Nurses are invaluable members of the healthcare workforce, and when you’re proactively building a nursing career that you can fully embrace and be proud of, there are plenty of strategies and mindset hacks to consider.
One of the greatest assets you carry as a nurse is the many skills you’ve worked hard to acquire. So, if you want to boost your self-confidence and make the most of your nursing career, it’s wise to humbly take full ownership of the many things you know and the incredible skill sets that make you the outstanding nurse (and human being) you are.
Knowledge is Power
It’s been said since time immemorial that knowledge is power. The things you know — including how to leverage the soft and hard skills you have under your belt — are central to what makes your nursing mind tick, and articulating what those are is crucial.
In nursing school, you studied and read like a madperson, wrote care plans (sorry to bring that up), learned to apply the nursing process (you may be sorry I brought that up), and turned your non-nurses mind into a nurse’s mind. I bet there are things your professors said that you still hear in your head, and some of those may be helpful. “If it wasn’t documented, it never happened” was one truism I heard repeatedly during my nursing education, and I never forgot it. What sticks with you?
After the crazy nursing school journey, the rubber hits the proverbial road when you start working as a nurse out in the real world. Some skills and knowledge were entirely theoretical during school, of course. But when you’re working as a nurse and solely responsible for the care of your patients, you can bet that those wheels are turning, and the smoke is coming out of your ears as the pieces fall into your mind.
If you’re a generalist (e.g., med/surg, internal medicine, primary care), you may not delve deeply into cardiac arrhythmia, chemotherapy regimens, or other specialized areas of knowledge and practice. But you’ll need to know a little about everything since you never know what will walk through that door. A generalist may seem from the outside like a jack of all trades and master of none, but you can rest assured that these nurses know their stuff and have all sorts of knowledge that makes them amazing.
As for nurses who specialize in diabetes, stroke, cancer, labor and delivery, trauma, critical care, or other areas of hyper clinical focus, their knowledge is going to run deep about some very specialized concepts, treatment regimens, and diseases, and that knowledge is worth more than we can say.
Knowledge is power, so acknowledging and expressing what you know is a skill in and of itself. And if you’re job-hunting, being able to write and talk freely about why you’re fantastic is part of the sales pitch that will help you land the position of your dreams.
Your Multifaceted Skills
When we think of nursing skills, we often think of so-called hard skills like venipuncture, rhythm interpretation, wound debridement, or ventilator management. We also need to remember that the 21st-century nurse has computer skills, including using EMRs and other technologies.
In the interpersonal realm, there are skills related to communication, including emotional and relational intelligence, counseling, and active listening. We can also point to patient and family education or the education and training of other nurses (e.g., precepting or mentoring).
Meanwhile, we can’t forget all-important leadership skills, whether as a charge nurse, a director of nursing, or a chief nursing officer. Leadership can also be a skill we naturally demonstrate on the job, even if we don’t have a title beyond “staff nurse.”
You might also have skills in medical writing, grant writing, research, sales, case management, or other areas where you find yourself. Many nurses do important non-clinical work, and their knowledge and skills are equally valuable.
The list of skills and knowledge that a nurse’s mind holds is like an ever-expanding encyclopedia.
The Humble Brag
Whether you’re gunning for a promotion, interviewing for an awesome job, applying for a grant or fellowship, or being interviewed on a nursing podcast, your confidence comes from your ability to own what you know and what you can do, as well as the overall value of your “nurseness.”
If you’re feeling glum about your nursing career, pull out a sheet of paper and try to list every piece of helpful nursing and medical knowledge you have in your head. Chances are you’d need to fill page after page with every tidbit of knowledge you can claim as your own. And if you also included a list of your many skills, you’ll likely fill an entire notebook.
You can proclaim your value, assertively list your knowledge and skills, and still live and work in a place of humility. Being humble doesn’t mean you can’t take ownership of what makes you who you are. It means you don’t have to boast about it or lord it over others. The “humble brag” will serve you just fine: state it as a fact without emotion, and you can get your point across without fuss.
Rejoice in your nurse’s mind and everything it holds, and enjoy the clear knowledge of the value of your numerous skills. You’re a valuable member of the healthcare community, and owning your worth is a powerful place to be.
As Vascular Nurses Week comes to a close, the impact of the work vascular nurses perform each day is clear. Vascular nurses work with patients who have vascular disease or who may be at high risk for vascular diseases including everything from blood clots to high blood pressure and other cardiovascular disease to circulation problems.
Patients depend on nurses in this specialty to help them treat and manage their diseases and so will turn to them for education about how to recover from surgery from having a stent or how to manage high blood pressure or peripheral vascular disease. Vascular nurses are also excellent sources of information on how to live with chronic conditions such as varicose veins. For patients whose family history shows a strong genetic predisposition to vascular disease, a vascular nurse will work with the patient’s team to help educate them about medication and surgical options, lifestyle changes and choices, and even symptoms to be especially mindful of.
As a career, vascular nursing offers extensive options and nurses can find the career track that fits their interests, pace, and preferred schedule. Nurses who choose to work in this specialty will see a range of patient ages and conditions, and they have the ability to focus in on specific populations with the choice of work location and setting. Nurses can work in hospital settings where they may assist with surgery, lead patient preparation and recovery from procedures, and be on the medical team with emergency situations. Vascular nurses can also work in outpatient settings and clinics where they will see patients who are coming for routine blood work, post-surgical care, and scans to help diagnose or monitor any problems. Other options can include home care.
These nurses work with a complex network of veins and systems that can change quickly. They need to be current in all the latest evidence-based practices so they can treat patients with the most current knowledge and also let them know about potential treatment options that are on the horizon.
As with other nursing specialties, career choices such as membership in a professional association is especially beneficial. Nurses can look into all the resources the Society for Vascular Nursing offers including mentorship options, patient resources, and conferences. Many nurses use annual conferences as a way to connect with other nurses all across the country and to learn about new developments in their specialty. They can bring those ideas and the energy from the conference back to propose potential improvements in their own workplaces.
For continuing knowledge, obtaining certification is an excellent career move. the Society for Vascular Nursing (SVN) and the American Nurses Credentialing Center (ANCC) offer the Cardiac Vascular Nursing Certification (CV-BC) which gives nurses the professional knowledge and recognition of expertise in the field.
Vascular nursing requires nurses who are dedicated to patient care, lifelong learning, and who have a passion for helping patients live the healthiest lives possible. Rates of vascular diseases continue to rise and the industry needs more nurses in this specialty, so the job outlook remains strong.
SWAT RNs serve as expert consultants and mentors to nurses working as bedside leaders in various clinical settings. With clinical practice experience of five or more years in the areas of critical care, emergency nursing, and flight nursing, these nurses enjoy the adrenaline rush that comes with quickly assessing patients at risk for condition deterioration.
SWAT RN Role
The role of the Specialized Workforce for Acute Transport Registered Nurse (SWAT RN) has evolved in national healthcare organizations. Early detection of patients experiencing physical decline is the hallmark of the SWAT RN role. Having identified an early condition decline, bedside nurse leaders working in various clinical settings collaboratively work with SWAT RNs to promptly stabilize and prevent patient injury and death.
Susan Dresser, Cynthia Teel, and Jill Peltzer, in their 2023 article entitled, Frontline Nurses’ Clinical Judgment in Recognizing, Understanding, and Responding to Patient Deterioration: A Qualitative Study, noted that nurses who work at the bedside are essential in the recognition of patients’ decline and initiating contact with the SWAT RN. Hence, the SWAT RN is a nursing role that is instrumental in the promotion of the nursing process and the National Council of State Boards of Nursing’s 2019 Clinical Judgment Measurement Model within the acute care setting, as they work collaboratively with bedside nurse leaders to facilitate positive patient outcomes.
A Hypothetical Case Study
The following hypothetical case study provides an opportunity to explore the SWAT RN role and examine how this role collaborates with bedside leaders to improve patient outcomes.
Case Presentation
Bernard Salzo is a 38-year-old male employed as a carpenter and painter. Unable to sleep and experiencing restlessness accompanied by shortness of breath for the last two days, Mr. Salzo presents to the emergency department (ED) at 3:00 a.m. with difficulty breathing. The triage nurse obtains his vital signs: blood pressure 134/82 mm Hg, respirations 30 breaths per minute, heart rate 102 bpm, temperature 99.8 F, and oxygen saturation on room air, 94%. The patient appears anxious and restless, requiring redirection as the triage nurse processes him. The patient states, “I have not been sleeping that well. I kind of feel discombobulated.”
History and Assessment
Mr. Salzo’s medical history is significant for childhood asthma and hypertension. His hypertension is managed with an ACE Inhibitor, Lisinopril 15 mg PO daily, and diuretic Furosemide 10 mg PO daily. Prescribed Montelukast sodium 10 mg PO once daily and a Proventil HFA inhaler twice daily and as needed for asthmatic symptoms. Mr. Salzo’s asthma has been stable for the past ten years. Mr. Salzo is a nonsmoker and abstains from alcohol.
Mr. Salzo is triaged, assessed by an ED nurse, examined by an ED provider, and admitted to a Medical-Surgical Unit. The nurse in the Medical-Surgical Unit suspects worsening respiratory distress, noticing that Mr. Salzo has become increasingly anxious and is moving about restlessly in bed during the admission assessment. Oxygen therapy via nasal cannula 2 L O2 is placed on the patient, and the nurse contacts the SWAT RN, who arrives in less than 5 minutes.
The SWAT RN provides a rapid assessment of the patient and reports their findings to the patient’s healthcare provider and bedside nurse leader.
Alert and anxious, use of accessory muscles of respiration, respiratory distress
RR- 32 breaths per minute and labored, BP- 143/88 mm Hg, T- 100.3 F (temporal), oxygen saturation- 90% on room air (sitting)
Peak flow- 185
HEENT, Skin, Neck
No bruits, nor thyromegaly or adenopathy
Bilateral tearing of the eyes noted with conjunctivae that are edematous and inflamed
Pharynx with clear postnasal drainage; nasal mucosa edematous with clear discharge
Fundi without lesions
Skin is supple, diaphoretic, pink, and flushed
Lungs
No egophony or fine crackles (rales); scattered coarse crackles present
Expiratory phase is prolonged with wheezes auscultated bilaterally
Diaphragm percusses low in the posterior chest with 2 cm; chest expansion is limited
Cardiac
No clicks or gallops
Tachycardia, regular
Notable slight systolic ejection murmur (SEM) at the left lower sternal border (LLSB) without radiation
Abdomen, Extremities, Neurologic
Capillary refill at 3 seconds, no clubbing, no edema; extremities clammy
Bowel sounds present, no hyperactivity; abdomen non distended
Liver percusses 2.5 cm below the right costal margin, but overall size 8 cm, no tenderness or masses
Cranial nerves intact; DTR 2 + and symmetric; sensory intact; strength 5/5 throughout
Preliminary Laboratory Results
pH- 7.48; PaO2- 70; PaCO2- 33 mm Hg
HCT- 33.0% and HgB- 7.2 g/dL
WBC- 7,680
PLTS- 246,000
Bedside Nurse Leader and SWAT RN Collaboration
The SWAT RN maintains closed-loop communication with the bedside nurse leader assigned as the primary care nurse for Mr. Salzo. The bedside nurse leader and SWAT RN discuss the patient’s time of initial decline, treatment approaches that were effective, and next steps. The SWAT nurse respectfully acknowledges the bedside nurse’s prior knowledge about the patient’s health history and recent health status change while modeling clinical judgment in managing the clinical case scenario.
Mr. Salzo complains of chest tightness. Intravenous access via Mr. Salzo’s right arm in the cephalic vein was secured. The bedside nurse leader inquires about potential allergen exposure and the use of methylprednisolone (Solu-Medrol) intravenously. The SWAT RN and team decided to assess the patient’s response to a bronchodilator. The SWAT RN administers Albuterol nebulizer treatments. An electrocardiogram (ECG) reveals sinus tachycardia (Figure 2.). The elevated white blood cell count (WBC) is suggestive of infection. A chest x-ray shows a large area of opacity in the right lung. A sputum sample is obtained and sent for culture and sensitivity. Blood cultures were obtained as well.
Admitted to the Medical-Surgical Unit with the primary diagnosis of asthma exacerbation and pneumonia, Mr. Salzo starts the intravenous (IV) antibiotic ceftriaxone (Rocephin) 1 gm twice daily. On day 2 of antibiotic therapy, a repeat chest x-ray reveals the presence of a mass in the right lung. Further diagnostic tests reveal that the mass is a malignant neoplasm. Mr. Salzo was diagnosed with lung cancer adenocarcinoma.
Education
The unknown or atypical presentations are the driving factors in bedside nurse leaders utilizing clinical judgment in the decision-making process to ramp patient assessment to the level of consultation before rapid patient deterioration occurs. Mr. Salzo’s diagnostic presentation appeared typical for asthma. However, his elevated WBCs suggested infection was present. The resolving pneumonia treated with IV antibiotic therapy revealed a malignant tumor mass, adenocarcinoma.
Adenocarcinomas typically proliferate within the cells that line the alveoli. According to the Centers for Disease Control and Prevention (CDC), in 2022, 50% to 60% of lung cancers were diagnosed in patients with no smoking history. The CDC noted in 2022 that 10% to 20% of nonsmoker cancers are squamous cell carcinomas and 6% to 8% small cell lung cancers. The CDC also noted that risk factors associated with lung cancer include family history, pipe smoking, cigarette and cigar smoking, beta-carotene supplements in heavy smokers, human immunodeficiency virus (HIV), and environmental risk factors. Mr. Salzo’s dual occupation as a carpenter and painter, both environmental risk factors, likely placed him at risk for the development of lung cancer. Wood dust can be inhaled and enter the airway and lung tissues, causing scarring and irritation. The paint contains benzene solvents that, inhaled, can lead to oral and lung cancers.
The National Council of State Boards of Nursing Clinical Judgment Measurement Model provides the nursing profession with a roadmap for enhancing critical thinking, clinical decision-making, and clinical judgment within the clinical setting. SWAT RNs, because of their advanced clinical practice experience and knowledge, effectively role model closed-loop communication and evidenced-based practice clinical interventions and provide clinical expertise “in live-time” to bedside nurse leaders during emergent patient cases.
Conclusion
Mr. Salzo, transferred to an oncology unit, begins cancer treatment. The bedside nurse leader provides him with education about his new diagnosis. His clinical presentation to the ED for an asthmatic exacerbation and the combined efforts of all healthcare team members have contributed to Mr. Salzo’s diagnosis and current implementation of treatment for lung cancer. The early involvement of SWAT RNs is instrumental in supporting bedside nurse leaders (and nurses in other settings) with the provision of rapid assessments and necessary diagnostics in ensuring the consistent delivery of evidence-based practice care for patients entering healthcare systems. In the 2020 article, Using Benner’s Model of Clinical Competency to Promote Leadership, Barry Quinn discusses the novice to expert level nurse in clinical practice. Because the SWAT RN is an expert level nurse, their role is essential in developing leadership and competency of bedside nurse leaders in recognizing patients with rapidly declining physiological problems. Hence, SWAT RNs’ roles are beneficial in promoting clinical judgment in bedside leaders at all practice levels (e.g., novice to expert).
Crystal Beckford is an accomplished healthcare executive with extensive experience in health systems in Maryland and Florida. She has a proven track record in hospital, health plan, long-term care, and health insurance leadership.
In her current role as chief nursing officer (CNO) and vice president of patient care services at Luminis Health Doctors Community Medical Center (LHDCMC), Beckford collaborates with the clinical team, medical staff, and executive team to develop nursing and clinical strategies that promote quality and operational excellence in clinical operations.
The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.
Meet Crystal Beckford, Chief Nursing Officer and Vice President of Patient Care for Luminis Health Doctors Community Medical Center.
Talk about your role in nursing.
As the CNO and Vice President of Patient Care for Luminis Health Doctors Community Medical Center, I provide leadership to our nursing and patient care support team members. I provide coaching, direction, support, and leadership to grow current and future leaders. To be an effective CNO, one of my main objectives is to ensure clear and concise communication with team members to remain focused on our goals and outcomes. Most important, I always remind our teams why we’re here—to provide high-quality, safe patient care.
How long have you worked in the nursing field?
I have worked in the nursing field for 32 years. I started my career as a licensed practice nurse for two years and then earned my BSN, RN. To expand my knowledge in health care, I received my master’s in healthcare administration.
Why did you become a nurse?
Since I was about seven years old, I knew I wanted to be a nurse. There were many influential people in my life growing up, and three of them were nurses, whom I admired for their character and work ethic.
What are the most important attributes of today’s nursing leaders?
Flexibility, balance, resilience, humor, humility, passion, and understanding.
What does being a nursing leader mean to you, and what are you most proud of?
Inspiring and influencing others to achieve their greatest potential is truly an honor.
Tell us about your career path and how you ascended to that role.
My first year of nursing was in the medical surgical unit. While at Catholic University, the nuns told us we must complete at least one year of Med/Surg. I quickly learned it wasn’t for me. Critical care was my life’s calling. I was captivated by the equipment, the technology, and the nurses’ knowledge. I practiced in just about every space in critical care, including the intensive care unit, cardiac care unit, open heart surgery, emergency department, and respiratory care unit. I quickly developed strong acumen, knowledge, and skills in critical care. My colleagues saw my potential as a great leader and encouraged me to apply for a managerial role. Once I landed the position, I kept pushing myself to grow in leadership roles because of my passion for the business and the clinical side of healthcare.
I chose Luminis Health Doctors Community Medical Center to make a difference in my home community. Healthcare equity is a major passion and concern of mine. The hospital has embarked on a $300 million campaign to renovate and expand the nearly 50-year-old campus, including building a women’s health center for inpatient obstetrics services, labor and delivery, and postpartum care. Right now, eight out of ten women have to deliver their baby outside of Prince George’s County, and the area’s maternal mortality rate for Black women is 50 percent higher than the national average. As a nursing leader, my mission is to collectively address health inequities, improve health outcomes, and make meaningful changes within our organization and the community.
What is the most significant challenge facing nursing today?
The most significant challenge facing nursing today is getting more young people interested in this career. In my role at Luminis Health Doctors Community Medical Center, I’ve made it my mission to speak, teach, coach, and mentor at area nursing schools, historically black colleges and universities, community colleges, and high schools. We offer internship opportunities for students that may lead to future employment. Since approximately 70 percent of our employees (including myself) live within Prince George’s County, we are focused on growing and maintaining our own diverse workforce. One of the reasons I enjoy working here is I’ve felt welcomed the moment I walked through these doors. It has a small southern town feel in a larger community, even though we’re outside Washington, D.C.
As a nursing leader, how are you working to overcome this challenge?
See above. My greatest support is not my words but my actions. I fully support a work-life balance by encouraging my team to take paid time off and offering various types of shifts that fit any lifestyle.
What nursing leader inspires you the most and why?
My former CNO has been my mentor and a source of inspiration for more than 20 years. She is now a COO for a start-up corporation but remains inspirational by being herself. She is smart, wise, humble, and demonstrates humility. She has always been a wonderful person and leader.
What inspirational message would you like to share with the next generation of nurses?
Nothing worth doing is easy. Don’t make five minutes of a bad situation your narrative for the day or your entire career. Instead, focus on the positive and good experiences we have as healthcare workers.
Is there anything else you’d like to share with our readers?
Nursing will always give you more than what you bargained for. Regardless of my title, I am and always will be a nurse.
Are you feeling stuck in your nursing career? Shadowing another nurse to learn about a new role and work setting can make all the difference in your career.
Whether you are you a new nursing student considering which nursing specialty fits your skills and passions or a veteran nurse who wants to move into a new area and gain additional expertise, taking the time to shadow another nurse can accelerate your decision making.
Shadowing helps you immerse yourself in an environment and a work flow that is unfamiliar to you. Instead of learning about how a team operate, you’re able to see it with your own eyes and determine if it’s the right path for you. As most nurses know, reading about working as a nurse and actually working as a nurse are entirely different experiences.
How can shadowing help you specifically?
Finding Your Fit If you’re thinking you might like working with cardiac patients, for example, you’ll want to know what a typical day looks like. What are cardiac nurses expected to do? How acute is the patient population? What skills do nurses use most? What technology are they using? As you spend time shadowing a cardiac nurse, you’ll notice that you’re excited by what you see or hesitant about the role.
Working in Different Environments Because nurses work in vastly different environments, shadowing a nurse who works in a new setting is essential. You might think that being a transport nurse is exactly what you want to do, but you need to be in the shoes of a transport nurse before you can make an educated and accurate choice.
Learning About Patient Populations Maybe you’re a nurse working in a fast-paced urban hospital and you’re thinking of striking out on your own to provide healthcare in rural communities. Spending time with a nurse, maybe even one in a solo practice, to see what needs the population has and experience the range of skills needed for the role is invaluable.
Building Your Network Shadowing a nurse gives you experience to help you make a decision. One of the unwritten rules of shadowing is that you’re not there to ask for a job–you are there only to learn. But that doesn’t mean that you can’t use your shadowing experience as a way to build your network. Be sure to follow professional guidelines meticulously while you are on site and follow up with a thank you for the opportunity. Stay in touch with the people you meet during your time by connecting with them on LinkedIn or make a point to say hi (and maybe reintroduce yourself) at a professional event.
Gaining Appreciation for Your Industry There’s no better way to appreciate the amazing work nurses do than to follow one around. Even if you have been a nurse for years, it’s difficult to image exactly what work is like for nurses outside of your specialty unless you see it yourself. Even if your shadowing experience makes you realize you’re happy exactly where you are, the hands-on knowledge is invaluable.
