Monday, April 10, 2023

When the Career Cookies Crumble

As a seasoned career coach working with nurses and other healthcare professionals, I often hear stories from my clients that are both heartbreaking and maddening. Nurses and nursing students go through so much in their careers, and there can be plenty of pain, struggle, and blood, sweat, and tears along the way. And when things go south and a nurse's career seems endangered, it can be a frightening and worrisome time.

No matter the cause of a nurse's career cookies appearing to crumble, there's almost always a way to get things back to the way they should be. I've seen so many varied scenarios of how a nursing career can take a bad turn, and I've seen many nurses turn it around and get back on top once again.

crumbled cookie

When the Cookie Crumbles

I've written before about recovering from being fired or bullied, as well as other speed bumps that crop up on the nursing journey. It's just not easy when the career cookie crumbles, is it? So, what cookies can crumble? What flies might you find in the ointment of your nursing career?

Getting fired: Being fired can be demoralizing and painful. We can judge ourselves harshly, beat ourselves up, and otherwise feel miserable. Failure -- or what looks like failure -- hurts, and picking ourselves up by our bootstraps after being fired is a tough task.

Not getting hired: When your job search seems fruitless and you're not getting called for interviews, it can be demoralizing. And when the interviews you actually have don't lead to actual job offers, you can feel very much discouraged.

Bullying: Bullying -- also known as lateral or horizontal violence -- is a scourge on the nursing profession. Nurse bullies are out there, although inspired individuals like my friend and colleague Dr. Renee Thompson are fighting the good fight to eradicate it from our midst, with Dr. Thompson doing so under the auspices of The Healthy Workforce Institute. Some nurses end up quitting jobs and even leaving the profession entirely because of the effects of bullying. This is unconscionable, but it happens every day.

Stress and burnout: Stress seems to be an enormous factor for nurses. Untenable nurse-patient ratios, long hours, passive-aggressive colleagues, poor management, difficult patients, difficult doctors and colleagues, and lack of time to rest, eat, drink, or go to the bathroom all add up to a overflowing rain barrel of fatigue, worry, and stress. And when that stress barrel overflows, nothing good can come of it. Physical, psychoemotional, and spiritual symptoms arise, and the nurse may soon realize that he or she is burnt out, toasted, fried to a crisp, and at the point of exhaustion.

Boredom and dissatisfaction: Sometimes, nurses aren't burnt out, bored, or otherwise under great stress. Believe it or not, sometimes we just get bored. When you've been doing the same thing for a long time as a nurse, it can become somewhat rote and robotic. In some ways, you can relax when things are so familiar that you can do your nursing job with one hand tied behind your back, but this type of familiarity can breed a form of lassitude and professional laziness that doesn't serve anyone. You can go through the motions, but if your heart is no longer in it, what's the point? Is a paycheck enough, or do you need and want more out of your work and career?

ADPIE for the Crumbled

The good ol' nursing process can be invaluable when things go south in your career. When a patient's condition begins to take a dive, what do you do? You go back to the nursing process -- ADPIE -- whether you're conscious of it or not.

When the cookie crumbles, one of the first things to do is to assess the situation and see what's going. Whether it's a cardiac patient with tachycardia or a nursing career turned sour after being fired, it's the same thing -- you gather data before taking action.

Next comes the diagnosis. Is it a lack of self-confidence? Was your workplace just too toxic and getting fired was inevitable? Did your communication skills alienate you from your colleagues, leading to an irreparable rift that resulted in your being laid off? Diagnosis your situation and determine the root cause if you can.

A plan is next on the crumbled cookie to-do list. What are you going to do about it? Career coaching could help, and so could counseling or psychotherapy. If your communication skills are lacking, maybe you need to find out what kind of communicator you are and learn to alter your style to fit various situations.

Next you implement the plan and see if it helps. Does the career coaching move the needle? Does counseling uncover some uncomfortable stuff you need to unpack? The plan may be short- or long-term, but it needs to be geared towards getting your career and life back on track and overcoming the manner in which your personal cookie crumbled.

Finally, evaluation is necessary. Did your interventions work? Have you moved the needle? Did you uncover new diagnoses that need to be addressed? Maybe parts of the crumbled cookie were reassembled, but some other areas still need some work. If learning about your communication style opened a can of worms about how your mother treated you when you were a child, maybe some communication coaching or training could open the door to the need for intensive counseling or psychotherapy. Perhaps it's time to reassess.

Fortifying the Self

Crumbled career cookies are no fun, and there's sometimes a lot of mess to clean up. You might be challenged emotionally, or the potential damage to your lifestyle could be financial. Our work is an intrinsic part of the fabric of our lives, and disruption in our careers can be difficult to process and move through.

If your self-esteem has been damaged by a negative work experience, it's a good time to lean into activities and relationships that fortify your sense of self-worth. Spend time with people who are able and willing to reflect your best characteristics back to you. Connect with a career coach who can help you identify your greatest strengths. Attend a workshop that can help you pause for some self-reflection, or spend time doing things that you truly love.

Whether it's camping, reading, writing, hiking, or skiing, there are things that make you feel good. So, when things in your career go south, lean into activities and people that can buoy your spirits and keep your self-esteem elevated.

Picking Up the Pieces

If your career cookie has indeed crumbled, picking up the pieces is essential. As mentioned above, fortifying the self is crucial. Next, finding the missing or damaged pieces related to your career trajectory is also important.

If you were fired because your clinical skills were lacking, do an honest assessment of what skills need to be sharpened and what you can do about it.

In your particular case, perhaps the nursing specialty you were pursuing isn't a good fit, for various reasons. Sometimes we nurses can feel beholden to work in the clinical space, but maybe we'd do better in academia, research, or entrepreneurship. I, myself, have left clinical work behind in order to pursue writing, speaking, podcasting, and coaching. What would make you most happy and fulfilled in terms of how you spend your time and earn your living?

When you're in the midst of a job search process, you may be dissatisfied and frustrated with the lack of response to the applications you're sending out. If you're not getting any positive feedback or interview offers and you're feeling like your strategy is lacking, a new approach to the job search process is called for.

A crumbled cookie isn't destroyed -- it's shape has been changed but it's essential ingredients are still intact. Your nursing career is similar -- nothing truly spells the end, unless you've determined that the end has been reached. Sure, there are situations wherein circumstances may determine that nursing must be left behind as a viable career path. But this is rare -- most careers can be reinvigorated and breathed back to life with some effort and sweat equity.

Has your career cookie crumbled? Do things feel like they're falling apart? Have you lost your way? Are you feeling as if the bottom has fallen out from under you in regards to your professional life? Never fear -- things can still be repaired.

Picking up the pieces may not be easy, and there may be a tough road ahead. However, with the right support, self-care, and a keen eye towards what's most prudent to do in order to make things right, you can get your nursing career back on track and your cookies reassembled. Whatever type of cookies they may be, it's not too late to bake a new batch and turn up the heat on your nursing career once again.


Keith Carlson, RN, BSN, NC-BC, is a Board Certified Nurse Coach offering holistic career development for nurses and healthcare professionals. All things Nurse Keith can be found at

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the  nursing profession. written for,, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University,, Diabetes Lifestyle, the ANA blog,, American Nurse Today, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. 

Living in beautiful Santa Fe, New Mexico, Keith shares a magical life with his partner, Shada McKenzie, a gifted, empathic, and highly skilled traditional astrologer and reader of the tarot.

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