Make a Difference--be an Advocate for the Nursing Profession

If you are a RN or LPN, passionate about your career and enjoy talking about it, do I have a gig for you!

Our nation’s nursing shortage, predicted to reach a shortfall of nearly half a million in the next decade, demands swift action. The Campaign for Nursing’s Future (CNF) was created and is underwritten by the Johnson & Johnson Company in response to the crisis.

In cooperation with several nursing organizations, including the National League of Nursing, the National Student Nurses Association and the American Nurses Association, CNF’s aim is to bring more people into nursing, develop more nurse educators and retain the talent already in the profession. That’s where you come in.

CNF is activating the troops. Who better to get the word out about nursing than nurses? CNF has created the Nurses Who Make a Difference program and is encouraging nurses to actively seek opportunities to speak before groups such as elementary (can’t plant those seeds too early) and high schools, youth activity centers and scout groups. If you’re concerned that you don’t know how to begin, CNF makes it easy by providing a kit, at no charge, that includes presentation materials and a scrub top to wear during the presentation. Free magnets, posters and pens may also be ordered through CNF’s Web site.

Nurses are trained to be good communicators and many of us are chatty, as well, so it seems that being an advocate for a nursing career would be second nature for most of us.

To be a part of the Nurses Who Make a Difference program, send an email to nursing@corus.jnj.com that includes your name, job title (RN, LPN, NP, etc.), mailing address and scrub size. Additional information can be found at www.campaignfornursing.com.

Arrange to speak to your children’s or grandchildren’s classrooms and extra-curricular activity groups. Don’t limit yourself to young people. Many nursing students are of non-traditional age, so be creative and look for audiences that are non-traditional. Most people are familiar with nursing generally, but not specifically. We can create excitement about nursing by showcasing the varied and highly technical lifesaving skills nurses perform every day. Let’s get busy. We have to replenish our ranks.

If any of you are already active in this program, please let me know to what groups you have spoken and how your message was received.

Job Resignations can be Difficult and Emotional

I just read an essay written by a nurse sharing how the job she loved changed into one she dreaded. Budget cuts, staff reductions and excessive paperwork finally caused her to throw in the towel. She moved on to a job that paid less but gave her increased patient contact and satisfaction. It got me thinking about job changes—specifically my own.

I’ve been a nurse for 40 years and have had just five jobs, only one of which I left by choice. Jobs number one and three were ended by my husband’s out-of-state job transfers. I left job number four to give birth and be a stay-at-home mom. Technically, that falls into the "by choice" category, but I didn’t see it as a choice. It was more like a given; have a baby, be a full-time mom. Archaic thinking to some, but I’ve never regretted it.

My current job is non-traditional—I’m a nurse who writes about nurses and nursing. During an interview with Diana Mason, editor-in-chief of the American Journal of Nursing, we talked about the looming nurse shortage, which resulted in my apologizing for not doing my part to ease the problem. She graciously told me that I’m doing my part by promoting the profession. Just a simple comment but it’s surprising how often it comes to mind and keeps my radar scanning for opportunities to publicize nurses and the important work we do. I love this job and I'm not planning to resign anytime soon.

So, that brings me to my second job. A job transfer had taken us from a big city to a much bigger city. I’d left a job as head nurse in a hospital-based out-patient department (OPD) for the medically indigent and was fortunate to find the exact job in my new location. Well, maybe not exactly the same job. In this case it was the same title, same department, but an entirely different set-up. In the original job I oversaw about 30 specialty and sub-specialty clinics, all grouped together in a single-story hospital wing. In the new job I managed just eight clinics, in separate units scattered around the hospital. Each one was its own little world—the staff of one clinic barely knew the staff of another, so it was nothing like the cohesive group at my previous job.

The new job wasn't terrible. The staff was pleasant, cooperative and hardworking but I felt disconnected and unhappy. Those things, however, didn’t seem good enough reasons to call it quits—I figured I’d work my way through it eventually. Besides, I was raised to live up to my commitments, to follow through with anything I said I’d do, to not disappoint anyone and certainly not to casually change jobs. Then, an attractive job opportunity at another hospital fell into my lap—an opportunity made vastly less attractive by the fact that I’d have to (duh!) resign my current position.

Chalk it up to youth (age 25), lack of life experience (age 25) or my genetic predisposition to accept guilt for just about everything – including being responsible for the nursing shortage – but, for whatever reason, I AGONIZED over having to tell my supervisor that, after a mere four months as the OPD head nurse, I was leaving to take another job.

I knew that each time a hospital brings in a new hire, a chunk of change moves into "the red" column. I felt guilty about the time and money spent orienting me to the job, the work involved with finding my replacement, and that I was letting them down by not sticking with my commitment. All of that weighed heavily on me; enough so, that my face-to-face verbal resignation, accompanied by a written letter, was a tearful one.

Two weeks later I was ushered into my supervisor’s office for my exit interview. She hadn’t yet arrived. All these years later, I can’t remember if my employee file was open or if there was a note clipped to the front, but my eyes were instantly drawn to a mention of the lachrymose or ‘tearful’ display resulting from my revealing I was leaving —followed by the words, flashing in neon, "emotionally unstable." Oh, come on! I didn’t throw myself across her desk and sob and wail—I’d shed a few tears. Big deal!

Well, that pretty much erased any guilt I’d had. In fact, it helped cure me of taking on (almost any) future guilt. Expressing regret hadn’t won me any points. I told myself that, henceforth, I would do what was best for me and let the chips fall where they may. I’ve never had the opportunity to test that promise to myself, which is fortunate. While I talk tough, I’m really just a big marshmallow who still feels bad when I renege on a commitment and, yes, sometimes a tear or two is involved. One of my nursing school instructors used to say that, in her opinion, there is something healthy about a damp eye. If that’s the case, I’m the World Champion Healthy Lady. Not a bad title to have—I’ll take it. The new job, by the way, was great—a perfect fit!

Who else has stories of changing jobs that fall to the lighter side? Please share them, even if they’re not-so-light. I’d like to hear them.

Are We Asking or Avoiding Questions about Domestic Violence?

Nurses have an opportunity, or, more accurately, an obligation, to make a difference in curbing domestic violence. Doing so requires only a simple action—just ask. I see two doctors regularly, usually once or twice a year for routine exams. At each visit I am asked a basic set of questions regarding my use of tobacco, seat belts and other lifestyle matters. I’ve never been asked if I am a victim of domestic abuse.

The incidence of domestic violence is such that it’s considered a public health pandemic by experts in medical ethics. It’s more prevalent among women than many medical conditions for which doctors regularly check, yet, a recent nationwide study involving 5,000 women found that only seven percent had ever been asked by a medical professional about domestic abuse.

Ideally a woman should be questioned in private, with no family members present, as part of a routine medical history. Although many women, even when asked, will deny they suffer abuse, they will remember they were questioned and may later—even years later—ask for help. Just asking the question often plants a seed for change.

A major report issued seven years ago by the Institute of Medicine, which advises the federal government, determined that health workers receive little or no training in the area of domestic violence. The report called upon the Department of Health and Human Services to establish centers to educate the medical community regarding the facets, implications and inquiry of such violence. Unfortunately, the recommendations were released on September 11, 2001 when the nation was consumed with the immediate aftermath of the terrorist attacks. The report was understandably pushed aside at that time but no action has been taken since and it’s high time something be done.

Meanwhile, nurses in offices, clinics and emergency rooms need to be more vigilant, attentive and proactive. Don’t dodge an uncomfortable subject. When you see bruising on a child you’re mandated to rule out child abuse. When you see bruising on an adult you also need to ask the tough questions. Even when there is no visible evidence or apparent reason to ask, you should ask. Although we’re not necessarily qualified to solve the problem, should the patient divulge there is one, we can and should be armed with contact information for safe houses for women, the domestic violence unit of the police department and other social agencies that deal with issues of abuse.

What are your opinions on the subject? Are any of you already asking? If so, I’d like to hear from you. If not, why not?

Nurses Week Gifts Both Appreciated and Scorned

What did you get for Nurses Week? That was the question posed recently by the moderator of an online forum for nurses.

There was plenty of feedback, with some nurses reporting remarkably generous gifts from their employers (Nike Shox shoes for all the staff nurses and $50 gift certificates to Outback Steak House), while other employers, who evidently failed to check their calendars, coughed up nothing at all. Most respondents checked in between the two extremes, but even in that mid-range there were high and low levels of recognition.

Based on the responses, nurses have reached the saturation point when it comes to logo-imprinted coffee mugs, water bottles, T-shirts and the like. Such items are viewed not as appreciation gifts, but as free advertising for the hospital—besides, no one needs more of those items.

Night shift nurses resent that special luncheons and other recognition events are often held only on the day shift, forcing the choice: free lunch or sleep? They long for at least a catered meal for their shift.

Some nurses were given boxes of Dove chocolates, one hospital set up a carnival (with rides) on the parking lot, another had an outdoor movie night with the movie projected on the side of the building and treats for the entire family. Yet another did something special each day of Nurses Week—free lunches, chair massages and gift certificates for manicures.

We all like to be appreciated for the job we do, but the comments on the forum highlighted some interesting points. First, it is nearly impossible to please everyone. Those who received nothing were unhappy but so were those who perceived their gifts to be paltry or self-serving for the giver. Would it have been wiser for the hospitals to give nothing rather than setting themselves up for ridicule regarding a specific gift? And, how far does the morale boost from the most generous of gifts go? How long does the employee’s gratitude last? Does the hospital get a good return on its gift expenditure?

I assume that hospital budgets are not equal and some simply don’t have the means to bestow extravagant gifts or host expensive galas. I’m married to a CPA. Budgets and fiscal responsibility are very important issues in my household, so I can easily imagine how those considerations affect corporate spending. Everyone seems to be complaining about exorbitant health care costs, so doesn’t belt tightening—even in the area of appreciation gifts—make sense?

Because I am not employed in a traditional nursing job, I was not expecting recognition during "my" week. But, it was a pleasant surprise to receive a greeting card that extolled the nursing profession. True, it was from a nursing school classmate, but I was pleased that she took the time to send it.

I’d welcome your thoughts on this subject.

Martha Stewart: She's a Good Thing

I am not a regular viewer of Martha Stewart’s daily hour-long TV show. I have nothing against Martha or her show; rather, at the time it airs I’m usually running hither and yon or at the computer writing. But, last week a promotional blurb caught my ear. In observance of National Nurses’ Week, Martha would be devoting an hour to honoring nurses. So, I set Tivo to record the program.

I must say, her producers put together quite a good show. The entire audience was made up of nurses, all dressed in scrubs of every hue and pattern, and Martha chatted with a few of them about the rewards of their jobs. There was an array of mannequins dressed in uniforms of ‘the day,’ beginning in the early 1900s and going to the 1960s.

A museum curator displayed antiquated instruments, utensils and equipment and described their use. In some cases, I was elated that those things were before my time. In other cases, it was downright depressing that so many of the items I used early in my career now fall into the ‘antiquated’ category. I guess we all know what category that puts me in?

Best of all, five nurses, all from the same Neonatal Intensive Care Unit (NICU), were honored on the show. A viewer’s letter, lauding the nurses for all they had done for her and her husband when their very preemie twins spent 100 days in the NICU, was read. It was a tug-at-your-heartstrings story with a successful outcome.

As a nurse, I most appreciated that the story was accompanied by photos of the nurses doing the very things the grateful first-time parents found so meaningful and comforting during an extremely stressful time in their lives. There is currently a push to publicize nurses and their clinical expertise. This segment certainly did that in the most favorable of lights. Nurses were caring for the fragile infants, monitoring every nuance of change and managing the complicated technical equipment that was keeping them alive—and there wasn’t a doctor in sight to steal any of the credit, as is common on TV medical dramas. Viewers who will never see inside a NICU now have an idea of the level of skill required of nurses who work in such a highly specialized critical care area.

I heard, but did not see, that Ellen DeGeneres also devoted a show to nurses. Kudos to Ellen and Martha for honoring the nursing profession and for promoting the fact that nurses are highly trained professionals who make lifesaving decisions—on their own—every day. It’s a good thing.

Welcome, New Grads, to the Best Profession in the World!

Graduations are special events. It has been more than a few years, but I remember the excitement of my high school graduation. It wasn’t so much a feeling of relief to have made it through 12 years of public school as it was the exhilaration of moving on into uncharted territory. At the end of summer I’d be leaving my little town of 1,400 salt-of-the-earth souls and moving to the big city, a two hour drive away (but, out-of-state, nonetheless), to begin a hospital-based diploma nursing program.

On day one of that program three years seemed like an eternity—and, believe me, there were single days during those three years that were an eternity unto themselves—but graduation rolled around surprising quickly. Again, I was awash with excitement. My first real job, in or out of nursing, awaited me and I was so rarin’ to go that I allowed myself just one week off between graduation and permanent employment. I didn’t consider the fact that, once on the job, I wouldn’t be entitled to a vacation for a full year. I was 20 years old. What did I know?

Nursing has changed in the ensuing years, as have nursing students. Instead of a gaggle of wet-behind-the-ears barely-twenty somethings, schools are graduating significant numbers of older students with more life experience and, I assume, more maturity.

This week I answered a knock at my door to see my neighbor, Kerry, who lives two doors down, standing on my porch, grinning from ear-to-ear, an envelope in her outstretched hand. I took it, opened it and felt the same excitement I’d felt all those years ago, along with a huge sense of relief for Kerry. The envelope held the announcement of her graduation from the local community college’s two-year nursing program.

Kerry is 39 years old, a wife and mother of two children, ages 10 and 12. She is an EMT and an ER tech but she wanted more—more education, more job and financial security, more job flexibility, and she knew nursing would give her all of that. The process took five years. She navigated the sea of pre-requisites and, then, the nursing program while juggling the rearing of, with her husband’s help, two amazing, polite and responsible children and her job as an ER tech in a town 20 miles from home. I was touched by the hand-written note inside the announcement: "It takes a family to graduate a nurse."

I know Kerry’s story is being repeated thousands of different ways across this country and I am chagrined to think how easy I had it compared to today’s multi-tasking students. I offer to Kerry, and all new graduates, my sincere congratulations and admiration for their perseverance in the pursuit of their goals. I know it hasn’t been easy but the results are worth every sacrifice. Welcome!

The World Needs to Know: Nurses are Smart, Skilled and Saving Lives Daily

This week belongs to us. Yes, this is National Nurses’ Week, a week set aside to honor our profession and bring attention to what we do. National recognition is a good thing but I daresay a week’s time won’t come close to enlightening John Q. Public as to the scope and importance of our work. I would venture a guess that the majority of the non-medical public still views nurses in the role of the doctor’s helpmate, following orders and unqualified to make critical, lifesaving decisions.

There is a current movement afoot that encourages nurses to toot our own horns, so to speak, and especially to cease minimizing the importance of our work. There is even a book that will guide us in effective ways to tout our accomplishments and to get over the "Aw, shucks, it was nothing" mentality that rears its ugly head when we are complimented on a job well done. The book is "From Silence to Voice: What Nurses Must Know and Communicate to the Public".

The book is filled with anecdotal examples of statements the way they were spoken and revisions of those statements to demonstrate what should have been said. I was dismayed to learn that, in my own subtle way, I have been doing my share of minimizing our expertise. An example cited a nurse’s response to a patient’s thanking her for explaining his diabetic diet and its importance in controlling his diabetes. The nurse replied, "Oh, it’s nothing. It’s my job," when she should have said, "I am glad that I was able to give you a clearer understanding of how important your diet is in controlling your diabetes. Do you have other questions I can answer for you?"

Yes, I am guilty, but I didn’t realize that, by being modest, I was trivializing what I do. I can certainly see that responding in detail makes the patient aware that valuable knowledge was required in order for the nurse to impart to him the information he needed.

I should have been following these guidelines long ago. Based on the occasional comment, my own mother and sister seem to view nursing as a less than challenging career, one that doesn’t require much in the way of brain power. From now on they’re going to be hearing more details and more play-by-plays of what a nurse does in a day.

There is more I want to say about nurses deserving publicity and recognition for their extraordinary accomplishments, but that will have to be in another post. Until then, make sure everyone knows that there can be no substitute for your knowledge, skill and expertise.