A Soft Landing for New Nurses

In speaking with large numbers of new nurses over the years, I consistently hear that novice nurses are not often given the guidance, nurturing, and mentoring that they truly need to move from surviving to thriving in their new nursing careers. New nurses need a "soft landing" as they enter the field, and it's up to us seasoned nurses to make sure they get it.

Photo by Alex Lehner on Unsplash

Nurse Bullying: We Shall Overcome

On May 20th, 2013 on RN.FM Radio, we discussed nurse to nurse bullying with Renee Thompson, a national expert on the subject. In the course of that discussion, we heard that bullying among nurses continues to be a problem nationwide--and most likely worldwide, as well. What will it take to turn the tide on what appears to be a widely acknowledged form of aberrant workplace behavior within the healthcare industry?

Book Review: "Do No Harm Applies To Nurses Too!"

Renee Thompson, MSN, RN, CMSRN, is a widely recognized national specialist on horizontal violence (also known as bullying) among nurses, and her new book, "Do No Harm Applies to Nurses Too" is a step-by-step guide to confronting this pernicious issue that impacts many aspects of 21st-century healthcare.

A Speech for Graduate Nurses

Since this is the time of year when nursing students are preparing for their graduation and entry into our esteemed profession, I am choosing to republish a commencement speech that I delivered at Holyoke Community College on June 23rd of 2005 for my graduating LPN students for whom I had served as lecturer during their course of study. This post is the most popular ever published on Digital Doorway, and it has received over 5,000 pageviews since its first publication. Enjoy.

Everyone's Going to Nursing School

Just today I learned that one of my cousins is getting ready to enter nursing school. With three aunts who were nurses (one of whom served with General Patton during World War II), there is certainly a precedent in our family for some of us to pursue a career in nursing, and a laudable precedent at that. My cousin is yet another person realizing the potential economic benefits of being a nurse at a time when many Americans are searching for a new recession-proof career.

As older nurses continue to retire and the Baby Boomers enter their golden years, the demand for nurses certainly seems to continue unabated. Recent reports, however, indicate that a strained economy is forcing many nurses who used to enjoy part-time or per diem work back into full-time positions, making competition for jobs more challenging for new nurses entering the field. And with nursing schools overwhelmed with applicants and short on professors to teach those fledgling nurses, many would-be nursing students may turn to other allied health professions like Occupational, Physical, or Speech Therapy.

A recent article published in the South Florida Business Journal cites a new study by The Florida Center for Nursing which concludes that attrition from the nursing profession is far greater than the influx of new nurses. For example, in the last two years, the number of nurses in Florida increased by 27,000, however more than 50% of that gain was offset by nurses leaving the field, making the net gain of nurses around 11,000.

With more than 3 million registered nurses in the United States at this time, it's clear that the profession is still holding its own as one of the backbones of the health care industry. Still, with a shortage of qualified professors due to a large wave of retirements and few willing to replace them due to better salaries for clinical positions, all signs indicate that the overall shortage of nurses will continue to plague the United States---and most of the world---for some time to come.

In my view, geriatrics and long term care are sure bets for future nursing job opportunities, and those who are willing to pursue an advanced degree as Nurse Practitioners specializing in geriatrics will likely be readily employable in most regions of the country, especially those areas most popular with retirees.

I am thrilled that my cousin is pursuing the family legacy of a nursing career, and I pray that she will be accepted to the school of her choice and be readily employed upon her graduation. Still, one must be realistic that the calculus of the nursing shortage and the opportunities for employment have indeed changed since the days when new grads waltzed into jobs demanding any salary they pleased. Despite the shortage, competition for jobs is stiff, and the competition to get into nursing school equally as difficult.

For myself, having taken almost a year off for travel and writing, I am readying myself to look for a job in the Santa Fe area where my wife and I plan to spend the summer, if not the next year. While I may be fluent in Spanish and have a relatively impressive resume (home health, community health, hospice, and public health), I have never worked in a hospital and thus am somewhat limited in the type of nursing jobs I can pursue. I do not anticipate finding work to be overly challenging, but in the current climate, I realize that it may not be as simple as it once may have been. And with new grads flooding the market and willing to work for less than seasoned nurses accustomed to higher wages, perhaps finding the perfect part-time nursing job may be more challenging than I originally anticipated.

There's no question that nurses are highly trusted professionals who are sorely needed by an aging population. But in the current economic climate, can enough well-paying jobs be created for the seasoned nurses and new grads who are more than willing to don their scrubs and get to work? Only time---and economic forces---will tell.

New Nurses: Where to Go?

It seems that newly graduated nurses who want to remain in New England may need to rethink their job-hunting strategy.

According to nursing students that I know who are graduating next month, the lack of nursing jobs in New England---especially in the Boston area---is an enormous disappointment. According to one student I spoke with today, only four of her fellow graduates have landed a post-graduation job, whereas in previous years, recruiters were falling over themselves to hire new grads as fast as they could pass the state boards.

While a nursing shortage still seems to be cooking in the health care cauldron, the economic engine driving the creation of new nursing jobs is sputtering, at best. And while New England currently seems to have a hiring freeze in place, states like Texas, Florida, California and Montana are apparently the places to go for new nurses---or seasoned ones---to find gainful employment.

If hospitals and health care facilities are still short-staffed but unable to hire, what are they doing to their nurses whom they still employ? Are double-shifts and mandatory overtime being touted as the answer to the shortage? With hiring freezes in place, do the nurses on staff work harder, care for even more patients, and sprint headlong towards burnout? What are the human resource consequences when conditions prevent new nurses from being brought into the workforce despite an ongoing shortage?

I'm no expert, but I can see that the nursing economy has been hit hard by the current economic downturn, and if I was a new nurse just out of school, I would think outside of the box, look as far afield as I could, and be willing to travel wherever the work was. Be it Florida, Texas or Montana, getting one's feet wet as a novice nurse is crucial, and spending some time in an unfamiliar region of the country might not necessarily be a bad thing, especially if one is young, unattached, and prepared to relocate for gainful employment.

I have encouraged many people to go to nursing school, and I hope that those who have heeded my advice don't rue the day that they made the fateful decision to become a nurse. But like all situations, this current economic reality will also pass, and nursing's economic and employment landscape will also change.

Lucky and blessed to myself have an interesting (but not terribly well-paying) job, I wish these new grads luck, and hope that they can navigate these current waters with grace and a modicum of patience.

Every nurse deserves a job, and every patient deserves a well-educated and well-paid nurse. My hope is that this current crop of new grads will find the employment they need, the experience they desire, and rest assured that they have chosen their new career well, no matter the current economic conditions.

If I Was a Wannabe Nurse

So, I recently posted about the $500 million dollars appropriated by Congress for nursing education and other healthcare-related expansion. As I speak with nervous friends and acquaintances who are keen to apply to nursing school, I assure them that there is money coming down the pike. In the meantime, I tell them earnestly, they should take care of as many prerequisite classes as they can, do volunteer work to add to their resume, network with nurses and other professionals for advice, and research every available scholarship, grant, loan program and nursing-related entitlement out there.

For women of color who want to be nurses, I am even more adamant that there will be money available for them if they want to pursue it. African American women, Latina women, Asian women, Native American women, Pacific Islanders---nurses of color are needed and there apparently will be money available for those particular groups to pursue their healthcare-related education. Of course, no government pool of money appears to be unlimited (unless, of course, it's money for bank and corporate bailouts), and some of these women and men will not be able to avail themselves of appropriated dollars to pursue their goals. Still, nurses are needed, and as nursing schools build capacity to educate more students, the best and brightest with the most robust resumes will have a corner on the market.

At this point in history, if I was a wannabe nurse, I would get on the phone, interview every nurse I could find, look for places to volunteer and learn, insinuate myself in places where a pre-nursing student would be a welcome extra pair of hands, and I would then proceed to make myself indispensable.

I would build relationships with nurses, doctors and other sympathetic professionals. I would read books and magazines, and then troll the internet for the latest information on nursing scholarships, the hottest nursing schools, the schools with the highest level of open spaces for new students, and the schools without specific faculty deficits. I would befriend nurse bloggers like myself and get the inside scoop on as many aspects of nursing and nursing education as
I could.

Once I chose the schools that interested me, I would write to the Dean of Nursing of each school, request informational interviews, meet with faculty if possible, and ask current students what they felt most helped them to get accepted. Making friends with the administrative assistant or secretary at each school of nursing would also not hurt my cause, especially if some gourmet chocolate found its way to their desk when I paid a visit.

Once contact was made, I would send hand-written notes to each Dean or faculty member who met with me, and I would subsequently follow up by email periodically to ascertain any changes or developments.

This may all sound cynical and calculated, but I truly believe that in a world where loans and scholarships for a limited number of slots in a limited number of nursing schools is the norm, building relationships and connections is the best way to find your way into the school of your choice, or at least a school which you would accept attending if need be. Also, one secret at this point in history would be applying to schools in multiple regions of the country. The Northeast , Southeast and West Coast are densely populated, and it would behoove pre-nursing students to examine schools somewhat off the beaten track in regions of the country which are perhaps somewhat less desirable places to pursue an education.

Nurses will be needed in droves for many decades to come as Baby Boomers continue to retire in ever increasing numbers, and as the most trusted people in America for the seventh straight year, nurses are in good moral and ethical standing on a societal level. While nurses may not always earn salaries commensurate with their level of education and expertise, they are desirable professionals providing a valuable and meaningful service to millions of people every day.

Nursing will perhaps soon enter a new heyday, wherein nurses assume an even more central role in health care as preventive care gains an increasing share of the limelight. Most nurses are experts in preventive health care, and we need more nurses to educate and care for the aging population of the U.S. (and other countries).

So, Dear Reader, if you are a wannabe nursing student with a fire in the belly and an itch to get that education under your belt so that you can wield a stethoscope and the ubiquitous nurse's pen, work those connections and hit the ground running. Now is the time to jump into the fray as nurses continue to be the growing edge of the health care industry.

New Nurses, Primary Care, and the Calculus of a Multifaceted Shortage

(Note: This is my twelfth---and final---post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

It seems that everywhere I turn, someone is telling me that, a) they just applied to nursing school, b) someone they know just applied, or c) they or someone they know was just accepted/rejected from nursing school.

New nurses---and those who wish to be nurses---are entering a profession in transition, a profession that is losing its older members more quickly than its educational institutions can churn out novices ready to enter the fray.

Today I was interviewed on a radio program in Gainseville, Florida about a recently published book of non-fiction writing by nurses in which I was a featured contributor. The show's hosts seemed sincerely perplexed when I explained that older nurses are retiring faster than they can be replaced, and that nursing schools simply cannot offer faculty salaries that can compete with what nurses are paid in clinical positions. Thus, thousands of qualified applicants for nursing school programs are turned away each year since there are not enough professors to educate them.

As a consequence, far too many eager and highly qualified applicants are rejected from nursing schools around the country---and in fact, around the world, as well---and where do they turn? Do they re-apply the following year? Do they look for another school to which they might have a chance of acceptance? Or do they give up their quest to join the nursing profession and simply move in another career direction entirely?

At a time when aging Baby Boomers are living longer with chronic illnesses and are increasingly in need of quality nursing and medical care, it's time for our government and other influential entities to step up to the plate. The government itself must realize that the calculus of the nursing shortage must change, and this continuous hemorrhage of nurses from the profession without a consistent transfusion of new nurses must be short-circuited.

I will grant that we are in difficult economic times. I will also admit that the U.S. healthcare system is dysfunctional at best, and broken at worst. It is also plainly apparent to me that a growing lack of sufficient nurses to provide care in numerous facilities across the country is a recipe for a public health disaster of enormous proportions.

Meanwhile, if an Obama administration gains control of the White House, a push for near-universal healthcare coverage for all Americans will most likely be an important agenda item in the first year of such as administration. This is a laudable goal that may or may not be achieved. However, it must be acknowledged that the process of bringing more citizens into the healthcare system must be met by a similar process of encouraging more healthcare providers to take part in delivering that care.

The nursing shortage is real, and it is effecting how healthcare is provided around the country. Similarly, there is a very real shortage of primary care physicians, with more physicians opting for specialties in which the demands and low pay of primary care are eschewed.

Now, it is easy to see that if more citizens are insured (a goal that should absolutely be pursued despite the current economic climate), then we must simultaneously ensure that a sufficient number of physicians and nurses are available to provide the quality care that would consequently be delivered.

We must create incentives to lure physicians back into primary care, perhaps by reaching out to medical students and residents with a campaign to describe the value and rewards of primary care. Financial incentives such as loan repayment programs could also be enacted for new doctors who enter the field of primary care or family medicine, whether they work with vulnerable populations or not.

In terms of the provision of primary care, an expansion of Masters-level Nurse Practitioner programs and Doctoral nursing programs (especially for the new Doctor of Nursing Practice designation), could go a long way toward assuaging the nationwide shortage of primary care physicians, especially if interest-free loan programs and other incentives are created and fully funded.

We also must urgently expand the capacity of nursing schools by subsidizing nursing professors' salaries, expanding programs, and enacting a massive campaign of grants, scholarships and interest-free loans to make nursing school more readily affordable for a broad spectrum of prospective students.

Yes, these programs would indeed be expensive, and a great deal of money would need to be designated for such a sizable undertaking. Yet we must examine the relative costs of our inaction, and the crisis of untreated chronic illness and substandard medical care that will be the result of such a failure to act.

As the population ages and people live longer with more complicated constellations of chronic illness and multiple comorbidities, the provision of medical care will necessitate an enormous number of nurses as well as a solid base of primary care providers for patients across the lifespan. Nursing education must be funded and supported, nursing faculty must be recruited and well-compensated, and primary care providers must be given viable reasons for remaining in an area of medicine that has fallen from favor.

We cannot afford to ignore the multifaceted issues which are throwing the American healthcare system into crisis, and rest assured that any money invested now in improving the delivery of care will pay astronomical dividends in terms of prevention, improved healthcare maintenance, and increased cost-effectiveness. It is in our best interest to act, and we can only hope that political will and popular support will be enough to set these wheels in motion.

Still Eating our Young?

The recent experiences of two friends who are newly-minted nursing school graduates underscores the notion that the needs of new nurses are not being met when they hit the ground running. In the hospital setting, especially, new nurses need gentle and constant nurturing and preceptorship in the first stages of their career. Taking into consideration that nurses in the hospital are dealing with acutely ill patients, often pre- or post-op, with a plethora of comorbidities and high risk of complications, new nurses cannot be expected to jump on that wagon alone for some time. It is disconcerting that some new grads seem to be getting the short end of the preceptor stick, as it were.

Having completely eschewed the whole hospital experience post-graduation (something I was told was professional suicide), I have not personally been responsible for six or more patients at a time on a Med-Surg floor, but in my current capacity as a Nurse Care Manager, caring for more than 80 chronically ill patients on an out-patient basis does give me some traction vis-a-vis the vicissitudes of detail management and multitasking.

I'm saddened that new nurses are invited into the intense environment of the hospital, given cursory orientations, left in the charge of preceptors who are themselves too stressed and overworked to do their junior colleagues justice, and then thrown to the wolves, often drowning amidst the acuity of their multiple patients and the resultingly overwhelming paperwork.

How many new nurses have been frightened away from their newly chosen career based on a devastating first work experience? How many new nurses have been proferred less-than-adequate guidance as they entered the fray?

Taking into consideration the overall nursing shortage, the simultaneous nursing faculty shortage, and the fact that nursing schools are turning away record numbers of qualified applicants due to that lack of faculty, it is even more imperative that new nurses be given the highest quality introduction to their new career as possible. If we lose them to other industries due to our lack of leadership and empowering mentorship, then it is not only us, but also the hospitalized and ill public, who will suffer in the end. Nursing shortages can translate into overworked staff, increased errors, increased nosocomial (hospital-born) infections, decreased satisfaction for both staff and patients, and overall poorer outcomes in both surgical and non-surgical patients.

It has been said for decades that nurses eat their young. You would think that after so much time, after so much experience garnered by so many, that this industry-wide practice by jaded and overworked nurses would come to an end. Apparently, it is still a nurse-eat-nurse world out there, and many a new grad is suffering because of such a widely tolerated atmosphere of poor management and lack of empathy for the new nurses in our midst.

If nurses wish to truly be the purveyors of health that they claim to be, then the nurturing must start with the self, extend to coworkers (and neophytes especially), colleagues, and then to the public at large in the form of our patients. If we do not care for ourselves and each other, we are truly only continuing outmoded practices propagated by the patriarchal paradigm. (Alliteration unintended but nonetheless entertaining.)

In a female-dominated industry, traditionally male managerial models of subjugation, humiliation, and trial by fire must be altered, or the unhealthy and overwhelming hell of being a new nurse may only be prolonged for decades to come. For all those who do indeed nurture the neophytes, thank you---your service will benefit more than you may ever know or experience. For those of you who are guilty of letting the struggling swimmers drown, it's time to embrace a new way of being and welcome those who join our ranks with open arms and willing hearts.