DiversityNursing Blog

By Tony Moton

It didn't take long for Annette Staack to realize that making the decision to pursue a career as a registered nurse (RN) was the right one for her.

"It was my calling," says the energetic Staack. "With the first thermometer that I put into my first patient's mouth, I loved it."

A 55-year-old mother of two adult children, Staack earned an associate's degree in nursing from an Iowa community college when she was in her 20s. She says she decided to go to school because she had long had an interest in a career that would allow her to help others.

And while circumstances are different for all nurses, Staack says that she was able to finish her nursing degree in two years, which led to a career that has provided her with a good living and a better work/life balance.

Staack currently holds the title of cardiac liaison and cardiac procedure nurse at her Los Angeles-area hospital, where she has worked for more than two decades. She specializes in testing and assisting in the treatment of patients with heart ailments. And most importantly, she enjoys every moment of it.

"You get to work with patients in all kinds of situations," she says. "You've got emergencies, patient contact, and being responsible for their lives. I like the hands-on aspect of it."

Here's a closer look at how Staack spends a typical day on the job at her hospital.

8:45 a.m. - In the cardiac procedure room, I greet a new patient and call for an Armenian translator because the patient doesn't speak English. I check the patient's vital signs and they are all normal.

9:00 a.m. - The translator explains the process to the patient and she verbalizes her understanding. I finish my computer charting, obtain sedation IV medicines, and wait for the doctor. I text him that we are ready.

9:15 a.m. - The doctor arrives and we begin a procedure to look at the patient's heart and determine whether there are any abnormalities. Within two-to-three minutes the patient is sedated. Images are taken during a five-to-seven minute time period.

9:45 a.m. - The patient slowly wakes up and responds appropriately. I check the patient's vital signs, which are stable. I fill out a patient's chart on the computer. I also provide a written report of meds and findings for the bedside nurse to review.

1:15 p.m. - I go to the surgery room, where a heart surgery is just finishing. The surgery involves another one of my patients, so it's important for me to monitor their progress. I update the patient's family, tell them "all is well," and the MD will speak with them in about 30 minutes. They were so worried, but now are so grateful and give me a hug.

1:45 p.m. - I go to eat my lunch and, sure enough, I get interrupted by EKG. I do three back-to-back-to-back Lexiscan stress heart tests. Today is a pretty hectic day, which is usually the case. But no two days are exactly alike for me.

2:30 p.m. - I head back to my office - to a cold lunch - but I eat it anyway.

3:00 p.m. - I head to Telemetry Unit to speak with a patient and their family about tomorrow's coronary bypass surgery. I need a Spanish translator to help explain and repeat the process to the patient and family. They verbalize understanding and agree to proceed. I schedule the surgery with the OR (Operating Nurse) booking clerk.

5:15 p.m. - I am out of here. Tired but fulfilled! I am thinking about what I might have for dinner and having a relaxing night at home in front of the TV. I'm usually in bed and asleep by 10 during the week because I need my energy for the next day.

BY DARIA WASZAK, RN, MSN, CEN, COHN-S

Gerardo Gorospe, RN, BSN, MSN, is frequently mistaken for a physician — not necessarily due to his skillset, expertise, white coat or bedside manner, but because of his gender.  “I am often asked why I am not a doctor. I politely say, ‘Because I wanted to be a nurse.’” 

Gorospe is the clinical nurse manager in the Department of Hematology and Hematopoietic Cell Transplantation at City of Hope in Duarte, Calif. He has been an RN for over 21 years and has his MSN in education and nursing administration. Although nursing is a predominantly female profession, he decided to become a RN because of his interest in health and science, helping patients achieve wellness and the “personal interaction aspect” of being a nurse.

He spends his workday managing a team of transplant coordinators and hematology clinical trial nurses, resolving problems, supervising staff and managing projects, among many other tasks. “I think because we are in a female-dominated environment, there is, in the community at large, not a great understanding of who we are and what we do,” he says. “There are some gender stereotypes when it comes to the territory of nursing.”

That couldn’t be more evident than when you take a look at older nursing textbooks, like a 1962 edition of Mosby’s Practical Nursing that Gorospe recalls picking up from a thrift store; the cover featured a picture of a woman in a white nursing dress, white cap and heels, holding a tray. “There is certainly gender bias in our early textbooks of nurses as women,” he says.

Heavy Lifting
So, does there continue to be a social stigma surrounding being male in a predominately female profession? What difficulties do men in nursing face today? Gorospe, 45, who went to nursing school in the early 1990s, says his patients never had a problem with his gender, but he did remark that since he is often the only male on duty, his female colleagues frequently turn to him for his physical strength. “I think when it comes to the physical work — lifting patients and heavy equipments — male nurses are often asked to assist,” Gorospe says, adding that his colleagues would often exclaim, “We are glad you are here today, so you can help lift.”

A Need for Role Models
Samuel Gomez, MSN, RN, PHN, CENP, was one of only two men in his nursing program in the early 1980s. Since men were even more uncommon in nursing at that time than they are now, he, like Gorospe, was frequently asked why he didn’t just become a doctor instead of a nurse.

Gomez, 48, explains that he was inspired to choose nursing as a career by a high school guidance counselor who was also a RN. “She told me that as a man, nursing was a great profession for me to explore and that it had many possibilities and opportunities,” he says. “She was absolutely right.” 

Now, Gomez is the one inspiring other men to join nursing. He is currently the executive director of cardiovascular services at Mission Hospital Regional Medical and Trauma Center in Mission Viejo, Calif., but he often speaks to medically underserved middle school youth. When he was a professor at the University of Southern California, he even started a special interest group for male nursing students. 

“What is most important to me as a nurse who is male is the importance of role-modeling for others, the importance men have in nursing and that as a profession, it is open and ready for more men to join,” he says. “I am always sure to point out to male students that nursing has been an outstanding career for me and it can be for them as well.”

A Tailored Fit
According to a 2005 “Men in Nursing” survey conducted by Hodes Research and published on the website of the American Assembly for Men in Nursing (AAMN), approximately 6 percent of nurses are men. Nearly half of the almost 500 respondents to that survey reported experiencing gender-related problems in the workplace, including being stereotyped as “muscle,” being a minority in the nursing profession, being perceived as not caring or having trouble communicating with female colleagues.

Scott Topiol, co-founder of the online men’s scrub store Murse World, adds that male nurses often face an additional problem: Nursing scrub stores rarely have a good selection or variety of scrubs for men. Unisex scrubs, which feature solid colors, a baggy fit and a V-neck cut, are no solution; they only come in a few styles and stores seldom carry all of those.         “Scrubs that are made specifically for men not only fit their bodies better,” says Topiol, “they also offer more masculine styling options that help male nurses and healthcare professionals look and feel their best on the job.“

Topiol says that one of the goals he and co-founder Alex Mayzels had in starting Murse World was to provide scrubs that are more attractive to men. “One thing we've found is that many men are looking for a more athletic, sporty cut and also want color accent options such as contrast color stitching,” he explains.  

Communication Styles
Like the respondents of the 2005 Hodes survey, 38-year-old Troy Gideon, RN, BSN, critical care clinical coordinator at St. Jude Medical Center in Fullerton, Calif., says that one of the biggest challenges male nurses face is continuing to improve their professional interactions with female colleagues. “A man in a female world must learn the intricacies of female communication and the dynamics of their interrelationships to be able to work collaboratively towards a goal,” he explains. 

Despite the communication hurdles, Gideon has seen improvement for men as nursing has evolved over time. “I think that the industry has changed greatly in its social context as the field has become more educated and professional,” he says. “With this change and the financial stability that comes with it, nursing has become a magnet for more males, thus dissolving preconceived stigmas.” 

Managing the Whole Patient
Gomez, Gideon, and Gorospe all spoke about how rewarding their nursing careers have been, whether they have involved teaching, leading and supervising other nurses or performing patient care.

“As nurses, we are for the whole individual, not just managing the medical condition or surgically managing a patient. We manage the patient holistically,” Gomez says. “That was all I needed to know about the profession of nursing — that it was aligned with who I was as a person and as a human being.”

BY CHILTON TIPPIN

With a baby on the way, Desharia Uribe, then 17, put her hopes in the Nurses Aid Program at Whiting High.

“I wanted to be a nurse,” she said. “And I knew this program would get my foot in the door.”

She enrolled in the program at the start of her senior year in 2005. Upon graduation in 2006, she was ready to take the Certified Nursing Assistant Test, administered by The Wyoming State Board of Nursing. She worked for about a year, saving money to take the test, and passed it in 2007. The Spring Wind Assisted Living and Memory Care Community hired her for her first job as a CNA shortly thereafter. She was 19, and her career was just beginning.

“Had I been a typical student, without a baby to care for, I could have taken my boards even sooner,” Uribe said.

Lorraine Saulino-Klein, a registered nurse and instructor of the course, which is also offered for Laramie High students, said about 40 juniors and seniors go through the program each year. They graduate with the knowledge and skill set to work in one of the fastest growing industries in the community: health care.

“This Nurses Aid program fills a tremendous niche,” Saulino-Klein said. “I have students in every medical institution or organization in this town.”

Since the program began eight years ago, about 98 percent of Saulino-Klein’s students have passed the course and the CNA exam, she said.

Ursula Harrision, principal at Whiting, revived the program after it had been defunct for nearly a decade. She was looking for an instructor to teach it, and Saulino-Klein filled that void.

“It’s a vocational program,” Harrison said. “And I particularly looked for programs that people could use to get jobs in this town.”

The course certifies students with the American Heart Association in CPR, AED and basic first aid. In the first nine-week period, students work with Saulino-Klein in the classroom, learning about the theories and tools used for the care of patients.

The second nine-week period is geared toward clinical experience. Students spend 40 hours at Ivinson Memorial Hospital and Laramie Care Center, working with patients and filling in journals, which they review periodically with Saulino-Klein. At the end of the semester-long course, students graduate with three college credits, awarded by Laramie County Community College.

Once they pass the CNA test, “they can go right out and get a job,” Saulino-Klein said.

“And these are decent paying jobs, too.”

Her students have spread into dozens of niches within the field of health care, from medics in the military to nurses in hospice or the surgical unit at the Laramie Premier Bone & Joint Center. Two of her students from the flagship class went on to become doctors.

Jamie Rhodine, a senior in this year’s program, said she decided to enroll because CNA certification is a prerequisite for pre-medical school.

“My plan is to hopefully get a CNA job this summer in Laramie,” she said.

This fall, Rhodine plans to enroll at the University of Wyoming to pursue a registered-nursing degree. After working for a few years as a nurse, she wants to go back to school for her doctorate.

“(The program) made me excited to see how large the field is and how many opportunities I have,” Rhodine said.

Brenna Westhoff, also a senior in the program, is going into pre-medical school at the University of Kansas on scholarship in the fall.

She plans to go on to medical school and specialize in pediatric oncology and hematology. For her, the program’s benefits stem not only from the experience, but from getting to see the medical practice from a nurse’s point of view.

“I’m excited to have the clinical time under Ms. Saulino-Klein,” she said. “It gives me experience on the opposite end of what I want to do, so I’m kind of getting the full spectrum of the medical field.”

Uribe said she gained everything from Saulino-Klein’s course. After landing her first CNA job with Spring Wind, she worked for four years in a home health agency. During those years, she cared for her first and second child and put herself through nursing school at Laramie County Community College.

This May, she graduates from LCCC with a registered-nursing degree.

The Nurses Aid program “gave me a responsible job to care for my child that I have,” she said. “The whole school at Whiting was supportive over everything. They really do find ways to set you up to be successful for life after high school.”

Uribe said Saulino-Klein will be the first person she invites to her graduation.

The most comprehensive review of new legal and regulatory issues affecting advanced nursing practice across the United States is now available in the "25th Annual Legislative Update," presented exclusively by The Nurse Practitioner: The American Journal of Primary Healthcare.The Nurse Practitioner is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health. 

Compiled by Susanne J. Phillips, MSN, FNP-BC, the annual supplement presents a comprehensive review of the legislative proceedings, bills, and laws pertaining to advanced practice registered nursing (APRN) practice in every state. The 25th Annual Legislative Update is now freely available on the journal website. 

Progress in Evidence-Based Reforms Improving Access to APRN Care 

The 25th Annual Legislative Update incorporates current information provided by state nursing boards and APRN associations about the "hot topics" affecting APRN practice in their states. "Despite attempts by medical boards to limit current practice authority, APRNs succeeded in improving access to APRN care in several states," writes Phillips. 

The special edition provides an essential update on recent legislative and regulatory activity promoting access to APRN care, prompted by decades of peer-reviewed research demonstrating the quality and safety of APRN practice. Efforts are ongoing to standardize laws and regulations governing APRN practice across states, and to establish effective consumer protections. 

Yet legislation continues to be "vehemently opposed" in many states, according to Phillips. She discusses steps APRNs can take to "empower legislators to move beyond the outdated, evidence-lacking arguments that APRNs are not educated enough, safe enough, or credentialed enough to care for the nation's residents." 

This year's update presents a rundown of the latest developments in the areas of legal authority, reimbursement, and prescriptive authority for all 50 states. It also includes a table summarizing practice authority for nurse practitioners in every state and the District of Columbia, along with updated statistics and the total number of APRNs reported by state boards of nursing. 

Nurses Encouraged to Work Together to Meet Challenges 

The past year has seen several important improvements in legal authorization of APRN practice, including passage of legislation and promulgation of regulations in 17 states. In addition, eight states reported statutory or regulatory activity leading to improvements in prescriptive authority. 

But challenges remain, including reports of defeated bills and unsuccessful regulatory reform efforts in five states. In addition, two states - Kentucky and Missouri - passed legislation limiting APRN practice in specific ways. Phillips urges APRNs and others interested in ensuring access to evidence-based healthcare to support state APRN organizations. 

Nurses are also encouraged to check out the Future of Nursing Campaign for Action, supported by the Robert Wood Johnson Foundation and AARP, to see what steps are being taken and participate in efforts to improve nursing practice. Phillips adds, "This is a great way for all of the APRN organizations to work together to implement the recommendations and improve practice in your state."

Article adapted by Medical News Today from original press release.

BY SCRUBS EDITOR

Ever wonder what the top 10 best paying nursing specialties are?. So far we’ve covered the top 3 – #1: certified RN anesthetists, #2 orthopedics and #3 geriatrics. This week, at number 4, we’re taking a look at perioperative nursing.

Nurses in this field make between $61,000 and $108,000 (high end, which you get by being an advanced practice nurse). It’s the perfect gig for OR nurses who don’t want to deal with anesthesia. Typically, it’s a good idea to have Basic Life Support and Advanced Cardiac Life Support certification.

If you’re a new nurse you may be wondering: What the heck is perioperative nursing? Quite simply, it’s the specialty that works with patients who are about to have operative or other invasive procedures. Perioperative nurses work closely with a range of medical personnel from surgeons, nurse anesthetists, surgical technologists and nurse practitioners. On a typical day you could find yourself performing preoperative, intraoperative or postoperative care.

BY JESSICA ELLIS

Confidence is a key factor in successful healthcare practice. Not only will you give better patient care when you’re more confident, but you’ll also enjoy giving care that is not hindered by second-guessing yourself. Knowledge is power! Here are a few CE courses essential for improving your basic knowledge and confidence:

1. Conflict Management

Face it: Conflict is impossible to avoid, especially in healthcare settings where tension runs high and patient outcomes may involve death. Do you know how to effectively address conflict among your peers, management and support staff? Hint: Avoidance doesn’t work. Learn how to manage conflict in a professional manner and your confidence will soar!

2. Time Management Strategies

Ever been so busy during a shift that you drive home with the nagging feeling you forgot something? Time management is essential to decreasing feelings of being overwhelmed and sloppy. This course will outline various time management methods and help you identify your own barriers to effective time management.

3. Team Building

As much as we sometimes hate to admit it, we need the assistance of our coworkers. Think about it. Are you more confident when you feel left alone to handle everything? Or are you more confident when you know your peers will jump in and help when needed? Do you know how to improve the team mentality on your unit? Having team building skills will not only improve productivity and patient safety, but also you’ll be in a better position to enjoy showing up for shift with a positive and calm attitude.

4. Medical Terminology 101

Did you ever read through doctors’ or radiologists’ notes and say to yourself, “Sounds like Greek to me!” Well, it just may be. While medical words rely heavily on Latin origins, the terminology also uses “pieces” from the Greek language. Taking a terminology course will help you memorize medical terms by body system. At the end of the day, patient chart comprehension will definitely improve your confidence!

5. Phlebotomy Basics

If you’re a seasoned nurse or provider, you may or may not be 100% up to speed in your phlebotomy or intravenous access skills. This course helps practitioners at all levels of experience review the principles of safe and appropriate venipuncture, including identifying patients and reporting critical levels of laboratory results.

The U.S. Bureau of Labor Statistics’ most recent report on registered nurses predicted a 26 percent growth rate in employment for registered nurses during the 2010-2020 period. That’s considered “faster than average” when compared to all other populations.

A number of factors are expected to contribute to growth in particular areas. For instance, the aging of the baby boomer population and increasing pressure on hospitals to discharge patients as soon as possible is expected to spur job growth in outpatient care centers, as well as in home health and long-term care facilities.

For the coming year, however, it’s unlikely that the overall employment situation will be significantly different from last year.

“I haven’t seen a lot of change,” said Geraldine “Polly” Bednash, PhD, RN, FAAN, chief executive officer and executive director of the American Association of Colleges of Nursing (AACN), which surveys nursing schools to gauge the experiences of new graduates in finding employment.

Do your homework

If you plan to look for a new nursing job in 2013, it’s important to prepare yourself. Check out the job market in the area where you wish to live, or, if you’re open to different locations, find out where nurses with your specialty have the most opportunities. Know which employers are hiring, and what types of positions are in most demand.

For example, in the field of school nursing, some areas of the country are eagerly looking for qualified candidates to fill vacant positions in schools, while other regions can barely afford the nursing staff they already have, due to funding issues.

“It’s all over the map, depending on the state,” said Linda Davis-Alldritt, RN, president of the National Association of School Nurses. “Some states are seeing not so much a shortage of school nurses but a shortage of funded positions. The further west you go, that’s the situation, especially in California.”

Be flexible

Although the overall job market for nurses is predicted to be good, nurses in certain pockets of the country--particularly the ones with the least amount of experience--may have trouble landing their dream job right away. But that’s been true for the last few years in high-demand areas like the Bay Area in California and a few other places, and experts typically recommend that job seekers show flexibility in those situations.

If you’re willing to move or work the night shift or try other types of nursing jobs, you’ll be in a better position to get hired; this flexibility can also help new graduates acquire the basic experience that so many employers are seeking.

Take advantage of advanced education

What is most likely to help you land a new job in the current health care environment? More education and training. That might mean attaining a certification in your specialty area, or it could mean returning to school for another degree.

A baccalaureate degree could be especially useful. The Institute of Medicine’s landmark Future of Nursing report, released in 2010, called for increasing the percentage of the nursing workforce with a BSN to 80 percent by 2020, and a growing number of hospitals are prioritizing candidates with the degree.

According to information gathered from nursing schools in August 2012 by the AACN, 88 percent of new graduates with a BSN degree received job offers within four to six months of graduation.

“We’re always very pleased to see the baccalaureate graduates are getting hired,” said Bednash, adding that employers “understand they can make a choice, and they are going straight to the best-educated clinicians and hiring them.”

Graduates with master’s degrees fared even better; within four to six months after graduation, 92 percent of them were fielding job offers, according to the AACN’s survey.

“The hottest commodity on the market today is a graduate-prepared nurse practitioner,” said Bednash.

Expect more jobs on the horizon, thanks to ACA

When the Supreme Court upheld the Affordable Care Act (ACA) in June 2012, many noted that the law will likely expand the possibilities for nurses in the future.

As the law continues to undergo implementation, more than 30 million additional people could be added to the insurance rolls. Those people will need primary care--and primary care providers. Advanced practice nurses will be called upon to fill those spots in many places, especially in light of the ongoing shortage of primary physicians. In fact, the January 2013 issue of Health Affairs even noted that the use of “non-physicians” could help improve access to care for many people and avert a physician shortage in the future.

“They ought to be thinking carefully about going on to get a graduate degree,” Bednash said of nurses who are interested in the new possibilities opening up.

The Affordable Care Act also encourages the patient-centered medical home model, which utilizes care coordinators.

“And that’s a nursing role,” said Bednash.