurses who work with children and their families. It offers guidance on education, advocacy, and clinical information to cover the needs of just about any pediatric nurse.
Nurses in this specialty are in high demand and can find a satisfying career in one office or by changing the focus of their career. They can find work in a family practice, a specialty practice, a hospital, an outpatient or surgical clinic, schools, or even rehabilitation centers.
By taking the exam, nurses are proving they have the most updated knowledge on evidence-based practices and on treating their young patients. This helps them give the best care possible as this specialty changes rapidly. Nurses who become certified are also demonstrating a specific commitment to being the best nurses they can and to gaining the tools necessary to make that happen. For a career move, this extra level is frequently noticed by your peers, supervisors, and organization. Nurses who are certified and keep their certification current are the nurse leaders organizations look for and depend on.
Whether you are an experienced nurse practitioner with years of clinical practice already under your belt, or you’re a student preparing for a fulfilling career devoted to helping people, you’re likely to face some unexpected challenges and some exciting opportunities in the work you have chosen. The role of the nurse practitioner is rapidly evolving, responding both to changes in the health care industry and to the evolving needs of the communities you serve. This article explores some of the most significant trends nurse practitioners are facing today.
An Expanding Role
The global health care shortage is not news, but what is news, perhaps, is how significant and widespread it is. In fact, in the United States alone, it is estimated that the shortfall in the number of physicians needed by 2033 will approach 140,000.
And that reality is rapidly and dramatically expanding the role of and the demand for skilled nurse practitioners. Where nurse practitioners might have once worked primarily in collaboration with a physician, increasingly, nurse practitioners are taking the lead in patient care. In many states, this includes overseeing and implementing treatment plans and even coordinating end-of-life care.
In addition to operating more independently than ever before, nurse practitioners are also finding themselves drawing on an array of skills, resources, and knowledge to provide more comprehensive care.
For example, as demand and cost pressures on the system mount, health care providers and patients alike are seeking more holistic strategies to promote wellness and prevent disease. This often includes, for instance, an emphasis on fitness and nutrition, constituting a significant shift in standard medical practices.
Historically, health care providers have been dissuaded or even prohibited from offering nutritional advice, as it may have been considered outside of the clinician’s scope of practice.
In addition to cultivating specialized knowledge to provide higher quality and more comprehensive care, nurse practitioners are also increasingly being looked to as multigenerational health care providers. In such cases, nurse practitioners may provide many of the services of a primary care physician, general practitioner, or family physician.
For this reason, a large number of nursing schools are offering students the opportunity to train as family nurse practitioners (FNP), enabling them to offer optimal patient care across all stages of the lifespan, from birth to death. Licensure as an FNP can be a particularly attractive option for those who seek to develop long-term, trusting relationships not only with individual patients but with an entire family.
Serving At-Risk Communities
Disparities in access to consistent, affordable, and high-quality health care have long been known and lamented. However, health care systems are increasingly turning to nurse practitioners to stand in the breach, filling a desperate need for health care providers in underserved communities.
That means that nurse practitioners may routinely find themselves asked to serve in remote, rural communities or impoverished urban areas where the need for qualified health care providers is greatest. In fact, nurse practitioners who have pursued specializations in community or public health can find themselves in particularly great demand and may build rewarding careers as traveling nurse practitioners, serving communities in need for weeks or even months at a time before moving on to the next post.
When it comes to both training and practice, nurse practitioners have more options and opportunities than ever before. In addition to choosing specific areas of specialization, such as adult or pediatric care, nurse practitioners can also select from an array of subspecialties which will increase their marketability.
However, the degree of clinical autonomy nurse practitioners enjoy will vary from state to state. In some U.S. states, licensed nurse practitioners enjoy what is known as full-practice authority (FPA), meaning that they can prescribe medication, order tests, and define and implement patient care strategies without requiring a physician to sign off on the plan. In other states, though, nurse practitioners still need a physician’s authorization before a treatment plan can be implemented.
Nevertheless, the opportunities for nurse practitioners to earn FPA are growing. For instance, attaining an Advanced Practice Registered Nurse designation can give you full practice authority in many states, including some states where a physician’s sign-off would otherwise be required. Most exciting of all, organizations such as the American Association of Nurse Practitioners are working to establish a nationwide certification protocol to enable qualified nurse practitioners to enjoy full practice authority in all U.S. states and territories.
It is an exciting time to be a nurse practitioner, a time of high demand, increasing independence, and tremendous opportunity. Nevertheless, the challenges are significant, principally due to an ongoing labor shortage and continuing disparities in health care access. In a time when both the need and the reward are great, nurse practitioners are perfectly positioned to fill the gap.
In this feature, we profile a particular type of nursing so that others in the field can learn about what nurses do in this position, what they enjoy about it, and how others can get into it.
Kathleen Martinez, MSN, RN, CPN, President, American Academy of Ambulatory Care Nursing (AAACN), and an infection preventionist at Children’s Hospital Colorado, gave us information about ambulatory nurses.
What is ambulatory care nursing and what do they do?
Ambulatory care nursing is unique in that it treats an individual in this fuller context of community, family, and population. Ambulatory care considers the access and quality of health care, but also evaluates the influence of other social determinants of health: economic stability, neighborhood environment, social context, and access to quality education.
I was introduced to ambulatory care nursing when I accepted a position in Children’s Hospital Colorado Telephone Triage Center. In telephone triage, an RN uses the nursing process (assessment, diagnosis, plan, implementation, and evaluation) to determine the significance of symptoms during a phone call. Every call requires all your skills and creativity. Each encounter requires total focus and attention; interpreting and clarifying information, considering availability of resources, navigating barriers, ensuring that the family understands the care instructions, or that they have called 911, or that they have transportation available to get to the ED or clinic.
And all of this is done within an eight-minute phone call, with a family you may never have met before. I was hooked! It is incredibly empowering and humbling to walk with a family through a child’s illness.
All state Nurse Practice Acts define “Dependent Practice” in circumstances where RNs are carrying out the orders of another provider, such as an MD, Advanced Practice RN, or Physician Assistant; and “Independent Practice” in circumstances where RNs are using their knowledge, skills, and training to initiate and complete tasks within the scope of nursing. Ambulatory care lives much more in the “Independent Practice” realm.
As an ambulatory care nurse, what are your responsibilities?
Well, that depends on your role. If you have a role in Care Coordination and Transition Management (CCTM), you might be checking lab results for a patient, or adjusting their medications based on those results. You may visit a complex patient in an inpatient unit who is preparing to transition home or to an extended care facility. Maybe you are doing a home visit to ensure a family can properly deliver the medications and treatments their child requires.
If you work in a clinic that performs procedures, you may be teaching a preoperative class. Or completing a post-operative wound assessment. Or completing a procedure, such as a fecal microbiota transplant in a GI clinic, or phototherapy in a dermatology clinic. Or performing a prenatal exam or well child check in a Federally Qualified Health Center.
What many people don’t understand is that the acuity of care performed in the ambulatory care setting is similar to care delivered during an inpatient stay. In fact, more than 80% of all cancer care is delivered in ambulatory care settings, including high-dose chemotherapy, preparative regimens for bone marrow transplants, and radiation therapy.
According to the Center for Medicare and Medicaid Services (CMS) 70% of all surgeries occur in an ambulatory setting. Clinics perform complex procedures such as bronchoscopies, endoscopies, and dermatologic surgeries. In all of these settings, RNs use the nursing process to provide care, education, and support.
What are the biggest challenges in being an ambulatory care nurse?
One major challenge: Broadening the scope and job responsibilities to accurately reflect our education, training, and licensure.
Federally Qualified Health Centers and Rural Health Centers are role models in allowing nurses to work to the top of their license. Nurses perform well-child checks, routine pregnancy care, and Medicare Wellness visits. They perform screenings and manage medications with the use of Standing Orders. They teach classes on managing chronic illness. They coach, encourage, and engage individuals to take charge of their health and wellness.
Other ambulatory care settings are learning from these models and creating exciting and engaging roles for RNs.
Another major challenge: Reimbursement for services remains a frustration for nursing in all settings and is a primary focus of the American Nurses Association and the Future of Nursing 2020-2030.
What are the greatest rewards in being an ambulatory care nurse?
The promotion of health and prevention of disease occurs over a lifetime, not in a single episode of care. Ambulatory care nurses meet people where life is lived: in schools, community centers, clinics, and in their homes. We walk alongside individuals through a season or a lifetime as mentors, peers, and teachers.
Statistically, only a small percentage of people are hospitalized each year, yet greater than 90% of Americans seek health care services in ambulatory care settings. And we are there to meet them!
When I was performing telephone triage, one of the most impactful statements I could make was saying, “It sounds like you are doing a great job.” Or simply, “Your child is lucky to have you as her parent.”
Creating this space of honor and trust allows the family to interact truthfully, which allows us to provide better care. It also just feels amazing to hear the relief and gratitude in the voice of the caller when their efforts are recognized and appreciated.
If nurses want to pursue a career in ambulatory care, do they need any additional education and/or training?
A Baccalaureate Degree in Nursing provides much of the knowledge and skills needed for any nursing role, including ambulatory care nursing. A strong “Transition to Practice Program” fills in any gaps and focuses on additional training. Just as critical care nursing is a specialty, ambulatory care is a specialty, requiring ongoing education and training.
AAACN offers tools and resources to support orientation and we have developed a very popular ambulatory care nurse residency program. We also provide extensive support via education events, networking/special interest groups, and targeted publications for those interested in pursuing a career in ambulatory care nursing. I always advise nurses to join an association supporting their specialty to open career doors and bond with colleagues.
To further advance the specialty, AAACN is working with the American Association of Colleges of Nursing to ensure all prelicensure programs include adequate material and experience in the ambulatory care setting.
What kind of advice would you give to a nurse wanting to work in ambulatory care?
I have been in ambulatory care-specific or associated roles for 30 years. Every year the opportunities are expanding. The Affordable Care Act of 2010 was a game changer. After half a century of hospital-focused care, there was suddenly a shift to health maintenance, disease prevention, care coordination, patient-centered care, and looking at social determinants of health as a larger context of care.
The Future of Nursing 2020-2030 calls for an increased focus on the role and value of the RN as a member of the health care team. During the 2019 Future of Nursing 2020-2030 Town Hall meetings, the focus was almost entirely on elements central to ambulatory care: environment, community, access to health and education resources, management of chronic diseases, and wearable technology. In addition, it’s important that patients are cared for in a comfortable and familiar environment. Use of telehealth specialty care decreases the burden and cost of travel. Telephone triage and telehealth visits allow sick persons to remain at home in comfort while accessing high-quality and reliable care. In some states, use of Standing Orders greatly expands the care that can be provided by the RN.