The National Institutes of Health Disappoints

When I worked at the National Institutes of Health, a colleague and I wrote an article: The Role of Nurse Practitioners Expands at NIH for the NIH Record newsletter in May of 2000 about the increase of Nurse Practitioners at the Institute. My short time there was exciting, especially as I witnessed NP positions increase and opportunities to become involved in research grow. I saw patients in the weekly clinic along with the Fellows, interviewed and examined potential research volunteers, mentored student interns, and participated as a team member in various research studies. And best of all, I had supportive relationships with a cadre of other NPs. I left because my husband accepted a job in North Carolina.

Imagine my shock to learn that the National Institute of Nursing Research chose a dentist to be the interim director. I can’t fathom that there was not a talented, qualified nurse to fill this position. I agree with latest post (below) from The Truth About Nursing that the appointment of a dentist smacks of undermining nursing autonomy and stripping away support for nursing practice. I will write a letter voicing my support of a nurse in this leadership position and disappointment in the poor judgment of the NIH leadership.

Please consider doing the same.

 

 

 

Anyone will do

U.S. nursing research institute appoints dentist as interim director

The National Institute for Nursing Research, which disburses federal grants, announced in August 2019 that its interim director would be…a dentist. And the interim deputy director is a biologist. But non-nurses are non-qualified to evaluate grants for nursing research. These appointments also reinforce the inaccurate stereotype that nurses are unskilled handmaidens, rather than autonomous health professionals. After some of our supporters sent messages asking NIH to rescind the appointments, NIH sent a newsletter proudly announcing the appointments, and then sent emails to our supporters assuring them that it was searching for a nurse to fill the permanent director position. But it did not comment on the interim appointments, so it seems those stand. And filling high-level federal government vacancies can take quite a while. We need your voice on this. Please join us in asking that qualified nurses be chosen for these interim positions! Thank you!

Click here to sign the letter–or write one of your own!

Mindfulness: Julia Sarazine

I met Julia Sarazine this past June when I spoke to Rush University nurses in Chicago about my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers. We agreed on the need for nurses to tell their stories.

When I discovered Julia’s background in teaching mindfulness techniques to nurses in order to reduce symptoms of stress (see How PTSD Is Hurting Nursing) I asked if she would share her expertise and experience about how mindfulness can help reduce Burnout syndrome/Post Traumatic Stress Disorder (BOS/PTSD).

I’m honored that Julia agreed.

 

You’ve said that some experts feel that Burnout syndrome among nurses is a public health crisis. BOS has been affecting nurses for as long as I can remember. Why do you think this problem has been so insidious and tenacious?

Burnout syndrome is now receiving attention as demonstrated by The World Health Organization including it in the Revision of the International Classification of Diseases as an occupational phenomenon.

Levels of burnout are higher in professions that have high risk associated with them, such as a nurse administering medications and treatments that may have a significant impact on someone’s life. Also, nurses are usually the ones that hear and witness the patient and families suffering.  In most situations, nurses see people when they are worried about their health, in pain or being treated for a serious illness.  Over time, this constant exposure to suffering can take its toll on the ability to maintain our own health and wellness.

Moreover, the demands of the healthcare system continue to increase with technology and integration of electronic medical records.  As more patient care is being provided in the outpatient arena, patients are sicker and may require more care than in the past.

 

You left a hospital nursing position because you had symptoms of BOS, yet a few years later you returned to the same position you left. How did you find the fortitude to do that?

 Once a nurse, always a nurse definitely applies to my situation and decision to come back to the nursing profession.  I missed working with patients and the sense of accomplishment I received while helping others.  It is the same reason I was drawn to the nursing profession in the first place.  I know it has been over communicated, but being a nurse is truly a calling, not just a job. It was not an easy decision, but it felt right for me at the time as I changed how I handled stress and suffering.  I basically learned to take care of myself with mindfulness at work and how to transition to be fully present at home.

 

What advice would you give to other nurses who have left nursing?

To leave the nursing profession is a very individual decision.  I believe all nurses are caregivers.  Where nurses are providing care may change and whom they are providing care to may also change.  For example, nurses may be taking care of their children, parents, family, friends or community members.  It may look different, such as volunteering for the food depository, listening to a friend discuss her new cancer diagnosis or asking the cashier at the grocery store how they are doing today.  Nurses are usually empathetic people and naturally take care of others throughout their lives.

 

There are terrible statistics about how many new nurse graduates leave the practice after a couple of years because of BOS. Among all the other tools out there to deal with this issue, what does mindfulness contribute?

 Mindfulness is not the magical wand that can solve all our problems and prevent burnout.  But it is a tool we can use to take care of ourselves so we can take care of others. I think all nursing students should be taught a few mindfulness skills when they begin nursing school.  If you can learn just a few simple skills to protect you while witnessing and feeling someone’s suffering, it can help prevent burnout and lower your stress levels.

 

What is your definition of mindfulness?

The mind naturally wanders from the present moment to the past or future. This is often referred to as autopilot.

  • Have you ever commuted to work and not remembered the drive or train ride?
  • Have you ever eaten something and not remembered tasting it?
  • Have you ever reacted to a situation and later regretted how you handled it?

These are all examples of mindlessness. In contrast, mindfulness focuses on being aware in the present.

There are multiple definitions of mindfulness, but the most commonly quoted is from Jon Kabat-Zinn: “Paying attention on purpose in the present moment, non- judgmentally.

 

How did you first learn about mindfulness?

Right after I left nursing, I was struggling with trying to process all of the deaths I witnessed. A friend recommended The Power of Now by Elkhart Tolle.  I read it and then began to meditate each morning. I found I was able to focus more and notice moments of joy in simple things such as a warm breeze on my face, a smile from a stranger and the taste from the first sip of coffee in the morning.

I continued to develop my own practice by taking mindfulness courses, attending silent retreats and eventually becoming a mindfulness instructor.  Mindfulness is never complete; everyone who practices is always learning and evolving through increased awareness.

 

How has mindfulness changed you?

Mindfulness allowed me to process all of the suffering I witnessed and absorbed while working at Cook County Hospital as a palliative care nurse practitioner.  During one of the mindfulness retreats, the teacher said, “ You don’t have to jump into the deep in of the pool, just dip your toe into the water as far as you can at this time.”  This was very helpful for me at the time because I was resistant to processing the deaths for fear I would drown in grief.  From this simple instruction, I was able to process each patient’s death by allowing myself to feeling the sadness and grief; then the grief lessened and I was able to wish the patient and family well.  I realized I was frozen in time, but the family and friends had moved on with their lives the best they could.

When I returned to my nurse practitioner position five years later, I used mindfulness to keep myself grounded in the moment so I could think critically and also not absorb all of the patient’s and family’s emotion.

Now I use mindfulness all day long to recognize when I am stressed and choose how to respond, enjoy pleasant moments more fully and to accept when I have feelings of sadness or grief while taking care of aging parents.

 

Please tell us about the success you have had in teaching mindfulness to the nurses at Rush University Medical Center.

 It is an amazing experience to be able to share the worst moments in my career and now teach how I processed the grief with mindfulness and continue to use it every day.

At Rush University Medical Center, we completed a study and determined that six months after nurses participated in a four-hour mindfulness and resilience workshop; they had reduced burnout and perceived levels of stress and increased mindfulness skills. We were thrilled with the results discovering that a short four-hour workshop can have an impact six months later.

 

 Please add anything else you think my Blog followers need to know about mindfulness.

 Here are some strategies and tips to incorporate into your daily life through informal practice, especially at work, where stress levels can be elevated. Just as a reminder, it is important also to practice informal mindfulness in times of minimal stress since it is easier to focus on being present and will make it more accessible during times of higher stress. Remember, it does not take any more time to be mindful.

 

Informal Mindfulness Practice:

STOP

STOP is a mindful technique that can be used in any situation to slow us down and reconnect with ourselves. It can be used before entering a patient’s room, sending an email, charting, speaking, or entering your home after work. The acronym STOP stands for:
• Stop whatever you are doing to pause for a moment
• Take a deep breath or two
• Observe any specific thoughts, emotions, or body sensations
• Proceed with more awareness

Two Feet, One Breath

This mindful technique can be used in times of stress to ground us and create a little space from the stressful situation being encountered.

With both feet firmly on the ground, while either standing or sitting:

  • Focus as much attention as possible on sensations in the sole of the left foot—perhaps pressure or sensations from contact with the sock or shoe.
  • Then shift attention to sensations in the sole of the right foot, with as much attention as possible.
  • Tune in to your breathing—just feeling the breath as it moves in and out.
  • Now, continue whatever you are doing in a more grounded and present manner.

Mindful Hand Washing

Use all the senses to bring awareness to the activity of washing the hands. Feel the temperature of the water and the sensations of the hands rubbing together, the smell of the soap, and the sound of the water running, and notice the bubbles forming from the soap. This awareness can be applied to any routine activity, such as brushing teeth, taking a shower, or typing an email.

 

Formal Mindfulness:

On-Line Mindfulness Workshop Opportunity:

TheMindfulness and Resilience 4- Hour Workshop has been shown to decrease stress and burnout symptoms and increase mindfulness skills 6 months after participating.

I am teaching it on Saturday, October 19thfrom 8 am – 12 pm CST.

For details:

https://www.sarazinemindfulness.com/corporate-mindfulness-programs

 

 

Julia Sarazine

Sarazine Mindfulness, LLC

www.sarazinemindfulness.com

Learning to Heal

I’ve long been a proponent of nurses writing their stories to educate the general public about what we really do. Here’s a book: Learning to Heal: Reflections on Nursing School in Poetry and Prosethat does that and more.

The essays, from seasoned nurses as well as recent grads and “respected elders,” are set in the United States and abroad and show the history, rigors, challenges, humor, and sadness that alternate during the nursing school experience. Not every author in this collection makes it to graduation.

The prerequisite of nursing—compassion, empathy, and psychological support—threads through the stories. The reader will learn the depth of the nurse-patient/family connection. This connection becomes ingrained in the nurses’ psyche as evidenced by Courtney Davis’ Wednesday’s Child. Her story mirrors my Baby in the Closet. She, too, wrote about a newborn with a deformity who was left to die in a linen closet. Courtney, like me, carried the fate of the baby along with unanswered questions for almost 50 years!

Never a specialty I wanted to practice, psychiatric nursing demands a special temperament.  Poetry especially captures the depths of human understanding needed to make a difference.

. . . Come to my group, my plea, as I knelt offering

filtered cigarettes as free admission tickets.

In an empty silence, we sat on single beds, arranged

in a square, in a room as cavernous as an airplane hangar.

What was my hurry? Most had lived there twenty years.

Hardly a word dropped into the atmosphere.

—Ward 24, Nancy Kerrigan

I associated with Geraldine Gorman’s Learning the Wisdom of Tea, who takes us though her education from a diploma nurse to a PhD. I, too, wondered where were the “(f)irst person accounts of interactions of patients and family . . .”  Where were the nursing stories? And I, too, questioned the authoritative methods of instructors in nursing academia. And I, too, felt fortunate to find a career path that allowed me to “practice outside the hospital.” My “wisdom of tea” began at the kitchen tables of my patients when I visited their homes as a guest, learning that I needed to obtain their cooperation in order to institute a treatment plan.

The stories and poems in this anthology are varied, educational, entertaining, and poignant. Whether the reader is a nurse or not, all will learn that nursing has come a long way as Learning to Heal stories excellently show.

Traits Every Great Nurse Has

I discovered a great nursing blog: Diversity Nursing Blog. Here is a post I especially liked. Hope you do too.

 

DiversityNursing Blog

Traits Every Great Nurse Has

Posted by Erica Bettencourt

Fri, Mar 23, 2018 @ 09:19 AM

 

What makes a good Nurse? What are the qualities of terrific Nurses? The Nursing profession is about kindness and caring for the whole person as well as medical, emotional and technical knowledge, and so much more. Below are a few traits that make Nurses so great!

 

GOOD COMMUNICATION

Communication is essential to patient safety, health and well-being. As you are at the center of patient care, it is your responsibility to facilitate dialog. As you care for older and more culturally diverse populations, you will need to strengthen your communication skills. Without strong communication skills, serious errors can occur.

 

EMOTIONAL STABILITY

As you know, Nursing is a stressful job where traumatic situations are common. The ability to accept suffering and death without letting it get personal is crucial. Some days can seem like non-stop gloom and doom. There are heartwarming moments like helping a patient recover, reuniting families, or bonding with fellow Nurses. But those moments are less common than the tougher situations. So remember to take care of YOU too so you can handle the inevitable crises.

 

EMPATHY

Empathy is a complex emotion and can be a complex concept while working with many patients who have different kinds of needs. Responding with empathy requires the ability to put yourself in your patient’s shoes, see situations from their perspective and demonstrate that you understand their feelings and are reading them accurately. Most importantly, it requires you to act on that understanding in appropriate and therapeutic ways.

 

ATTENTION TO DETAIL

Paying attention to minute details is important in the Nursing profession, especially when you have a lot on your plate. You must document everything you do on patients’ charts, listen closely to their description of symptoms, ask the right questions, and remember to bring medications at appropriate times. It’s critical to remember even the smallest detail amidst all of the commotion. At the end of the day, one small slip-up could become a fatal mistake.

 

PHYSICAL ENDURANCE

You encounter many patients with lifestyle-related disorders. With this in mind, a basic understanding of the role physical fitness plays in prevention and rehabilitation is key. You can be a positive influence on patients who have to make life­style choices if they see you’ve made good choices. If you stay fit, you not only feel good, you’re a great role model for your patients.

 

Physical fitness improves your ability to effectively perform the physical tasks you do every day. One study of 146 Registered Nurses, over a 12-hour shift, found they covered an average of 4 to 5 miles per shift. I’m sure you’re not surprised by this information!

 

DESIRE TO CONTINUE LEARNING

Medical knowledge and technology are advancing rapidly. As a great Nurse, you know the importance of working on your professional development and skills, and learning new things.

 

SENSE OF HUMOR

This is imperative! A joke and a few laughs can take the edge off of a tough day and…it feels good. Need we say more?

Are Nurses Losing Ground? Part 2

In my last post I discussed the Woodhull Study that was published in 1998, which showed nurses were quoted in the media (newspapers) 4% of the time. The 2017 replication of study showed a drop to 2%.

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Click here to view a video discussing the study, findings, limitations, and input from a panel of journalists/media experts. At the end of this post, I’ve listed some suggestions to improve nursing presence given by the nurse researchers and media panel (In no special order).

But before I get to the list, I was heartened in the last few weeks to note nurses quoted in the media:

In the Nation, May 3, 2018, Nurses have a prescription for the Democratic Party: Back Single Payer, by John Nichols citing nurses as experts in knowing what will help their patients achieve optimal health and what will benefit the health care system.

In letters re: Children of the Epidemic,a nurse wrote to the editor in the New York Times Magazine, May 27, 2018 describing her work with women addicted to crack cocaine during the AIDS epidemic in the ‘90s. During a span of two years, the babies followed by the nurses were on target developmentally. They were not “medical burdens.”

In my local paper, the News & Observer:

  • NPs step up as demand for doctors outpaces supply. (Reprinted from the Star Tribune in Minneapolis) by Jeremy Olson, April 29, 2018
  • Midwives say they can help fill gap in women’s health care,by Anna Douglas and John Murawski, May 20, 2018.
  • Medicare for all,letters to the editor, Patti Rieser, RN, FNP “supporting all medically necessary care, including dental, vision and mental health services and cover everyone from birth.” June 2, 2018.

Now back to the suggestions to improve nurse input and visibility in the media:

  1. Nursing leaders should meet with the PR department of their institutions to inform them about what nurses can contribute.
  2. Schools of nursing can provide media training for students and “media competencies” for nurse instructors/clinical experts.
  3. Nurse researchers should write press releases to the media about their study findings.
  4. Nurses need to make themselves available to journalists; develop a relationship so when a spokesperson is needed, the journalist will think of the nurse.
  5. Increase education in health care policy across nursing educational programs.
  6. Nurses should register with SheSource as experienced experts on health topics.
  7. Nursing schools/colleges are encouraged not to limit communication to other nurses and nursing sites using “inward tweets,” but cast a wider net to contact the non nursing sites/individuals or “outward tweets.”(Journalists look at both Twitter and Facebook for inspiration and sources.)

Remember:

There are 3.5 million nurses

Physicians are not the center of the universe

Of course, I am always advocating that nurses tell their stories using every media venue available to educate the public, and especially the journalists, about who we are, and what we do, and how we make a difference.

Have you ever considered being on a Board?

I have choosen to reblog this post because I believe nurses bring invaluable skills and knowledge to various health care boards. I am currently serving on a board at Duke Raleigh Hospital in Raleigh, NC.
Next week I will be in Chicago at the Beryl Institute Patient Experience Conference along with the Chief Nursing Officer, and the Manager of Service Excellence to give a presentation about our Patient Advocacy Council. I will post updates from the conference and share more information about my board experience on future Posts.

NurseManifest

Here at the NurseManifest project, we have tended to emphasize grass roots, “on the street” kinds of activism to bring our deepest nursing values into everyday experience.  But manifesting nursing values needs to happen everywhere, and one of the spheres whereconference-table this is vitally important is in the Board Rooms, large and small.  Lisa Sundean, who is one of our NurseManifest bloggers, is embarking on her dissertation project to explore nurses on Boards, and in the interest of sharing her work wide and far, she has established website and blog – SundeanRN.org!  Her first blog post is now available, explaining why this is vitally important!  I highly recommend that you read her post: What do Boards Have to do with Nursing?  And if you have never considered serving in this capacity, think about it now!  We need to be manifesting nursing everywhere – at the bedside, the chairside…

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Nurses Save Lives

 

 

What a pleasant surprise to read that nurses save lives (italics mine) in a news article yesterday, September 21. Unfortunately, the story was not a happy one. The Raleigh, NC News & Observer detailed the memorial service for the crew of a Duke Life Flight Air Ambulance that crashed on September 8 killing all aboard: pilot, patient and two flight nurses.

“Like all medical personnel at Duke, Life Flight’s Crew ‘have a strong desire to save lives (italics mine),’” said Irene Borghese, program director. She goes on to say “what sets this group apart is their desire to do so (save lives) while putting themselves in harm’s way and without the safety net of an entire health care team . . . They simply depend on each other.”

What she is saying is that the nurses can rely on their own knowledge and expertise when they deal with difficult patient problems on a flight mission and not have to follow doctor’s orders, although there probably are protocols when needed.

The nurses who died, Crystal Sollinger and Kris Harrison, had worked together on a flight “that wound up saving the life (italics mine) of an infant . . .that baby is now 3 years old, and her family brought her to” the service.

We all know that in most instance nurses are not recognized for the intelligent, caring and competent health care providers that they are.

In a post I wrote in February 2013, Businessweek reporters gave doctors credit for caring for Hillary Clinton while she was admitted to the hospital when she had a blood clot. Nurses were never mentioned. I can’t imagine a doctor was around to do vital signs on the night shift.

Thank you to Ray Gronberg and Tammy Grubb, the authors of N & O piece, for giving credit to Crystal and Kris for doing what they really do: save lives.

 

 

 

 

 

 

 

 

Nurses of a Certain Age

Excepted from Off the Charts, May 31, 2017

 

AJN Facebook Readers on Influences, Public Attitudes to Nursing, Practices of Yesterday

by Betsy Todd, MPH, RN, CIC 

What do you remember from early in your career that would never be seen or done today?

We “nurses of a certain age” remember!—and we’re amazed at how far our profession has come. As one nurse commented, in response to early nursing practices that seem primitive today, “Oh my goodness, how has humanity survived?!”

There were, of course, our caps, white dresses, white hose, and white shoes. One nurse recalled that we always wore our school pins on our uniforms. These seem not much in evidence these days, but were always a source of pride and connection (and sometimes, lighthearted rivalries) back in the day.

In addition, nurses pointed out that the scope of practice has certainly changed. Nurses mixed soft soap for enemas, mixed weak solutions of Lysol (!) for vaginal douching. Wound care has, shall we say, evolved. Nurses recalled packing wounds with eusol (chlorinated lime plus boric acid—“cleaned wounds by removing patients’ flesh with it!”), Savlon (chlorhexidine combined with a chemical later used for disinfecting floors), Milton (a bleach solution), or sugar mixed with Betadine or egg whites. Some remembered “vigorously rubbing talc onto bums to relieve pressure” or “Maalox and heat lamp for sore butts.”

Are automated medication dispensing systems (for example, Pyxis machines) and bar codes part of your daily routine? Several comments described pouring meds from stock bottles on the unit or mixing chemotherapy solutions in the medication room. There were no medication carts, just medication trays with cups and handwritten cards for each patient (different colored cards for b.i.d, t.i.d., etc.).

“Point of care” lab testing didn’t include quality checks. One nurse remembered “burning urine samples in a glass tube over a Bunsen burner to check sugar levels.” DeLee suctioning of newborns—“I ended up with a mouth full of stomach contents more than once”—or pipetting blood and urine samples for the lab via mouth suction were also routine.

Many comments reminded us of tools rarely seen in today’s hospitals. There were time-taped IV bags, glass syringes and IV and chest tube bottles, mercury thermometers, crank beds and egg-crate mattresses, “gloveless everything,” and no hand sanitizer.

Routines and work practices of years ago may be hard to imagine today. Nurses recalled smoking during report, and patients smoking in bed. Patients were admitted “just for observation,” or a day or two prior to surgery. Each shift charted in a different color of ink. Nurses recalled time to talk with patients, and actual “acuity-based staffing” (“RIP,” as one nurse commented).

Another nurse summed up a certain sadness as she described some lost aspects of patient care:

“morning care before breakfast, clean sheets every day, evening care with back rubs, trash emptied, fresh water and being aware of the patient’s environment. [We] took time to assess the patient by the RN and listening. The care was impeccable because of the nurses who controlled the patient experience.”

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Are You Glad You Became a Nurse?

I found an interesting study regarding nurses’ satisfaction with their career choice. Note the respondents were middle-aged (45 – 64) and predominately female.

Since my specialty is gerontology, I have included the comments made by three older nurses. Yes, Yes, I know they are all positive.

I look forward to a study that includes younger nurses and more males. Would there be differences in the outcome?

Most Nurses Have Few to No Regrets About Career Choice

by Alicia Ault

Medscape, January 25, 2017

When asked what they liked best about their career, most nurses could not narrow it down to just one answer — instead, they gave multiple reasons, with relationships with patients, being good at what they do, and having a job they liked being among the top answers, in a new survey by Medscape.

The Medscape Nurse Career Satisfaction Report for 2016 surveyed 10,026 practicing nurses in the United States, including licensed practical nurses (LPNs), registered nurses (RNs), and advanced practice registered nurses (APRNs). The respondents were largely female, middle-aged (aged 45 to 64 years), and in practice more than 21 years.

The different nurse specialists varied slightly in how they ranked the most rewarding aspects of their job. For LPNs, the top answers were gratitude from patients and relationships with patients, along with being proud of what they do. For RNs, those answers ranked high in their response, along with working at a job they liked and being very good at what they do.

I have been a nurse for 54 years & am still practicing part time. I have loved almost every one of my jobs & have so expanded my mind & approach. Nursing is so varied that one can do almost anything. I was originally a diploma nurse & have taught in an AD program. After 13 years as a practicing nurse, I returned to school to find that I was given little if any credit for my excellent 3-year diploma program. I had to start all over again & spent 4 years as a full time student (with another year of graduate school). The AD & BSN programs offered similar clinical practica. It’s very unfortunate that the clinical aspects of the diploma programs could not be salvaged for the other two. Nursing needs an internship after the 4-year education. Practical skills will always be necessary for clinical nurses.

I was recently hired by my current employer at 72 years of age because of my experience. How nice to be so valued even at my age. I can’t imagine doing anything other than nursing. What a rich and rewarding professional life it has been.

Lynne D. Pancoast, RN, MSN

Among APRNs, gratitude figured least highly for clinical nurse specialists (CNSs) and certified registered nurse anesthetists (CRNAs), when compared with the higher percentages among nurse midwives and nurse practitioners. Working at a job they liked and being good at that job were the biggest rewards cited by CNSs and CRNAs.

Money was rarely cited by any nurse — at around 2% for most of the specialties — as the most rewarding aspect of their job, although 8% of CNRAs said it was important.

Although salary and pay did not figure greatly into the rewards side of the equation, it did come up when nurses were asked about least satisfying aspects of their job. The “amount of money I am paid” was the top answer for LPNs and CNSs, cited by 23% and 17% respectively, as the least satisfying part of the job.

Surprisingly, some 6% to 11% of respondents said “nothing,” when asked what was least satisfying about their job.

Lack of Respect a Looming Issue

I’m glad I became a nurse and would do it again.  I’ve worked on the same inpatient oncology unit for 35 years. I am nearly 70, work 24 hours a week and wil continue working for sometime.  Financially I do not have to work.

I am employed by one of the largest HMOs in the country which has many unionized employees.  My pay and benefits are excellent.  The most satisfying part of my job is being appreciated by the patients.  I work on a unit that has exceptionally dedicated staff that truely care about the people we take care of.

The least favorite part of my job is charting; it’s cumbersome, duplicative and often not read. It takes us away from comforting, listening to and teaching our patients.

Margaret McGowan-Tuttle|  Registered Nurse (RN)

A good many nurses — LPNs, RNs, and APRNs — found documentation requirements to be burdensome, and 11% to 13% of respondents said a lack of respect from physicians and other colleagues was also discouraging. For CRNAs, the lack of respect was the greatest frustration on the job, with about a third saying it was an issue.

Although the low percentage of survey respondents who said respect was a problem might not indicate a huge problem, it was a repeated theme in comments. Nurses of all stripes indicated frustration with what they viewed as a lack of respect from administrators, physicians, patients, and even peers.

One expressed dismay with the “attitude of some patients that the hospital is a hotel and that I am a glorified waitress.” Another APRN cited “the constant battle to be seen as a provider and not just another nurse by the nurses and support staff in the office.”

Some nurses also expressed frustration with what they saw as a lack of support, citing overwhelming workloads; insufficient staff or resources; and excessive regulations, oversight, and payer denials. On the negative side, managers were called unsupportive, incompetent, uncommunicative, and not having a good appreciation of their jobs. Physicians were described as bullying, rude, and disrespectful.

Most Would Change Practice Setting

Some 95% of survey respondents said they were glad they’d become a nurse, and close to as many said they’d choose nursing as a profession if they had to do it all over again. CRNAs were least likely to say they would choose nursing again (73%).

I chose nursing as a career by accident. I entered a diploma program in 1964 because: it was affordable ($600 for three years of education, books, uniforms and housing); I was good at science; and I didn’t want to be a teacher or secretary. Nursing was the best thing that ever happened to me. I loved every bit of it, working in ICU, pediatrics, mental health and finally teaching.

I went on to get a BS, MSN and EdD, all paid for by my employers. The flexible hours allowed me to work and raise a family. When I needed money for college for my children, I continued teaching and worked weekends in the hospital. I loved working with patients and sharing my passion, knowledge and skills with students and other nurses.

Although I am retired, I still do occasional consulting to nursing programs. One of my greatest rewards is seeing nurses I have taught at work and knowing I played a small role in their career.

Jessica Price|  Registered Nurse (RN)

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Most nurses indicated they would not choose the same practice setting if given the chance to start over. Those who worked in hospitals were the most likely — at 28% — to say they’d stick with that setting. Close behind, 27% who work in an academic setting said they’d choose that setting again. Those in skilled nursing, home health, or contract/agency positions were least likely, at 11% to 15%, to say they would choose the same setting.

Dissatisfied Not Making Big Changes

Those who were dissatisfied and said they would not choose nursing again were asked what they might do in the next 3 years to address their frustration.

Small numbers said they’d choose a different career path within nursing, retire earlier, reduce their hours, leave nursing to pursue other jobs, or seek other professional training. About a quarter to almost a half said they would not pursue any of those options.

Survey participants commented that nursing paid decently, offered job security, and that it might be too expensive or time-consuming to make a big career change at this point in their life.

APRNs were less likely than RNs and LPNs to say that they planned to act. Not surprisingly, similarly, the survey found that the higher the nurse’s educational level, the less likely the nurse was to plan a career change within 3 years.

When asked what they might do if they left nursing, some respondents said they’d start their own business, pursue an MBA, or go to physical therapy, dental, or medical school.

The desire to become a physician did not necessarily reflect badly on nursing as a career, said one respondent. “I am not sorry about my nursing career, which has been rich and fulfilling, but if I had to do it over again, I would pursue medicine as a career,” the nurse commented.

What is a Student Nurse?

Carol Ann, a friend of mine from nursing school, recently came to visit. She and her husband live in California. They cruised the Panama Canal over Christmas, drove to see friends in Clearwater, Florida, toured both Savannah and Charleston and traveled to Raleigh, North Carolina to stay with us for a few days. Immediately, we began to reminisce about our school years. I pulled out the Lumine 1962img_0075 yearbook so we could scan our younger selves when we lived in the nursing residence with 42 other young women. For three years, the Gray Nuns of Montreal instilled in us the essence of nursing along with the skills and art of the profession.

Of course, much has changed since then (I will write more about this in later posts). At the time, we nursing students staffed the hospital on the evening and night shifts where a senior student nurse filled the charge position and second year students worked under her. None of us were paid for this “experience.”

The following essay printed in our yearbook describes the student nurse—all young women. I don’t know the author, Barbara Garrity, nor do I agree that student nurses wore white before they graduated.

Many of you older nurses will recognize the out-dated attitudes of the time and most of you youngsters may be scratching your heads wondering could a student nurse be a real person.

What do you think?

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WHAT IS A STUDENT NURSE?

By Barbara Garrity

Student nurses are found everywhere, underneath, on top of, or slithering past patients’ beds. Doctors yell at them, head nurses criticize them, residents overlook them, mothers worry about them, and patients love them.

A student nurse is courage under a cap, a smile in snowy white, strength in starched skirts, energy that is endless, the best of young womanhood, a modern Florence Nightingale. Just when she is gaining poise and prestige, she drops a glass, breaks a syringe or steps on a doctor’s foot.

A student nurse is a composite. She eats like a team of hungry interns and works like the whole nursing staff put together. She has the speed of a gazelle, the strength of an ox, the quickness of a cat, the endurance of a flagpole sitter, the abilities of Florence Nightingale, Linda Richards, and Clara Barton all rolled into one white uniform.

To the head nurse, she has the stability of mush, the fleetness of a snail, the mentality of a mule and is held together by starch, adhesive tape and strained nerves. To an alumna, she will never work as hard, carry more trays, make more beds, or scrub on more cases than her predecessors.

A student nurse likes days off, boys her own age, the O.R., affiliations, certain doctors, pretty clothes, her roommate, Mom and Dad. She’s not much on working 3-11, days off with class, alarm clocks, getting up for roll call, or eating corn beef every Tuesday.

No one else looks forward so much to a day off or so little with working 3-11. No one else gets so much pleasure from straightening a wrinkled sheet or wetting a pair of parched lips. No one else can cram into one little head the course of a disease, the bones comprising the pelvis, what to do when a patient is in shock, how to insert a Cantor tube (usually at 3 A.M.) plus the ten top tunes of the hit parade.

A student nurse is a wonderful creature; you can criticize her, but you can’t discourage her. You can hurt her feelings, but you can’t make her quit. Might as well admit it, whether you are a head nurse, doctor, alumna, or patient, she is your personal representative of the hospital, your living symbol of faith and sympathetic care.