Many nurses, once comfortable with the day-to-day practice of nursing, decide that the next natural step is to go the specialization route. The thinking is that nurses who select a specialty will enjoy a higher salary, greater employment demand, and career-long job security than those who don’t. The US Bureau of Labor Statistics reports that registered nurses earn a mean wage of $68,910 annually, while nurse midwives earn $92,230; nurse practitioners earn $95,070; and nurse anesthetists earn $157,690. Not all specialties guarantee increased earnings—a parish nurse, say, is typically unpaid—but the niches that demand additional training, certification, and experience that’s in short supply almost always do.
However, not everyone agrees that specialization is the best approach to navigating a nursing career. “Some nurses start out interested in pediatrics, ER, or labor and delivery, but most don’t,” says Donna Cardillo, RN, MA, a nursing career coach (www.donnacardillo.com). “Many nurses feel pressured to choose a specialty and feel deficient in some way if they don’t. That’s an old, outdated model. Most of us used to work in one specialty our whole career. It’s not like that anymore. We’re going to work in many different specialties and work settings. It’s common to weave in and out of specialties all the time.”
Cardillo believes the health care landscape has changed and so has the job market. Jobs are moving out of hospitals to alternate inpatient settings—long-term care, inpatient rehab, subacute care, and long-term subacute care.
“New nurses have to think more about the opportunity itself—the support they will get and the opportunity to grow personally and professionally, rather than ‘choosing a specialty,’” says Cardillo. “But they also have to think about opportunities outside of the hospital. For example, if interested in pediatrics, consider pedi long-term care, pedi home care, [or] pedi rehab.”
Regardless of whether you pursue a specialty or a good opportunity, as Cardillo advises, it turns out that the steps are very similar. It means thoughtful consideration, energetic career exploration, and possibly pursuing more education, certification, and on-the-job training. Here are three simple steps to specialization, plus the career stories of three nurses in some of today’s most popular specialties.
Look Inside
One of the best online resources for nurses considering a specialty is at www.discovernursing.com, which is sponsored by Johnson & Johnson. They offer a comprehensive Find Your Specialty quiz that starts with your education and skills (current or projected), then goes on to your favorite work roles and preferred work environment. Here are some representative questions and possible answers, slightly modified for brevity:
Q: What are you good at?
A: Tech savvy; good communicator; strong leader; compassionate; calm
Q: When it comes to your patients, the best way you can help them is:
A: Face-to-face; managing, training, or teaching nurses; doing research, writing, or advocating
Q: When mingling with colleagues, how do you join the conversation?
A: I lead it; I usually listen at first; I listen
Q: At work the perfect pace for you is:
A: Slower; steady; faster
Q: Your ideal day at work is:
A: Pretty much the same; slightly switched up; completely different
At the end of the test, you’ll get a top recommendation for a specialty, plus two alternatives. Each one is described in detail and includes a list of advanced training, educational degrees, or certifications required to practice. Finally, there’s a profile of a successful nurse in that specialty to give you a sense of what’s required to find satisfaction on that career path.
Look Outside
After self-exploration, it’s time to do some workplace exploration. Nurses get a great deal of first-hand knowledge of various categories of nursing as they do their rotations during nursing school. If you pay careful attention to your “gut level” reactions—to medical-surgical, pediatrics, obstetrics, or critical care—you will discover which specialties appeal to you at a deeper level. You may want to explore additional specialties through internships, externships, temporary assignments, or PRN work outside your regular work duties.
If an actual, in-the-field trial is not an option, consider going online to learn about other categories. At www.discovernursing.com, there is a database of 104 nursing specialties that you can access in a variety of ways. The specialties cover the gamut, so there’s something for everyone: 34 are outside hospital settings, 68 are research connected, 37 are managerial, and 92 are patient-facing.
One of the best parts of this database is that you can filter it by health care setting, degrees/certifications required, and job characteristics, so you don’t have to wade through all 104 specialties. The site will “curate” the ones that match your specific requirements.
One of the key factors that nurses consider when choosing a specialty is employment demand. Many associations survey their members about employment and publish results. Say that you’d like to be an OR nurse and know that the Association of periOperative Registered Nurses (AORN – online at www.aorn.org) reports that the average age of their members skews high, plus a quarter of OR nurses plan to retire or work part-time in the near future. Those demographic factors may increase job demand—or not. You have to dig a bit deeper to find out.
Now that you’ve chosen a few specialties to explore, it’s time to get out there and do some personal sleuthing. You can attend the professional association meetings near you, go to area conferences, or connect with RNs online at nursing specialty forums and at networking and social media sites.
So, when pursuing insights about being an OR nurse, for example, ask nurse leaders what prospective nurses should know about that specialty. Here’s what Deb Cooksey, RN, MBA, MS, CNOR, vice president of nursing at AORN notes: “First, they need to understand that their experience with the patient is very different; it’s very short and concise—probably the biggest difference they would experience. Also, working as part of a team is often a big change; many nurses are used to working autonomously. Another area where there is a significant difference is in how work is done; in Periop, it’s often multitasking but in a consecutive way. That can take getting used to.”
Next up, arrange one-to-one informational interviews with nurses who are successfully working in that specialty to find out more about their individual career path and what they’d suggest to a newcomer. Cardillo recommends asking experienced nurses these questions:
• How did you get started in this specialty?
• What do you like most and least about your specialty?
• What are the most important attributes of a nurse in this specialty?
• What trends do you see in this specialty?
“You’ll get your best information from those in the field, but take it with a grain of salt—that’s another reason why you should speak to four or five people,” Cardillo adds, so that nobody’s opinions weigh too heavily on your decision to pursue a specialty. Make a point to ask each person you interview for the names of one or two other nurses, and if they’re willing to make an introduction or let you say they referred you.
Assess Opportunities
Take a look at your overall career goals and areas of interest, the type of lifestyle you aspire to, your personality and work style, and the time and other resources required to pursue an avenue.
So, for instance, if you think you’d enjoy independent case management but you don’t have funds available to get a business off the ground (and wait for it to grow to support you), maybe that isn’t a good initial specialty.
Then, of course you’ll want to see what offers you get as a way of determining if your job target is actually viable. “Whether a new or experienced nurse, you don’t want to stay unemployed for any length of time,” says Cardillo. “You can continue to pursue your dream job while you’re working. Say you’re interested in pediatrics, but can’t get hired in a hospital on that unit. Maybe you get offered a job on a telemetry unit. You might consider taking that because it’s easier to get transferred into another unit than hired from outside.”
Below, three nurses weigh in on their journey to a specialty, with some advice for other nurses:
Lisa Pacheco RN, BSN, Director of Maternal Child Services, Children’s Hospital at Nevada University Medical Center, Las Vegas
My personal journey
I always knew I wanted to help moms and babies, because of a nurse who took care of me when I had my older child. I went into nursing school with the idea of maternal care but was advised not to specialize early on so I did medical-surgical nursing, then neuro subacute nursing, then I made a full circle back to my passion, a women’s care unit, and realized my love of taking care of women and children. It’s a place where I can leave my footprint and make a difference. We’re a voice for families, making sure they’re taken care of. I’ve been doing this for 23 years. There are so many aspects to this field—antepartum, NICU, women’s care unit, community nursing—it’s so broad so you can really find your niche.
Who does well in this specialty
Nurses with a passion for taking care of mothers and children do best. Follow your heart, and then even on that hardest day when you don’t think you can come back to work, you will. Find a unit that takes in new grads and trains them. Be careful not to take just anything. You want it to work for your goals.
What might surprise you about this specialty
A lot of nurses want to take care of moms and babies, but sometimes there’s disillusion. Having a baby is a dangerous thing. I always say it’s the most dangerous point of a young woman’s life. We triage patients, we have an OR for C-sections. If you work in a birthing center, it’s usually a quiet, beautiful experience. But if it’s high risk, like here at the hospital, you’ll have your fill of adrenaline. The NICU is different still, and so is postpartum.
Also, when I started, if you weren’t healthy you didn’t have babies. Now patients can have diabetes, heart problems, and asthma, and still get pregnant. Their health is compromised and their pregnancy is high risk. Patients come in by ambulance, very ill, and a lot of moms end up in the ICU later—with nothing that’s pregnancy related.
Downside of specialization
If you do specialize early, you may fear layoffs. If you’ve been a NICU nurse for 15 to 20 years, for instance, those nurses have a really hard time getting another job if we have a layoff.
For more information on this specialty, visit The Association of Women’s Health, Obstetric and Neonatal Nurses website at www.awhonn.org.
Erik Meyer, RN, BSN, Nursing Supervisor, Providence Seaside Hospital, Oregon
My personal journey
I chose ER for selfish reasons—I’m an instant gratification person. In the ER, either we fix them or we send them away. Instant results. We get a go at it, and if they stabilize they go to ICU or another department. When I was in nursing school, I saw a level 1 trauma center in inner-city Detroit. Everything you see on TV—well, that was that place. It was just a one-shift visit, but the next day I applied for a two-year internship. There were 500 applicants and they hired 30 of us. It was a free-for-all, fly-by-the-seat-of-your-pants kind of place, but a great place to learn.
I’ve been in the ER at a small, rural, critical access hospital for 18 years, now as a nursing supervisor. I work two 12-hour shifts; my wife and I are raising four kids and running a coffee business. That’s the great thing about nursing—you can work as much or as little as you want.
Who does well in this specialty
It’s so intense and we’re so busy that waiters and waitresses make the best ER nurses. You know to grab everything you need before leaving the kitchen, then check in on everyone to see how they’re doing and give them the best service possible! The ER is so like the food-service industry. That’s what I grew up doing—waiting tables.
Job search advice for new nurses
Just keep pushing. Introduce yourself to the ER manager and let them know your goal. Tell them, “If you need help, I’m available.” Keep pushing. When you pass them in the hall, ask “When can I work for you?”
ER personnel will respect people who are assertive. If you’re leaning in this direction, start getting your certifications in order and working towards becoming a Certified Emergency Nurse. Get the books and start studying for the test.
For more information on this specialty, visit the Emergency Nurses Association at www.ena.org.
Brittney Wilson, RN, BSN, also known as “The Nerdy Nurse,” Clinical Informatics Nurse, Georgia
My personal journey
After my second year of bedside nursing, I knew that I couldn’t do it forever. It’s backbreaking and emotionally draining. I began searching for MSN programs that would allow me to elevate my career and stumbled upon something called “Nursing Informatics.” When I read the job description, it was like the clouds parted, the sun broke through, the angels began to sing. Most informatics nurses are BSN-prepared. So I decided to pursue the career without the MSN in hand to see if I got any traction; three months later, I was hired. Of course, my technology savvy as conveyed through my blog (www.thenerdynurse.com) were a big help with that. In my day job, I get to do what I love every day: combine technology and health care to improve patient outcomes.
Who does well in this specialty
One of the primary parts of my job is translating the needs of nurses to IT and the needs of IT to the nurses and other clinical staff. Sometimes, when nurses and nerds get together, it can seem like they’re speaking two separate languages. That’s where informatics nurses come in.
Job search advice for this specialty
Informatics nursing has become a hot specialty, and because of this, it can be really difficult to get your foot in the door. I will say that, at minimum, you should be BSN-prepared with at least three years of bedside nursing experience. The MSN credential will certainly be a help, but many organizations also want experience, so try to find some way to get IT or technical experience.
Certifications do command a higher salary. According to the HIMSS 2014 Nursing Informatics Workforce Survey, the average salary for an informatics nurse in 2014 is $100,717, while the average salary for a nurse who is certified in nursing informatics is $121,830.
For more information on this specialty, visit the American Nursing Informatics Association at www.ania.org.
Career advice for any nurse
Read nursing blogs! There are many message boards that are filled with negativity and lots of complaining. If you want to find something more uplifting and connect with people who are really passionate about nursing, then nursing blogs are where it’s at!
Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.
With the increasing demand for more highly educated nurses and many hiring requirements now mandating a BSN, the nursing job market is in the midst of a massive shift.
The BSN figures prominently in the nursing field, especially since the Institute of Medicine’s report The Future of Nursing called for 80% of nurses to have a BSN by 2020. More nurses are attaining the degree, but many of them wonder just what advantages the BSN can bring.
According to recruiters, a BSN automatically raises both your professionalism and your marketability. Recruiters, who act as a link between job seekers and the organizations looking for staff, also say a BSN is only one piece of the professional package needed to land your first job out of school.
“More and more, a BSN is becoming the minimum requirement, as opposed to the preferred idealistic requirement,” says Amanda Bleakney, senior managing director of health services operations with The Execu|Search Group. In fact, many top-tier hospitals won’t hire a nurse without a BSN. “Nurses who aren’t getting a BSN are ruling themselves out of job opportunities,” she says.
Recruiters can help new grads find a job, but as a job seeker, you still have work to do. Recruiters want a BSN backed up by experience, but they also want to hear about any special skills you might have. They are trying to keep their clients happy and send them candidates they need, so the more precise and polished you are, the better the fit will be.
“Anything we can use as a selling point to the client helps,” says Bleakney. “When it comes to the candidate side, we always have a selling point.” So if you’re looking for a job in the Bronx and you speak Spanish, you might be more valuable than someone who has a little more experience, but isn’t bilingual.
However, no matter how great your experience is, it means nothing if you don’t present yourself well. A recruiter can open the door for you, so it’s just as important to show them your best, most professional self.
“A recruiter is a gatekeeper,” says Terry Bennett, president of the National Association for Health Care Recruitment. “Recruiters are helping to screen candidates the managers will then interview. Where graduates can present their best selves is by helping to qualify what they will bring to an organization.”
Your resume is your first introduction, so use it to tell your story. “Tailor your resume,” Bleakney advises. Anything you want to highlight, such as your bilingual skills, your experience with specific populations, or your electronic medical record training, should be at the top.
“Bad or poorly formatted resumes will rule nurses out of a job,” says Bleakney. Even if a nurse hires a pro to craft her flawless resume, Bleakney says it shows that she is someone who cares about presentation and likely has strong administrative skills, too.
Recruiters want candidates whose preparation and professionalism will shine a light back on the recruitment firm. “We want to send the highest quality, top candidate as we can because that candidate stands out for us,” says Bleakney. Very often, an initial phone screen will be followed up by an in-person meeting to go over all the candidate’s qualifications and background checks.
If you have anything that could be interpreted as even slightly negative, be upfront with your recruiter, suggests Bleakney. “It’s always best to disclose something,” she says, or it can cost you a job instantly.
“Reputation is everything,” says Brenda Fischer, PhD, RN, MBA, CPHQ, FACHE, senior director of clinical education programs with AMN Healthcare, a workforce solutions firm, so watch your social media posts and appearances carefully. “Employers can be very selective,” says Fischer, and they will look at a candidate’s online information.
Recruiters want people who represent them well, and they use your first meeting to assess how you will present yourself to a client. Although it’s not an actual job interview, it is your first step in getting a job. Don’t be late, dress professionally, and bring your resume and any other requested documents, recommends Bleakney. “Half of getting a job is showing up and being prepared,” she says. “If someone cancels continuously or is a no-call and no-show, I know if they do that to me, they will do that to my clients.”
When you advance to an interview your recruiter sets up, do your research. “Know about the organization,” advises Bennett. “For the unit, what types of patients are there?” Make sure the organization knows why you want to be on that unit, with that manager, with that organization, and why you are the best person for the job, she says.
What Does a BSN Do for a Nurse’s Career?
“Students should realize what they are getting from a BSN that is special,” says Hayley Mark, PhD, MPH, RN, an associate professor and the director of the baccalaureate program at Johns Hopkins School of Nursing. “The degree means they have the ability to think critically. They can evaluate evidence and apply it, and that skill is critical.”
Critical thinking means a nurse can assess the quality of care, says Mark. “It goes beyond the skills,” she says. “A BSN gives a system-wide perspective and helps nurses look beyond the one-on-one.” For instance, if there’s ever a medical error, a nurse can gather the reasons why it happened, can use that information to understand why it happened, and will then take that knowledge to implement changes to make sure it doesn’t happen again.
A BSN also opens doors for other prospects. “The future of nursing is with a BSN,” says Julia Taylor, a BSN grad who works at Memorial Sloan Kettering Cancer Center on an in-patient gastrointestinal surgical oncology unit. “You’re more of a well-rounded nurse and will have more opportunities down the road to pursue a master’s or doctoral degree.”
When you are interviewing, highlight not just your BSN but also the knowledge that comes with it. As with any education, a BSN gives you more in-depth nursing knowledge, but the specific training from a BSN also means you know how to look at the whole system and you have the skills to work in a leadership role across all systems, says Mark. “Generally, if a company is comparing a BSN nurse to a less educated nurse, they will hire [the one with] the BSN,” she says.
When a nurse looks at the industry systemically, issues such as cost effectiveness, patient centeredness, communication skills, awareness of the latest in patient safety, and familiarity with information technology are most pressing, says Fischer. That scope often mirrors an organization’s approach as well, so hiring nurses who think that way benefits the entire company.
How Does a BSN Translate to Real Work?
The BSN degree prepares students for the broad thinking required of future nurse leaders, but any hands-on experience a new grad has or can get makes recruiters take notice. Many organizations are looking for a couple years of experience, says Bleakney, but are willing to consider new grads who can demonstrate how their clinical—or even their volunteer work—prepared them best.
A practicum in a similar unit will increase your chances as you will gain similar skills, says Bennett. But even work outside of health care is helpful if you frame it right. Did you manage a restaurant? Then you have great customer service skills, says Bennett. Did you head up an Eagle Scout group? You also fine-tuned your leadership skills in the process.
As a minority nurse, you can also highlight your diversity skills. In most organizations, the ratio of cultural diversity with patients and providers is not representative of the population. If you are a minority nurse looking for a job, recruiters in certain locations want to see your resume because health care organizations are seeking a more diverse staff. “I would use that in crafting my resume and present it as a strength,” says Fischer.
Farzana Abed, a recent graduate of the Johns Hopkins School of Nursing, chose a BSN program for the breadth of the studies, but her own background offers employers a valuable perspective. “A BSN offers a more comprehensive program with the social, cultural, and political aspects of nursing,” she says. Combining her education with her life experience as an immigrant from Bangladesh who knows the challenges of language barriers, financial difficulties, and even racism makes her very aware of the challenges some patients face.
If your cultural or racial background gives you a better understanding of what minority patients might need or how they approach health care, your life experience combined with your BSN is going to be a sought-after skill. If you understand various cultural traditions surrounding health choices or if you are bilingual, let recruiters know those skills up front.
What Can You Do?
“Get any work experience on the unit and do the job well,” advises Mark. A shadowing experience also helps you boost your knowledge and get yourself noticed, she says. Bleakney suggests seeking out professional organizations that mirror your ideal job, whether that brings you to the Case Management Society of America or with the Nurse Practitioner Association of New York State, so you can meet leaders and connect with others in the field.
Networking, although it can be difficult for some, is a vital step when you are looking for a job. Get in touch with people through your alumni network or call a nurse manager or a nurse recruiter and impress them. “Every opportunity for volunteerism or professional development helps,” says Fischer. “Build every relationship through your clinical experience or through your school. Use every experience to form good relationships.”
Fischer acknowledges the special barriers of nurses who are going back to get a BSN after several years on the job. Unless they have actively worked at keeping their industry networks vibrant, it’s going to be harder for them to get out there and make the connections. They likely have pressing family obligations or more job responsibility than a new grad and less time for networking. “Make your own network,” Fischer advises, saying a group of colleagues can give specific career advice and family and friends can help out.
Where Are the Jobs?
The need for BSN nurses is great and will continue to rise as tougher standards are adapted. “Your educational background is first and then your work experience,” says Bennett. But for new BSN nurses, flexibility with location or setting plays a big role in your job search.
Talk with recruiters in different areas of the country to find out about job prospects and consider relocating, even if it’s only for a short while. For instance, suburban and rural areas are traditionally less competitive job markets than the big cities like New York or San Francisco, says Mark, so you might land a position that matches your interests, even if it’s not your first location choice. “Once you come in with experience, it makes you a totally different candidate,” says Mark.
Be open to different options, but even if you consider a placement as a temporary stop on your way to something else, don’t treat the job as a place marker, advises Bennett. Recruiters and employers want a candidate who is committed to the job, so give it your all to gain the experience you need.
If your field is especially competitive, consider all the places where you can gain skills first. “As nurses, we have to be proactive and strategic,” says Fischer.
A long-term care facility, a school, or a substance abuse facility can offer enough experience to make you that much more marketable, says Bleakney. “This is not the time to be particular,” she says. “This is the time to get the experience on your resume. Nurses who get the experience and then apply for their dream jobs are ahead of all the others who don’t have the experience.” Even working at a smaller community hospital might just give you enough knowledge of certain cultures or neighborhoods to make the difference in your next interview.
How Do You Find a Recruiter?
Finding a recruiter is not hard. Ask around to find out who colleagues have worked with or who your school recommends. You can also call the human resources department of your dream organization and ask which recruiting firm they work with or even the contact information for the recruiter, says Bennett. “If you really want to work somewhere, call that recruiter and ask what the process is,” she says. Do they have rolling starts or is it a month of interviews? Do they welcome calls after you have applied or are calls a no-no? Are new grads considered?
By asking relevant and specific questions, you can help shape your own process to maximize the recruiter’s time and resources as well as your own.
When you meet a recruiter, use the time wisely and be organized and open-minded. Your different skills can help recruiters recognize other areas that would offer a good fit for your skills. Even roles you may not have ever entertained might turn out to be an excellent prospect, says Fischer. Health coaches, care coordinators, and clinical documentation specialists are just a few roles emerging for nurses, says Fischer.
“Flexibility is key in health care, especially as a new graduate,” says Bleakney.
Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.
Advancing your education isn’t a prescription for debt. Here’s how to earn that degree without interest.
One out of 10 Americans has student loan debt. That debt is steadily on the rise, with projections putting the total at $1 trillion this year, according to numbers compiled by Consolidated Credit. That number may seem unfathomable to many, but how big is your slice of that debt pie? Do you view student loans as the only way to fund your nursing education?
If you answered yes, it’s understandable why you may feel that loans just come with the territory of higher education. After all, tuition is at an all-time high—with no signs of slowing down. According to The College Board’s Annual Survey of Colleges, average in-state tuition and fees are $8,893 for public four-year and $3,264 for public two-year institutions. To put those numbers into perspective, the average yearly tuition at a four-year school in the 1980s was $3,449.
If you dream of becoming a nurse or if you are already a nurse and wish to earn an advanced degree (or two), know that you don’t have to contribute to those startling national student debt totals. Take the time to become financially savvy and seek out the right opportunities, and you could come out with substantially less student loan debt than your fellow classmates.
One of the first steps before making decisions about funding your education is to step back and thoroughly research your options. Look at the type of degree you are considering and make sure there is a high enough demand in the job market and job growth projections for that specialty. Also, look at salary averages for your chosen degree/career plan.
“Very few people can afford to pay for college out-of-pocket,” says Tiffany “The Budgetnista” Aliche, author of The One Week Budget: Learn to Create Your Money Management System in 7 Days or Less! “But student loans are avoidable if you plan carefully. Student loan debt in itself is not bad. The problem is that most people chose student loan debt as their first option and it really should be their last.”
Aliche stresses that getting an education is an investment. “What you put in should give you more money back in return, and if it doesn’t then you have made a gross error,” she warns. “If you invest $150,000 and only make $40,000 coming out, that’s a mistake. It doesn’t make sense. For example, if a doctor invests $100,000— that’s OK because they’re probably going to make over $100,000.”
Shannon McNay, community outreach and customer support manager at ReadyForZero, an online debt elimination tool, agrees. “Crunching the numbers is the absolute best way a nurse can decide if he or she should pursue an advanced degree,” she says. “What are the projected earnings for the position a higher degree will get you? Compare the price of the schools you’d go to and see which one you’d pick. If the tuition is equal to one year of the pay, it could be a worthwhile opportunity.”
The college or university you select can instantly drive up or reduce the cost of your education. “People will say ‘go to the best college you can.’ I disagree. I say go to the college that offers you the most money,” argues Aliche. “If you go to this amazing college and they offer you no money [scholarships], and you come out owing hundreds of thousands of dollars, no one cares that you went to Princeton and you don’t have a job. If you work really hard and do internships, you can compensate for not going to a school with a big name. But you can’t compensate for owing $100,000 in debt. And then you’re going to be stuck with a job that you hate because you have to pay off the student loan debt.”
The Importance of a Nursing Education
The Institute of Medicine’s 2010 report The Future of Nursing reported that the Bachelor of Science in Nursing (BSN) degree is the new starting point to get hired as a registered nurse. In fact, according to the findings, nurses with a BSN will increase from 50% to 80% by 2020.
There’s no denying that the higher you go in your nursing education, the higher you can go in your nursing career and earning potential. With our ever-changing health care landscape that is a result of the Affordable Care Act, advanced practice nurses (e.g., nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives) are often primary care providers. Those roles require a master’s or doctorate degree. They also require a large investment of time and money.
Paying for Your Education
Before you sign on the dotted line for that student loan, it’s wise to explore other options for paying for your degree. For starters, look into scholarship opportunities—you may find easy money waiting for someone like you to claim it.
Aliche says that most students never apply for any scholarships. “It’s smart to explore scholarships as many programs offer them but have no applicants, making the competition low,” she explains. “There are a lot of people who say ‘I don’t want to apply’ or ‘I won’t get it.’ Apply, since you may be the only one. There may be three scholarships and three people applied; so by default, you win.”
Another alternative to student loans is to work while you’re in school and pay as you go. Many students can’t go to college full-time and literally work their way through evening and weekend programs. Accelerated master’s programs can be good options for parents who need to maintain employment while working on their degree.
“I think employment during your college/advanced degree experience is a good way to pay for—or at least offset—the cost of tuition, fees, books, and living expenses,” says John Heath, an attorney with Lexington Law, a credit repair firm. “Further, there are employers that will pay for college/advanced degree courses as long as the course fits their respective business model and you meet the criteria expected by the employer.”
If you have exhausted all other options for paying for your education, it’s time to look into student loans to help fill the gaps. But it’s vital that students fully understand the various types of loans and the terms and conditions.
As a general rule of thumb, Aliche advises students to steer clear of private loans because of interest fluctuation. She says federal loans are the best choice because they offer a fixed interest rate and less risk overall.
“With private loans, if you get sick or even if you pass away, you may still owe because, usually with a private loan, you have to get a co-signer—making that person equally responsible for the loan,” explains Aliche. “If you pass away, that person may still have to pay. But with a federal loan, if you pass away or become disabled, your student loan is forgiven. If you can no longer perform those tasks or face financial hardship, you can apply for forbearance, which means they allow you not to pay [on the loan] for six months to a year until you get back on your feet. Private loans do not offer that option. That’s why I tell people, if you’re going to get a loan, try not to get private loans because, when it comes to repaying it, there are very strict guidelines that are not there for federal loans.”
Loan Repayment Programs
Because skilled nurses are in high demand, especially in urban and rural areas, there are programs through the government, nonprofits, and employers offering loan forgiveness to nurses who are willing to work in underserved areas for a specified amount of time.
The US Department of Health and Human Services Health Resources and Services Administration offers the NURSE Corps Loan Repayment Program (http://nhsc.hrsa.gov) for professional registered nurses working in a critical shortage facility. Those accepted receive 60% of their total qualifying nursing education loan balance for two years of service.
National Health Service Corps alumna Tamara Bumpus, MSN, NP-C, a nurse based in Toledo, Ohio, took advantage of the loan repayment program and has already completed her two-year commitment.
“I work for the Neighborhood Health Association, which serves the homeless, and the other office I work at serves the underserved— people with low-to-no insurance,” says Bumpus. “I always heard that there’s money out there. I researched and found that the National Health Service Corps was available, and I applied for it. It seemed like a difficult process at first, but it was more of a waiting game—waiting to see if you were going to be approved or not for the loan reimbursement—and I was approved the first time I applied. There’s nothing better than getting money back after you’ve taken out student loans. I wanted to be a nurse practitioner, and it was so helpful to have that burden removed. If I had known about the scholarships, I would have done that also.”
Smart Budgeting for Repayment
If you already have existing student loans or plan to get one in the future, it’s smart to plan early for how you will repay the debt. Aliche says an old-fashioned budget is the best place to start.
“Include everything from your rent to getting your hair done,” Aliche says. “Before you can pay a loan back, you need to know how much you can afford. So if you add up your money list and your life costs you $2,500 per month and you make $4,000, you will know how much you can afford to make in payments.”
Aliche says that only you can know how much you can truly afford to pay each month— not your lender.
“No one should tell you how much your payment should be, you should tell them,” she argues. “You can say, ‘Honestly, I did my budget and, with my bills, I don’t have $300 per month . I have $150 that I can guarantee.’ It’s a different conversation when you say that. ‘I have a budget and you want me to promise you $300, but you’re not going to get that.’ That’s the kind of conversation that you want to have. You can definitely try to negotiate your monthly payment. It may take you talking to five people on the phone or a week of calling. I know someone whose monthly payment was $900 and she got it down to $400 per month. You can e-mail them a copy of your budget so they can see that you don’t have things like cable. Most people are not having that conversation with their lender, so that’s why it’s easier for someone to say yes to you.”
Another good strategy for those still in school is to make payments now, not after graduation.
“Calculate a small amount of money to pay each month so you can get a head start,” McNay suggests. “You may also want to dedicate some monthly savings to building an emergency fund. If you end up finding a higher-paying job out of state, you’ll want some startup money to get you there. Don’t lose out on opportunities just because you’re not financially ready for them. School is a great time to save.”
McNay says nursing students should stay mindful of what’s available to them after graduation. “If you’re really struggling, the [federal government’s] Income-Based Repayment Program [https://studentaid.ed.gov] can be an absolute lifesaver— yet so few people know about it,” she says. “Stay up-to-date on changes in legislation that can benefit your finances—these changes aren’t just for current students.”
By educating yourself on the various options for funding your education, you can avoid the many pitfalls that land so many students in mountains of debt. Careful planning will allow you to begin to build the life you dream of after you graduate, whether that’s traveling the world or buying a home. The less student loan debt you have, the faster you can finance your other dreams.
Student Loan Do’s and Don’ts
There is so much information out there about student loans. Keep these expert tips in mind to keep your loans in check.
Do Face Your Debt
“If you don’t already know who you owe or how much you owe, drop everything and find out right now. Ignoring the student loans will not make them go away. This website will help you figure it out: www.nslds.ed.gov.” —Shannon McNay, community outreach and customer support manager, ReadyForZero
Do Be Careful When Consolidating
“Do not refinance a federal loan to a private company. All of the protection you get with a federal loan, you will not get it if you refinance with a private company. With a federal loan you can consolidate. So if you have 10 federal loans, they will take the average interest and give you one payment.” —Tiffany “The Budgetnista” Aliche
Do Shop Around
“Pick your top five schools and talk to each of them about the real cost of your degree. Financial aid packages vary greatly, so let the schools make you an offer.” —Matt Kelly, founder, Momentum: Personal Finance Coaching
Don’t Waste Refund Checks
“If you get back $2,000, some people think that’s free money. No, that’s money that you owe. If you don’t need that money, send it back. That will lower how much you owe when you get out of school.” —Tiffany “The Budgetnista” Aliche
Don’t Overborrow
“It’s a mistake to take a large amount (more than needed) of student loans to maintain the lifestyle you were accustomed to at your parents’ house. It is better to live like a student while you are a student than to live like a student after you have graduated because of your large student loan payment.” —John Heath, attorney at Lexington Law
Denene Brox is a freelance writer based in Kansas City, Kansas.
Christal Leitch found out firsthand that the biggest surprises often come when your mind is focused elsewhere. “I was so surprised,” she says, laughing, noting that she almost didn’t open the e-mail notifying her of her win right away.
Leitch, who begins her nursing school studies at the Georgia Baptist College of Nursing at Mercer University this fall, came to nursing in a roundabout way. “My mom is a nurse,” she says, “but that was never one of my things. I wanted to work in an office 9 to 5.”
In 2006, Leitch realized she wanted to change careers. Her ill mother-in-law came to stay, and Leitch nursed her and cared for her. “It was so rewarding,” says Leitch. “I thought, ‘This is what I want to do.’”
Leitch immigrated to the United States from Trinidad and Tobago Islands in the 1980s and says her primary goal was to earn a college degree and return back home. But being unfamiliar with the accreditation process in the United States led her to get a degree in office technology in 1996 from a school that had state, but not national, accreditation.
By the time nursing came on her radar, Leitch had already started a family and worked for a variety of Fortune 500 companies. But, she says, something was missing from her career, and she now realizes it was a mismatch between her interests and her job. “I am naturally a very caring person, and I didn’t realize that that’s where I’m most comfortable.”
In 2009, when she decided to return to school for a nursing degree, she had to begin taking her prerequisite classes all over again. But on the same day she started classes, she also started a job as a medical assistant for a group of vascular surgeons, and she knew she was on the right path.
In earning her prerequisite classes for nursing, Leitch qualified for a bachelor’s in psychology, which she earned last May. Nursing school will be challenging, but Leitch is excited. She’s confident that her journey will be smoothed by her strong support system of family and friends.
“My focus will be on trying to keep patients comfortable and giving patients someone to lean on and to hold their hands,” says Leitch. “I want them to know ‘I’m here and you don’t have to be alone.’”
Leitch says in those particularly stressful times, a nurse is essential. “In times of distress, I want them to know someone is there to comfort them,” she says.
Leitch envisions a career as a certified nurse-midwife or a certified registered nurse anesthetist, although she realizes that could change. Noting that each stage of nursing school could reveal something that is a calling, she is especially looking forward to the labor and delivery training.
Eventually, she would like to work for an organization like Doctors Without Borders. “It’s one of the first things I’ll do when I get my degree,” she says. “I am so ready to sign up.”
Despite coming to nursing a little later than most, Leitch is comfortable knowing she is finally where she belongs. “When my aunt heard I was going to nursing school, she said, ‘It’s about time,’” Leitch says laughing. “I just never thought about it, and then it just dawned on me.”
Although her journey to nursing is long, Leitch says she lives and models what she tells her sons—failure is not an option. “Your hard work will pay off in the end,” she says. “Nothing comes easy, but at the end of the day, no one can take your education away from you.”
Runner-up, Karachi Egbuta
From a young age, Karachi Egbuta knew she wanted to be involved in health care. A bachelor’s degree in biology led her to different health care jobs after graduation, but it was seeing the interactions between nurses and patients at various jobs and volunteer positions that convinced her nursing was the career choice for her.
“Nurses interacted with patients from start to end,” says Egbuta, a student at Roberts Wesleyan College in Rochester, New York. “I saw how caring nurses are, how they comforted patients, and how they would advocate for their patients.” And seeing patients put so much faith and trust in the nurses—confiding in them in ways they might not with their physicians—impressed Egbuta.
“I just watched that, and I knew I wanted to do nursing,” she says. Her husband, an OB/GYN resident, opened her eyes to actually making a career out of nursing and encouraged her to follow that path.
Egbuta’s varied health care experience, through work, volunteerism, or her own travels, have all given her a global understanding of health care’s pressing and vast issues. She spent two years as a public health advocate with the Jacobi Medical Center researching and testing patients for HIV, and she continues to volunteer in an ER department where she sees all kinds of health care needs and situations. Her work impressed upon her the importance of patients’ health care education and information. Her own travels to visit family in Nigeria gave her insight into the discrepancies of global health care and fueled her passion to help others. “They talked about the hunger and the struggles, and it makes you realize everything you have here,” she says. “It’s all those little things they need that we have access to here.”
Egbuta, who expects to earn her nursing degree in May 2015, knew going back to school wasn’t going to be easy for her. She says she struggled getting her first degree, so she knew another degree would require all her focus, but she was pulled by nursing’s appeal.
“The beauty of nursing is that you can do anything,” says Egbuta. “I love that because I like a little bit of everything.” And with an infant daughter, she says nursing’s flexibility will help her manage work and family.
Egbuta already knows the challenges of trying to manage family and work. Her daughter was born during the toughest semester of nursing school yet. With the help of family, support from faculty, and a razor-sharp focus to finish nursing school, Egbuta had her baby on a Thursday and was back in class on Monday.
As a student, Egbuta sees that nursing is a challenging profession despite its rewards. “There’s lots that will test you in nursing,” she says. “The hardest is dealing with different patients’ moods. You want to do everything you can to make them happy.”
Egbuta finds compassion for their situation helps: “You have to put yourself in their shoes. No one wants to be in the hospital. They are just uncomfortable. So you have to be comforting to them even when they are in a bad mood.”
Egbuta plans to start in a medical-surgical unit upon graduation so she can get broad experience. “You learn about everything that has to do with medical conditions,” she says. And with dermatology and skin conditions being one of Egbuta’s top interests, she is likely to see patients with a range of skin issues. “Skin is the first barrier,” Egbuta explains.
Eventually, Egbuta can see furthering her education to become a family nurse practitioner, but until then she wants to just be the best nurse she can be.
“A lot of people know nursing is the hardest undergrad and a lot of people don’t make it,” Egbuta says. “I always say, ‘If I can do it, anyone can do it.’ You have to put in the time. It’s very intense, but they are trying to prepare you to be the best nurse you can be.”
Runner-up, Yvonne Shih
Yvonne Shih took a huge leap of faith when she moved from California to Boston to attend the Boston College (BC) William F. Connell School of Nursing. Tough as it was to leave family and friends behind in the area where she spent her whole life, Shih knew the move was going to bring her closer to her goal of becoming a nurse. “It’s not about seeing problems or obstacles but to just look ahead,” she explains.
Pursing a nursing career wasn’t something Shih even considered until her freshman year of high school. When a family member had health issues, a visiting nurse made a lasting impression when she simply said to Shih, “Maybe you should think about nursing.”
“I didn’t know it was even an option until she said it,” says Shih, who expects to graduate in May 2015. But, she says, her own personality traits of enjoying taking care of people and making others comfortable might have tipped her off.
“I definitely like the idea of being able to help people for the rest of my life,” Shih says. Making patients feel comfortable in an unfamiliar setting or situation that isn’t always easy appeals to her. And the variability of a nursing career, one where you can care for patients at their bedside in a hospital setting or out in the community, is something that she finds compelling. Events like school shootings or the Boston Marathon bombings, which happened so close to BC, have helped shape Shih’s future course. She is interested especially in psychiatric nursing. “With the school shootings, you can see how important being a psych nurse is and how it can benefit the community,” she says.
Despite the enormous time challenges of any nursing student, Shih fits in even more nursing-related activities outside the classroom. She is the president of the Massachusetts Student Nurses Association; she is a group leader at the Cornerstone Church of Boston; and she represents BC in several networking and leadership events. Of everything, Shih finds her own internal expectations to be the most daunting: “It’s just tough being hard on yourself, and making sure you are on top of everything and presenting yourself well. It’s hard to maintain a balance of everything.”
Shih finds incredible support in her family, friends, school, and her faith. And, she says, even pressure beyond just the typical school worries show her just a taste of what life after college might hold. But she has had incredible mentoring experiences working with BC faculty on an advanced study grant for her research on nurse staffing ratios in California and Massachusetts and a fellowship for an NIH-funded study on sleep apnea.
Although she says people might first notice her skin color or her features, being a minority isn’t a disadvantage as a nurse, even if some people might still believe that, she says. She would like to empower other minority nursing students to see their strengths. At BC, she has even led a faculty and student discussion on racism at the BC Connell School of Nursing Diversity Advisory Board Stand Against Racism event.
Shih believes in meeting others and being brave or bold enough to just ask people for help. When she first arrived at BC and wanted to find out how to combine studying nursing with the economics and business of health care, she simply asked a dean about it. The dean, in turn, put her in touch with several faculty who had the expertise she needed.
With one more year to go, Shih is thankful to her family and her school for the support they have given her. She follows the advice she would give to any nursing student who is trying to make a mark and to find others to guide them along their journey.
“You might not instantly click with everyone,” she says. “But don’t feel discouraged. And don’t ever give up.”
Current literature reminds us that active learning helps promote critical thinking and problem-solving abilities. Active learning requires that students be engaged through more than listening, reading, writing, and discussion.
Research has significantly proven the opposition amid adult and child learning styles. Established on the research that adults do not learn in the same style as children, it is practical to accept that one cannot teach adults employing methods developed and planned to facilitate the learning experience of children. Malcolm Knowles, a pioneer in the field of adult learning, hypothesized some assumptions to assist teachers with teaching children and adults. These assumptions include:
The Need to Know. Adult learners need to know why they need to learn something before undertaking to learn it.
Learner Self-Concept. Adults need to be responsible for their own decisions and to be treated as capable of self-direction.
The Role of Learners’ Experience. Adult learners have a variety of life experiences that represent the richest resource for learning. These experiences are, however, imbued with bias and presupposition.
Readiness to Learn. Adults are ready to learn those things they need to know in order to cope effectively with life situations.
Orientation to Learning. Adults are motivated to learn to the extent that they perceive that it will help them perform tasks they confront in their life situations.
The reason most adults enter any learning experience is to create change. This could encompass a change in their skills, behavior, knowledge level, or even their attitudes about things. In a 2006 article published in the journal Urologic Nursing, Sally Russell suggested that, compared to school-age children, the major variances in adult learners are in the degree of enthusiasm, the extent of earlier experience, the level of engagement, and how the learning is applied. Double testing allows the adult student to be engaged in the learning process.
Students need support and validation from their peers. In any classroom, evaluation is necessary. In 2012, the National League for Nursing suggested in its fair testing guidelines that tests and other evaluative measures should be used “not only to evaluate students’ achievements, but, as importantly, to support student learning, improve teaching, and guide program improvements.” Double testing is one such teaching method in which evaluation, peer support, and validation can be instituted to support student learning.
Instructors who teach in higher education can no longer rely on lecturing as their main teaching method. In Teaching in Nursing: A Guide for Faculty, scholars Diane Billings and Judith Halstead emphasize that dependence on the use of the lecture is no longer an accepted teaching technique. Instead, faculty must integrate the use of technology so that students will be more actively involved and engaged in the learning process. Also, faculty must focus more on teaching in a learner-centered fashion, as opposed to the teacher-center approach.
Double testing has been proven to be an effective teaching method. A 2013 study published in Nursing Education Perspectives found that learning, communication, and collaboration were prevalent themes in students’ perceptions and opinions of double testing. According to the researchers, the study found that “a majority of students preferred double testing and indicated that this testing method had more advantages than disadvantages.”
Throughout nursing programs, instructors are responsible for assessing students’ abilities and assuring they are competent to practice nursing. Since one of the nursing instructor’s goals is to prepare students to be safe and competent nurses, I believe that collaborative learning, such as double testing, is an excellent strategy to assist students in being able to successfully care for patients. I have used this teaching method for more than two years with senior two-year nursing students and have found that double testing promotes group interaction, interpersonal skills, and interdependence among the nursing students—qualities needed to work with members of any health care team.
In using the double-testing method, I have also found that students are more engaged and more cooperative; they also exhibit improved critical thinking skills. For example, when double-testing scores were compared over a six-month period, students’ overall grades increased from 69% to 82%. Indeed, a systematic review conducted by The Campbell Collaboration confirms that the benefits of collaborative testing “include—but are not limited to—better critical thinking skills, better collaboration and team work among peers, reduced test anxiety, and improved test taking performance.”
In a 2011 study published in Science, Deslauriers, Schelew, and Wieman compared the amount of learning students experienced when taught—in three hours over one week—by traditional lecture and by using interactive activities based on research in cognitive psychology and physics education. The researchers found that students in the interactive class were more involved and absorbed more than twice the learning than their colleagues in the traditional class.
Twenty-first century students should be allowed some control over their learning. For many years, teacher-centered instruction has been dominant in higher education. In a traditional classroom, students become passive learners or just receivers of teachers’ information; whereas, with double testing, the students make the decision whether or not to participate. This way, students take charge of their own learning and are openly involved in the learning process.
In “Helping Students Get to Where Ideas Can Find Them,” an article published in 2009 in The New Educator, Eleanor Duckworth asserts that teacher-centered learning actually hinders students’ learning. In contrast, double testing is a learner-centered teaching method, which focuses on how students learn instead of how teachers teach.
I believe that double testing is a worthy teaching method that instructors can use in the classroom to enhance student-student and student-teacher interactions. Most educators understand that learners have different preferences and styles of learning and believe that it is essential to use teaching methods and approaches that will satisfy the variety of learning styles in the learning event.
Annie M. Clavon, ARNP, PhD, MS, CCRC, is an associate nursing professor at Keiser University in Ft. Lauderdale, Florida.
